A Vibrant and Engaged Community
By Daniel Vreeman, DPT, Chief Standards Implementation Officer, HL7 International
The launch of the HL7 3-Year Plan in 2022 marked a pivotal moment for our organization and community. Throughout 2023, as we worked towards the plan’s 10 key strategies, we witnessed remarkable advances in the interlinked activities of standards development and implementation. Our community’s vibrancy drives this progress, and this theme resonates throughout my reflections.
As we push ourselves to keep adapting and addressing the next epoch of global interoperability challenges, we do so amidst a rapidly transforming landscape. In our complex adaptive healthcare system, HL7 Fast Healthcare Interoperability Resources (FHIR®)-enabled transformations constantly mix with other changing forces like regulatory and business drivers. And no doubt, the spread of ubiquitous, powerful artificial intelligence (AI) will radically change healthcare and accelerate our learning cycles. I want to underscore though that HL7's progress, especially with FHIR, has always been driven by the power of community, peer-production, and the commitment to working openly. With a growing implementation base and AI at our side, we expect to build more and faster feedback loops throughout our work. Always learning, always sharing, and always improving.
Your participation in HL7 brings a unique perspective, and we are grateful for how you choose to contribute these gifts to the public good. Here, you’re part of an unparalleled global brain trust that is catalyzing innovation across the industry. 2023 was full of examples of how your work is driving digital transformation around the world. From the adoption of FHIR in many new national regulations to HL7 and the World Health Organization (WHO) forming a landmark collaboration, we see the specifications developed at HL7 becoming the foundation for person-centered digital solutions around the world. In the Fall, the Digital Square organization recognized FHIR as a bona fide Global Good – a resource helping shape the future of health data for digital transformation. We continue building connections to other Global Good communities of practice, including a new collaboration agreement with Open Concept Lab that is advancing semantic interoperability using FHIR-based terminology approaches. In fact, 30 of the 36 Global Goods recognized by Digital Square use HL7 FHIR, so we're in good company.
As we push ourselves to keep adapting and addressing the next epoch of global interoperability challenges, we do so amidst a rapidly transforming landscape. In our complex adaptive healthcare system, HL7 Fast Healthcare Interoperability Resources (FHIR®)-enabled transformations constantly mix with other changing forces like regulatory and business drivers. And no doubt, the spread of ubiquitous, powerful artificial intelligence (AI) will radically change healthcare and accelerate our learning cycles. I want to underscore though that HL7's progress, especially with FHIR, has always been driven by the power of community, peer-production, and the commitment to working openly. With a growing implementation base and AI at our side, we expect to build more and faster feedback loops throughout our work. Always learning, always sharing, and always improving.
Your participation in HL7 brings a unique perspective, and we are grateful for how you choose to contribute these gifts to the public good. Here, you’re part of an unparalleled global brain trust that is catalyzing innovation across the industry. 2023 was full of examples of how your work is driving digital transformation around the world. From the adoption of FHIR in many new national regulations to HL7 and the World Health Organization (WHO) forming a landmark collaboration, we see the specifications developed at HL7 becoming the foundation for person-centered digital solutions around the world. In the Fall, the Digital Square organization recognized FHIR as a bona fide Global Good – a resource helping shape the future of health data for digital transformation. We continue building connections to other Global Good communities of practice, including a new collaboration agreement with Open Concept Lab that is advancing semantic interoperability using FHIR-based terminology approaches. In fact, 30 of the 36 Global Goods recognized by Digital Square use HL7 FHIR, so we're in good company.
Participation is Our Fuel
HL7's active global community is the fuel for our collective progress.
BUILDING CONSENSUS
Day in and day out, we seek, receive, and incorporate feedback from standards developers, testers, and implementers. Your sustained, ongoing commitment to processing that feedback and building consensus solutions keeps our forward momentum.
Overall, in 2023 we found consensus on and resolved more than 5,200 comments across all our specifications!
147
of 375 people who submitted comments on HL7 specifications in 2023 were NEW!
ATTRACTING NEW VOICES
At HL7, we're committed to becoming a continuously welcoming community. Last year, we received a healthy infusion of ideas from new contributors. More than a third of all comments submitted on our specifications came from people who had not commented in the prior two years.
LEVERAGING INDUSTRY WISDOM
There are many ways to participate in advancing our shared mission of interoperability. As your interest and engagement with HL7 grows, so too will the opportunities to enhance your personal and professional development. You can grow your expertise, hone your skills, collaborate to solve problems, and gain recognition as an interoperability leader.
As an organization and a community, we celebrate the service of many individuals who have stepped up into leadership.
As an organization and a community, we celebrate the service of many individuals who have stepped up into leadership.
50
PROJECT FACILITATORS ON 61 ACTIVE PROJECTS (IN JIRA)
Project Facilitators are the point people for stewarding an HL7 project through to meet its objectives, including in many cases, developing or maintaining specifications.
111
TRACK LEADS ENABLING 109 TRACKS AT 3 CONNECTATHONS
Track Leads are those who organize, lead, and facilitate a track at an HL7 FHIR Connectathon.
142
C0-CHAIRS SERVING 38 GOVERNANCE GROUPS
Co-Chairs provide the leadership, stewardship, and oversight of the governance group in which they serve, helping that community achieve its mission.
Cultivating Community with Intention
In HL7's 3-Year Plan, we made a conscious commitment to cultivating a diverse, equitable, and inclusive community where everyone can experience the deep satisfaction of contributing their unique perspective towards the common goal of interoperability.
To better understand where we stand and help plot the course towards what we want to become, we surveyed work group co-chairs and management group members. We also made the significant step of hiring Daniel Bach as our HL7 inaugural Community Manager. What does a Community Manager do, you might ask? Well, in this role, Daniel is focused on helping us intentionally cultivate a vibrant, healthy community ethos. He is using program management approaches to develop and execute on the contributor engagement plan, curate a community health dashboard, and create a community roadmap.
Some of the initial focus areas of our community roadmap include:
To better understand where we stand and help plot the course towards what we want to become, we surveyed work group co-chairs and management group members. We also made the significant step of hiring Daniel Bach as our HL7 inaugural Community Manager. What does a Community Manager do, you might ask? Well, in this role, Daniel is focused on helping us intentionally cultivate a vibrant, healthy community ethos. He is using program management approaches to develop and execute on the contributor engagement plan, curate a community health dashboard, and create a community roadmap.
Some of the initial focus areas of our community roadmap include:
- Creating a dashboard of key community metrics and systematic approach to tracking
- Developing an enhanced member recognition program
- Tailoring our onboarding processes to help better connect people with interest areas and resources
- Education and outreach activities seeking to ‘demystify’ HL7 standards, making them accessible and relevant to professionals beyond the “experts in interoperability” space
Evolving Standards for Evolving Interoperability Needs
In 2023, HL7 International published (or reaffirmed) 61 new specification versions. This pace is pretty much on par with our recent past, however, it is remarkable because it also includes the tremendous collective effort to bring HL7 FHIR Release 5 to publication.
We celebrate these specifications not because our end goal is publishing artifacts. Rather, we celebrate them as the outcome of reaching consensus about how a community of practice wants to address a particular interoperability problem. They are building blocks to enabling new system capabilities and services that are transforming health care around the world.
FHIR Release 5 represents the collective progress and implementation experience of the FHIR community, including thousands of incremental updates, corrections, and enhancements that improve the overall quality and capability of the standard. Some of those notable enhancements include:
We celebrate these specifications not because our end goal is publishing artifacts. Rather, we celebrate them as the outcome of reaching consensus about how a community of practice wants to address a particular interoperability problem. They are building blocks to enabling new system capabilities and services that are transforming health care around the world.
FHIR Release 5 represents the collective progress and implementation experience of the FHIR community, including thousands of incremental updates, corrections, and enhancements that improve the overall quality and capability of the standard. Some of those notable enhancements include:
- Capabilities for topic-based subscriptions are now part of the core specification, enabling proactive event notifications based on data changes in the source system.
- Significant revisions to the Medication Definition resources to better support the needs of manufacturers and regulators and use in drug catalogs and pharmacopoeias.
- More than a dozen new resources defining structures for different types of health-related information. FHIR R5 now defines 157 different resource types.
- New operations are defined for efficiently managing large resources such as Groups and Lists
FHIR R5’s infrastructure introduced further innovations that enable the management of coded terminologies and FHIR extensions to be managed more appropriately alongside the core FHIR specification. This move allows us to iterate on them more quickly, ballot them as a distinct specification, and allow a bit more “breathing room” for review than they might typically get as part of the FHIR core specification. The FHIR Extensions Pack was first open for comment in the January 2024 ballot cycle, and we published updates to HL7 Terminology (THO) on our regular release schedule. The next version of FHIR is planned to be a milestone release (Release 6) as a normative standard.
People around the world are using FHIR to create interoperability solutions. The specifications underlying those solutions are increasingly built using our auto-build pipeline. The auto-build pipeline runs around-the-clock, creating continuous integration builds of specifications under development by HL7 International, HL7 affiliates (15 or so of them), and many others. There are now more than 440 implementation guides connected to this pipeline!
Throughout 2023, the FHIR product team made regular performance and feature improvements to the IG Publisher, FHIR Validator, and validator.fhir.org. These toolsets provide a core foundation for ensuring the quality and validation of FHIR specifications and data. To support publishing the Clinical Document Architecture (CDA) R2 and the Consolidated CDA (C-CDA) Edition 3 ballot (and we expect more specifications down the road) using FHIR StructureDefinition, we also invested heavily in the validation capabilities for CDA.
Looking ahead, I'm really excited about the work that’s been going on behind the scenes that will enable our FHIR publishing ecosystem to support a federated set of terminology servers. In brief, we now have a mechanism for the publishing infrastructure to interact with different terminology servers that serve up their own terminology content!
People around the world are using FHIR to create interoperability solutions. The specifications underlying those solutions are increasingly built using our auto-build pipeline. The auto-build pipeline runs around-the-clock, creating continuous integration builds of specifications under development by HL7 International, HL7 affiliates (15 or so of them), and many others. There are now more than 440 implementation guides connected to this pipeline!
Throughout 2023, the FHIR product team made regular performance and feature improvements to the IG Publisher, FHIR Validator, and validator.fhir.org. These toolsets provide a core foundation for ensuring the quality and validation of FHIR specifications and data. To support publishing the Clinical Document Architecture (CDA) R2 and the Consolidated CDA (C-CDA) Edition 3 ballot (and we expect more specifications down the road) using FHIR StructureDefinition, we also invested heavily in the validation capabilities for CDA.
Looking ahead, I'm really excited about the work that’s been going on behind the scenes that will enable our FHIR publishing ecosystem to support a federated set of terminology servers. In brief, we now have a mechanism for the publishing infrastructure to interact with different terminology servers that serve up their own terminology content!
Always Sharing, Always Improving
As an open community of innovators, we foster a spirit of sharing that helps us work together more productively and efficiently. Throughout 2023 we collated, synthesized, and are now in the process of sharing several collections of best practices. We published Using Terminology in HL7 Standards and Conducting eVotes using a Template, and began work on FHIR Testing Best Practices: Continuous Reference Implementation Development and a series of Templates for Jira Dashboards to help visualize, organize, and manage your work.
HL7 International remains dedicated to supporting its vibrant affiliate network around the world. In 2023, we began a pilot with HL7 Australia and HL7 New Zealand to extend the HL7 International Jira balloting capabilities to support balloting of their standards. We are establishing the technical and process capabilities with these first two affiliates for their balloting activities in 2024, and then plan to invite other affiliates who may wish to take advantage of this service.
We also continue to make significant, continual investments to improve our infrastructure. Among the highlights of these 2023 efforts were the following:
HL7 International remains dedicated to supporting its vibrant affiliate network around the world. In 2023, we began a pilot with HL7 Australia and HL7 New Zealand to extend the HL7 International Jira balloting capabilities to support balloting of their standards. We are establishing the technical and process capabilities with these first two affiliates for their balloting activities in 2024, and then plan to invite other affiliates who may wish to take advantage of this service.
We also continue to make significant, continual investments to improve our infrastructure. Among the highlights of these 2023 efforts were the following:
- The launch of Single Sign On capabilities
- Better automation for HL7’s Unified Terminology Governance process
- Afresh new look and functionalities for fhir.org
- A cross-referenced library to navigate the FHIR package ecosystem of published implementation guides
- A host of behind-the-scenes investments to make our cloud infrastructure more resilient
HL7’s curates an external funding portfolio (e.g. grants, contracts, cooperative agreements) that provides support for standards advancement, core infrastructure development, process improvement, pilot testing, and dissemination. HL7 has worked closely and successfully with the U.S. Office of the National Coordinator for Health Information Technology (ONC) for many years. Throughout 2023, HL7 executed on three awards (#90AX0035/01-00, #90C30007, and #75P00120C00078) from ONC. This support enables HL7 to develop many of the tools and standards development infrastructure that HL7 makes freely available to the public. Furthermore, ONC’s funding support has directly contributed to the development of HL7 standards that are now critical to the function of the US healthcare system.
Closing
Let me close by once again expressing my gratitude for your contributions in the HL7 community. You help reduce the activation energy for change. Your participation plays a pivotal role in fostering collaboration and driving innovation in the field of healthcare data standards. The advances you’ve fueled have not only enhanced the efficiency of healthcare systems, but have also paved the way for improved health and well-being around the world.
Your involvement in HL7 is invaluable. Together, we are not just people working in the same field – we are a force driving forward the future of healthcare technology.
Thank you for your continued dedication and support. Here's to another year of innovation and collaboration!
Your involvement in HL7 is invaluable. Together, we are not just people working in the same field – we are a force driving forward the future of healthcare technology.
Thank you for your continued dedication and support. Here's to another year of innovation and collaboration!
