In 2011 the Board of HL7 initiated a project called “Fresh Look” with the intent of determining how better to address the interoperability problem. This work was born from an understanding that HL7 v3 had “failed” and was “too hard” to implement in the real world.

A ground up approach was required to solve what was rapidly becoming the most important problem in Healthcare IT.

From this discussion was born a new idea called “Resources For Healthcare”. This was largely the work of Graeme Grieve, whom we may safely regard as the inventor of what later came to be called Fast Healthcare Interoperability Resources”, or more simply, FHIR.

The basic idea behind FHIR is simple. Instead of attempting to model all of healthcare, work instead to the 80/20 rule, and focus instead on the 80% of the problem domain that will be used the most frequently. Allow implementers to cover the remaining 20% with so-called “extensions”.

FHIR itself is intended to be comprised of around 100-150 or so “resources” that represent key concepts in healthcare (think Patient, Encounter, and so forth ..) Each of these resources is specified in a variety of modern web languages such as JSON, XML, and UML that implementers can easily understand and work with. Resources can be easily retrieved, stored, and modified using HTTP and other protocols.

In 2012 FHIR became a free standard whose first normative edition would be made available free to all implementers. This was a break away from HL7’s prior approach of selling access to standards, and it will be interesting to see what impact that has on the standards body, of which I am a card-carrying member.

In December of 2014, a set of well-known industry participants including Cerner, Epic and McKesson became members of the so-called Argonaut Project, a consortium dedicated to advancing the cause of FHIR, both financially and politically.

Release three was published this year, together with the first STU (Standards for Trial Use) release, and FHIR is now on its way to becoming the most important standard in healthcare.

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