🔌 🔥 Why YOU should attend a FHIR Connectathon 🔌 🔥
(and what I learned when I did)
At Flexpa we build dev tooling for teams building in digital health (check us out here) and a lot of our learning has come from listening to and sharing ideas with the digital health community.
One of the best ways we’ve done this is through our dev team attending the HL7 FHIR Connectathons. These events are great, happen every ~3 months, and bring together people in the FHIR community from around the world.
One of our beliefs as a company is that as our team grows, every member of it should be attending community events. This was my first time at a Connectathon, so I wanted to share my learnings for folks that haven’t been to one yet.
Why are Connectathons important?
Ok so first off, how do Connectathons work? In my opinion they’re a bit of a contradiction, which is what makes them so great to attend. On the one hand they’re community based and social (breakout rooms, new friendships are made, you put faces to names).
On the other hand they’re tightly regulated and serve as the official mechanism for advancing the FHIR standard. Format as follows:
Each Connectathon consists of a series of tracks
Each track focused upon a specific use of FHIR to solve a healthcare need (ex: International Patient Access).
There is a detailed process required to create a “track”,
Track creation and maintenance is steered by the 5 levels of the FHIR Maturity Model which ensures that FHIR artifacts are tested and improved over time.
We participated in this process back in the September, 2021 Connectathon when a member of our dev team tested our open source TypeScript toolkit for health projects.
Our participation goals
We wanted to attend the connectathon to learn more about the FAST FHIR Project (FAST stands for FHIR At Scale Taskforce). Why? Because we’d never been to a FAST FHIR working group at a connectathon and thought what they were working on was increasingly important (more info on history of the task force here).
FAST is trying to scale FHIR by solving obstacles to it’s growth such as solving endpoint coordination, which is also one of Flexpa’s product objectives (see our doc here). It’s also involved in things like Digital Identity & Patient Matching, and Security for Scalable Registration, Authorization, and Authentication (more on that below).
What did we learn?
I listened to a lot of smart people talk and if I had to boil things down to one key takeaway I think it would be this:
The work of the FAST FHIR project stands to supplement and in many ways operationalize the goals of TEFCA, through the application of UDAP protocols, and that this could be a big win for interop.
The two tracks I most attended were FAST Security & Identity and FAST National Directory & US Realm.
What is TEFCA?
The Trusted Exchange Framework and Common Agreement outlines a common set of principles, terms, and conditions to support nationwide exchange of electronic health information. It was first proposed by the ONC in 2018, and published in January 2022. TEFCA has itself, in January 2022, acknowledged that:
“However, the healthcare information technology landscape continues to evolve and TEFCA will have to evolve with it in order to continue to add value and, more important, to avoid holding back industry progress. The HL7 Fast Healthcare Interoperability Resource (FHIR®) standard uses a modern approach to standards and interoperability and has already gained wide support in the United States1. We expect to accelerate adoption as FHIR Application Programming Interfaces (APIs) for general use become required in all ONC-certified Electronic Health Record (EHR) systems by the end of CY 2022“
What is UDAP?
Unified Data Access Protocols were created to increase confidence in open API transactions through the use of trusted identities and verified attributes. They’ve since led to the development of additional implementation guides focused on key use cases in the deployment of reusable identities, including Dynamic Client Registration and Tiered OAuth.
UDAP profiles can be used to scale the secure use of open APIs while simultaneously protecting the personal information of identity participants. You can register for a UDAP developer account here.
Ok I understand the definitions now. So how are they all connected?
There a few big takeaways from the interrelationship of the orgs mentioned above, and how they were discussed at the Connectathon. On the pessimistic side, there is a very real skepticism in the builder community around how TEFCA can solve things.
More optimistically, there is a lot of healthy and active convo around pragmatic solutions here. Josh Mandel rounded out the second day with a great roundtable where he invited criticism of his TEFCA skepticism (or Deus Ex-ism as he puts it).
To actively monitor the dialogue check out Zulip here and here.
I think most importantly, however, I learned both how much in common TEFCA and FAST have, and also how formal and explicit their relationship and interdependencies run. Put simply, TEFCA cares about network facilitated FHIR exchange, and that is kind of another way of talking about what the FAST FHIR Security & Identity track events I attended were interested in as well and which deeply discussed the use of UDAP for dynamic application registration.
These similarities of interests don’t stop there. TEFCA literally goes into great detail about how, when and where FHIR has to be used in accomplishing its objectives, in its FHIR Roadmap for TEFCA Exchange doc in January 2022. Part way through the doc you’ll see:
It is anticipated that implementation specifications for brokered FHIR exchange will also need to be developed soon after the pilots are accomplished. For both facilitated and brokered FHIR exchange, IGs from FAST and other FHIR-related industry initiatives will be used as appropriate to accelerate development activities