New devices are democratizing health. We see it not only in the array or wearable fitnessgear that an estimated 21 percent of Americans own (and that some actually wear), but also in innovative uses for mobile phones (such as testing vision in regions that lack doctors or checking athletes for concussions) and now in low-cost devices that are often open source hardware and software. Recent examples of the latter include the eyeSelfie, which lets a non-professional take an image of his retina, and the WearDuino, a general-purpose personal device that is the focus of this article.

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Andy Oram

The previous part of this article laid down a basic premise that the purpose of security isto protect people, not computer systems or data. Let’s continue our exploration of internal threats. This is a policy issue that calls for involvement by a wide range of actors throughout society, of course. Policy-makers have apparently already decided that it is socially beneficial–or at least the most feasible course economically–for clinicians to share data with partners helping them with treatment, operations, or payment. There are even rules now requiring those partners to protect the data. Policy-makers have further decided that de-identified data sharing is beneficial to help researchers and even companies using it to sell more treatments. 

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Andy OramThe HIMSS report certainly appears comprehensive to a traditional security professional.They ask about important things–encryption, multi-factor authentication, intrusion detection, audits–and warn the industry of breaches caused by skimping on such things. But before we spend several billion dollars patching the existing system, let’s step back and ask what our priorities are. It’s a long-held tenet of the security field that the most common source of breaches is internal: employees who were malicious themselves, or who mistakenly let intruders in through phishing attacks or other exploits. That’s why (you might notice) I don’t use the term “cybersecurity” in this article, even though it’s part of the title of the HIMSS report.

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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 hasestablished 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.

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Andy Oram

FHIR is large and far-reaching but deliberately open-ended. Many details are expected tovary from country to country and industry to industry, and thus are left up to extensions that various players will design later. It is precisely in the extensions that the risk lurks of reproducing the Tower of Babel that exists in other health care standards. The reason the industry have good hopes for success this time is the unusual way in which the Argonaut project was limited in both time and scope. It was not supposed to cover the entire health field, as standards such as the International Classification of Diseases (ICD) try to do. It would instead harmonize the 90% of cases seen most often in the US. For instance, instead of specifying a standard of 10,000 codes, it might pick out the 500 that the doctor is most likely to see. 

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