<br><br>---------- Forwarded message ----------<br>From: <b>Adrian Gropper</b> <<a href="mailto:agropper@healthurl.com">agropper@healthurl.com</a>><br>Date: Monday, May 16, 2016<br>Subject: FHIR Use Cases and relationship to other standards<br>To: Grahame Grieve <<a href="mailto:grahame@healthintersections.com.au">grahame@healthintersections.com.au</a>><br>Cc: "fhir <<a href="mailto:fhir@lists.hl7.org">fhir@lists.hl7.org</a>>" <<a href="mailto:fhir@lists.hl7.org">fhir@lists.hl7.org</a>>, "Boone, Keith W (GE Healthcare)" <<a href="mailto:keith.boone@ge.com">keith.boone@ge.com</a>>, "McDonald, Clem (NIH/NLM/LHC) [E]" <<a href="mailto:ClemMcDonald@mail.nih.gov">ClemMcDonald@mail.nih.gov</a>>, Ioana Singureanu <<a href="mailto:ioana.singureanu@gmail.com">ioana.singureanu@gmail.com</a>>, Josh Mandel <<a href="mailto:Joshua.Mandel@childrens.harvard.edu">Joshua.Mandel@childrens.harvard.edu</a>><br><br><br>Thank you Grahame for the clear response. If there's not to be any standard to deal with data blocking in the vernacular sense of the words, I'm hoping to find some folks that would work together to define an objective measure of data blocking. Given a measure, each regulatory jurisdiction could apply it as they see fit and the standards would just have to follow.<div><br></div><div>My current favorite is what I posted at <a href="http://thehealthcareblog.com/blog/2016/05/13/independent-decision-support-at-the-point-of-care-for-both-patients-and-physicians/" target="_blank">http://thehealthcareblog.com/blog/2016/05/13/independent-decision-support-at-the-point-of-care-for-both-patients-and-physicians/</a> </div><div>because it's easy to point to the patient-level FHIR Subscriptions and History features and ask if they are implemented and accessible via any patient-specified OAuth Authorization Server. For any particular implementation of FHIR is concerned, the answer to these three questions could be given a name and that name would be a measure of data blocking.</div><div><br></div><div>What do you think?</div><div><br></div><div>Adrian<br><div><br></div><div><br><br>On Monday, May 16, 2016, Grahame Grieve <<a href="javascript:_e(%7B%7D,'cvml','grahame@healthintersections.com.au');" target="_blank">grahame@healthintersections.com.au</a>> wrote:<br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div dir="ltr"><div class="gmail_extra"><div class="gmail_quote"><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div dir="ltr"><div><div><div><div><div><br></div>I'm somewhat familiar with DICOM and IHE and the gap between platform standards and interoperability in the consumer sense of the word. I can't think of any practical interoperability standard (in the real-world sense of the term) that depends on conformance statements.</div></div></div></div></div></blockquote><div><br></div><div>no. It's because there's no standards process for *healthcare*. It's the reality that HL7 lives constantly. We cannot produce tight standards because we cannot dictate the business and clinical practices of those that use them. The easiest illustration is allergy tracking. Everyone that provides care has to do this, and it's not a matter of differentiation of service. In any other industry, that would lead to a standard so that everyone could save money and improve their service by exchanging this information. In healthcare, however, we are only now trying to impose common record-keeping standards by stealth using IT interoperability standards, and the problem is that there are deep stacks of existing data, and everyone stores different information about this. And clinicians generally regard this as an IT problem. </div><div><br></div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div dir="ltr"><div><div><div>This is not consumer interoperability.<br></div></div></div></div></blockquote><div><br></div><div>no, it's not going to be. And you're dreaming if you think there'll ever be in an international standard. Right now, we're trying hard to make a single little piece interoperable at the consumer level: vital signs. And we're facing stiff opposition for both technical and policy reasons. </div><div> </div><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div dir="ltr"><div><div><div>I still don't know what the healthcare personal data interoperability standard will be called but maybe some members of the FHIR community would like to work on that with me.<br></div></div></div></div></blockquote><div><br></div><div>The easiest way to explain it is:</div><div>* Argonaut is working on consistent access to data - but the data won't be particularly consistent </div><div>* HSPC is working on consistent access to consistent data - but the policy framework you want is not in scope; that will have to wait for the future.</div><div><br></div><div>My view is that HSPC is a decades long process. Until then, 'data blocking' will remain the order of the day - except that I know it as 'care for legacy data and processes'</div><div><br></div><div>Grahame</div><div><br></div></div>
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