Turning HYPE into VALUE -- DISCUSSION THREAD

Umberto -- I completely agree. I made a FHIR joke in a meeting yesterday when I said: "it's like riding a hype-cycle... once you learn how, you never forget". (with apologies to bicycle-riders everywhere...)

Hello Derek, great article (unfortunately I discovered it just now).

I agree with the idea of turning hype into value, but you missed a part of it in my opinion: IHE shall act as a sort of hype filter as well. Because we all know: hype is quite often overpromising and sometimes turning into a bubble ready to pop.

After the great presentation that Derek did I asked few questions regarding information vs data models, how FHIR fits into this picture and what to use to manipulate data (data analytics, big data and other popular terms).

Instead of having 1:1 email conversation we decided to move this over the IHE Canada thread. Please feel free to express your thoughts.

I also think it may be useful to bring someone from OHDSI to present OMOP data model, i.e., what advantages it has over FHIR model, practical use, etc.

With Derek’s permission his answer is below:
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RE: the information model / data model distinction – I think it’s important to reiterate that FHIR is a data model (it is a message model intended to traverse the wire). Information models are more conceptual in nature. OpenEHR archetypes, for example, are based on an underlying Reference Model (RM)… and this RM is an information model. The HL7 RIM is a conceptual/information model, too.

To successfully support big data analytics – the content must be in a computable format and it must be “understandable” what that content represents. This is one of the strengths of the OHDSI initiative (and its adoption of OMOP) – there is an agreed, underlying information model that each participating entities’ data model… and data… can be mapped to. I know there are some who are leveraging FHIR as such an information model. The problem with this is – what happens when the FHIR spec changes? (think of Apple… which has wedded its HealthKit information model to FHIR DSTU 2… and which now finds that this information model is out of step with the latest version of the FHIR spec).

Is this related to what IHE does? To be honest… that depends. IHE’s core focus is on interoperability – so it very much finds itself concerned with the “wire formats” that describe message formats and data exchange patterns. But if you look at the arc of IHE’s work over time – there have been multiple IHE profiles that address the same underlying workflow and which are, in fact, harmonious with each other’s underlying information models (e.g. PDQ, PDQv3, PDQm). One of the things that came up last week during the F2F IHE meetings in Chicago was the premise that, going forward, IHE profiles should be behaviourly compatible with each other – regardless of whether they are HL7v2 based, or CDA-based, or FHIR-based… or whatever. So there is, potentially, a role that IHE profiles can and will play in collecting big data assets that can drive broad-scale analytics. This topic is very much in-scope for the new Computable Care Guidelines work item, for example.
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Hi all -- a hearty thanks to everyone who attended today's webinar and especially to those who contributed their very-helpful comments and questions. Much appreciated!!

Since some of you have asked, I've uploaded a copy of the slide deck from today's webinar to my GDRIVE; it can be found here . I also managed to find the ZOOM recording on my hard drive and convert it into a viewable video format that I could upload to Vimeo. The video of the webinar is here (and sorry for how goofy I sound during the first few minutes... it took me a bit of time to get sorted out with Zoom): vimeo.com/302135632 .

As a word of caution... my slides don't always make as much sense without the voice-over as they do with the voice-over... so please, if you're re-using any of the content, do try to preserve the "context" and associated meaning they were intended to convey. Of course... if it doesn't make sense no matter how many times you listen to the ZOOM recording, please post a comment or suggestion to the thread that will help clear things up for us all (especially me!). It takes a village...

Thanks, Mike -- these are very insightful comments. Your point is well-taken; IHE profiles can and do reference multiple underlying standards (not just FHIR). This is, I think, one of the key strengths -- an IHE profile of FHIR can draw in and include complementary specifications that are "out of scope" of the FHIR standard. Importantly, an IHE profile can also be leveraged to provide a functionally equivalent FHIR option alongside legacy options that are already widely deployed in our digital health landscape. In this way, IHE profiles can provide the long on-ramp that any new technology will need as it diffuses and is broadly taken up over time.

In my view, Mike -- this FHIR uptake will happen; I really do think that FHIR has a momentum that HL7v3 (or v2, or OpenEHR) did not ever achieve. Equally... I'm convinced this diffusion will happen in ecosystem time... not technology time. The former tends to be comparatively geologic while the latter (with all its hype) is often measured in dog-years.

Regarding the blog graphic's LMIC flavour -- you caught me! The example care pathways all denote WHO or UNICEF as the underlying guideline source. We could just as easily imagine the Canadian Diabetes Association or the Canadian Partnership Against Cancer along that top row. Of course, I'd point out that our immunization guidelines here in Canada (and everywhere else in the world) are based on the global EPI guideline. This is generally true for evidence-based care pathways -- they are remarkably consistent with each other, country to country.

Mike -- I hope you can join the webinar next week. Yours is an important, experienced voice on the topic of IHE and its role!

Thanks for the blog post, Derek. You reminded us all of the importance of IHE in the digital health ecosystem. A couple of comments:

• This article focuses around FHIR, but it should be pointed out that IHE profiles work with many other standards as well.
• You indicated that "HL7’s FHIR is an important informatics standard that will, over the coming years, become the predominant global specification for health data exchange"... I've heard this message before, in the context of HL7v3. It's important that we dispel the notion that FHIR "can do it all", and will replace all other interoperability standards. Let's remember that FHIR is indeed important, full of promise (and hype), and is evolving very rapidly. But, like all technologies, will be replaced by one or more "better" options at some point in time. Other standards technologies are also considered important currently, and will continue for the foreseeable future.
• Your graphic describes an IHE model for the developing world, but we need to also highlight that IHE-based infrastructures form the basis of many of the world's countries' national interoperability frameworks.

This material is presented to help you contextualize the blog post in preparation for the upcoming webinar. I hope it's helpful.