As we enter a new decade, the FHIR world seems to have reached a new level. Normative FHIR has arrived, solidifying content across the industry. Wide deployment of FHIR capabilities can be seen across EHR vendors' products. Technology companies ranging the full gamut from startups to giants have committed to. So why are FHIR applications still struggling in the wild? Join us to learn about the main trust paradigms in healthcare, the use of FHIR in each, and where we need to go as an industry to better help patients and providers.

1. Who Trusts FHIR? Paradigms
of Exchange in an API World
Brendan Keeler
Product Owner
@BrendanRedox

2. ● Illuminate
● Enlighten
● Teach
Goals
● Interest
● Entertain
● Humor
● Inaccurate
● Erroneous
● Offensive

3. ● HL7
analyst
Who am I?
● CDA
evangelist
● API
enthusiast

4. ● JPM
Conferences
● HIMSS ● HLTH

5. © 2018 Redox, Inc.
• Intro to Redox
• Three Trust Paradigms
• Iceberg of Adoption
• Increasing FHIR Adoption
• Redox and FHIRAgenda

6. © 2019 Redox, Inc.
Analytics Monitoring
AutomationCoordination
Telehealth
Traditional
Interoperability
© 2019 Redox, Inc.

7. © 2019 Redox, Inc.
Analytics Monitoring
AutomationCoordination
Telehealth
Traditional Web of
edge interfacing
© 2019 Redox, Inc.

8. © 2019 Redox, Inc.
Analytics Monitoring
AutomationCoordination
Telehealth
Redox connecting
apps to
organizations
© 2019 Redox, Inc.

9. Implementation agnostic
9
HL7v2
ONE ENDPOINT
CONSISTENT API
FHIR
API
API 2

10. FHIR Implementation agnostic
10
DSTU2
ONE ENDPOINT
CONSISTENT API
R4
R5
R6

11. Three Trust Paradigms
● Edge interfacing
● Enterprise interop
● Patient authorization

12. Edge Interfacing
● Oldest trust framework
● Connecting the systems
within an enterprise
● Contracts and BAAs
● Lots of HL7
Hospital

13. ● Networks of trusted exchange
○ Carequality, Commonwell,
Surescripts, HIEs
● Transition of care between
enterprises
● One agreement/contract per
network
● Lots of CDA
Enterprise Interoperability

14. ● Newest exchange paradigm
● Patient portal credentials
● No BAAs or contracts
● USCDI via SMART on FHIR
Patient Authorized Exchange

15. Analogy time

16. Iceberg ahead

17. Web API
Application Programming Interface
Web Service
Remote API
Public API
Health API
XML
SOA
SOAP/WSDL
OOP
Java, C++
JSON
REST
Open
Self-service
2000s 2005ish 2010 2014Pre Gen-Z

18. Growth

19. Standards are a reverse iceberg
Industry groups
Vendor adoption
HCO
deployment

20. Industry groups
Vendor adoption
HCO
deployment

21. Redox and FHIR
21⋅ Standards
− What could be
⋅ Regulators
− What must be
⋅ EHR Vendors
− What will be
⋅ HCOs and ISVs
− What is

22. Vendor Adoption
22

23. FHIR in practice
⋅ Incredible strides in
patient authorized
exchange
⋅ Some deployment
for edge interfacing
⋅ Minimal deployment
in enterprise
interoperability
23

24. How does the iceberg progress?
24
Industry groups
Vendor adoption
HCO
deployment
⋅ Regulatory pressure
⋅ Customer demand
⋅ Strategy

25. Regulatory Pressure
25
⋅ Most uniform
⋅ MU2
− NCPDP and C-CDA
⋅ TEFCA
− C-CDA/XDS
⋅ 21st Century Cures
− Patient auth FHIR

26. Customer Demand
26
⋅ Less uniform across
EHRs
⋅ May be resisted by
EHRs
⋅ Slow process for
long tail of EHRs

27. Strategy
27
⋅ Ease the burden of
support
⋅ Additional revenue
generation through
app programs
⋅ EHRs as platforms
rather than products

28. FHIR and Redox
28
Design
⋅ HL7 member
Develop
⋅ R^FHIR
⋅ FHIR API support
Deploy
⋅ FHIR Messaging

29. Aligning the Iceberg
29
HL7v2
ONE ENDPOINT
CONSISTENT API
FHIR
API
API 2

30. Links
● History of FHIR
● Brief and Opinionated History of Standards
● Trust in Healthcare
● Redox

31. Questions?