It has been several years since we reviewed the progress of the HL7 FHIR standards adoption rate. Health Level Seven's (HL7) Fast Healthcare Interoperability Resources (FHIR) is an emerging standard that has rapidly captured the mind-share of the Health Information Technology (HIT) standards community. FHIR is a standard that enables healthcare data sharing between systems in a manner that is more easily implemented and more expressive than previous HL7 standards such as HL7 Version 2, 3 and Clinical Document Architecture (CDA). Regardless of the version of HL7 standard used, the purpose of these standards is to send clinical data in messages, whether to a party inside or outside your organization. HL7 devises flexible message formats so the receiver of the message can open it up, know who sent it and why, and break it down into understandable segments and data fields.

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News media coverage of wildfires commonly frames them as "natural disasters" - dangerous elements of the natural world over which humans have little control. The language of climate change, fear of fire and the sense that it has become inevitable can be overwhelming, leaving people with the view that little can be done to manage these events. But in fact, people aren't helpless. While fires can be dangerous, they are inevitable and necessary in many ecosystems, and humans have long adapted to them. Across North America, indigenous peoples have actively managed forest ecosystems through the use of fire. Euro-American settlers were struck by the rich biodiversity of California's forests, woodlands and prairies, but they didn't understand that indigenous people's use of fire was responsible for them.

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I read two articles this week that got me thinking, Robert Charette's "Inside the Hidden World of Legacy IT Systems" (IEEE Spectrum) and Douglas Holt's "Cultural Innovation" (Harvard Business Review). Both deal with what I'll call legacy thinking. It's a particular problem for healthcare...If you are in healthcare and rely on legacy systems, you're in trouble. If you are in healthcare and are not acutely aware of what your Achilles heel is, someone else is going to exploit it. Even if you are a new healthcare entrant with more modern technologies but still based on the current ideology, your impact is going to be limited.

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The race for a SARS-CoV-2 vaccine is well underway. It's tempting to assume that once the first vaccine is approved for human use, all the problems of this pandemic will be immediately solved. Unfortunately, that is not exactly the case. Developing a new vaccine is only the first part of the complex journey that's supposed to end with a return to some sort of normal life. Producing hundreds of millions of vaccines for the U.S. - and billions for the world as a whole - will be no small feat. There are many technical and economic challenges that will need to be overcome somehow to produce millions of vaccines as fast as possible.

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I attended the ONC summer Tech Forum in August 2020 which brought together over 1,500 industry experts and Federal partners to discuss technical innovations in health information technology and their potential impacts on the healthcare ecosystem...One of the most interesting parts of the conversation was focused on the efforts made by Honk Kong to develop an open source digital health platform. Over the past 20+ years, Hong Kong has been pursuing a "one system, one record" policy primarily built on open source components. Though they had little money to invest at the beginning, for them open source is more about retaining control than about controlling cost (though the lower price tag certainly got them started down this path)...

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You might have missed it amongst all the headlines about the U.S.P.S., the 2020 elections, and, of course, that little thing we call the pandemic, but Fortnite got kicked off Apple's App Store (and subsequently Google Play). I'm not a gamer, but I am fascinated by gaming, because, as Steven Johnson put it, "The Future is where people are having the most fun." Tim Sweeney, the founder and CEO of Epic Games, Inc., which makes Fortnite, seems to be having a lot of fun. And he thinks the future is the Metaverse. Healthcare, take note. The tech giants were reacting to Epic allowing "permanent discounts" on developer fees for in-game purchases made directly, rather than going through Apple or Google. Developers thus avoid the 30% commission charged in those Stores. Mr. Sweeney has been railing about the commission level for some time, leading to the recent decision.

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