Navigation Between Heavy-weight and Light-weight Standardization (Part 2)

The previous section of this article laid out the context for HL7 FHIR standard and the Argonaut project; now we can look at the current status.

Tripathi portrays the Argonaut process as radically different from HL7 norms. HL7 has established its leading role in health standards by following the rules of the American National Standards Institute (ANSI) in the US, and similar bodies set up in other countries where HL7 operates. These come from the pre-Internet era and emphasize ponderous, procedure-laden formalities. Meetings must be held, drafts circulated, comments explicitly reconciled, ballots taken. Historically this has ensured that large industries play fair and hear through all objections, but the process is slow and frustrates smaller actors who may have good ideas but lack the resources to participate.

Andy Oram

In contrast, FHIR brings together engineers and other interested persons in loose forums that self-organize around issues of interest. The process still tried to consider every observation and objection, and therefore, as we have seen, has taken a long time. But decision-making takes place at Internet speed and there is no jockeying for advantage in the marketplace. Only when a milestone is reached does the formal HL7 process kick in.

The dream of interoperability has long included the dream of a marketplace for apps, so that we’re not stuck with the universally hated EHR interfaces that clinicians struggle with daily, or awkwardly designed web sites for consumers. Tripathi notes that SMART offers an app gallery with applications that ought to work on any EHR that conforms to the open SMART platform. Cerner and athenahealth also have app stores protected by a formal approval process. (Health apps present more risk than the typical apps in the Apple App Store or Google Play, so they call more more careful, professional vetting.) Tripathi is certain that other vendors will follow in the lead of these projects, and that cross-vendor stores like SMART’s App Gallery will emerge in a few years along with something like a Good Housekeeping seal for apps.