Why is FHIR query-based exchange so slow to be adopted? When it comes to FHIR Query/Pull, only Provider-to-Consumer exchange reasonably works using FHIR as the user identity of the patient comes from the provider’s own patient portal system. I propose that the issue with adoption for provider, insurer, or public health query-based exchanges is that we need one system for nationwide healthcare user identity. This has been known for over a decade, and the can was kicked down the street multiple times. FHIR was founded as the outcome of the Data Access Framework (DAF) project initiated by the Office of the National Coordinator (ONC). Its only evaluated use case was public health. The goal was a peer-to-peer pull (query) of data. The result was FHIR. But the DAF project intentionally left out a user identity solution. As a result, we don’t have peer-to-peer exchange because we don’t have user identity. Peer-to-peer exchange is a great concept to lower overhead costs. But it need...
Healthcare Information Exchange (HIE), HIE architecture, Direct Project HISP, and other Data Sharing topics.