It was neither the best nor the worst of times, and it if it was the season of Light, then the lights were all a’flickern and a’fluttern, and marked a rhythm at once reverie and rondelet, nostalgic and phantasmagoric.
This is a tale of two thons and not for the squeamish. Not everything I write here, Dear Reader, is meant to inspire or promote. Sometimes it is just meant to be — to sit here as a book you intend to donate to Saint Vincent’s because you’ll never get around to reading it. But still, you know there is something here for you, thus it remains.
And so, the tale must be told, neither to forewarn nor foreswear, merely to add facet to the great miasmatic prism that is the stuff of life. IT is the nexus and nadir of healthcare, and if you are not running, you are standing still, with the waters rising quickly. Best learn to fly or find a tree on high. But for goodness sakes, don’t just sit there.
Healthcare is a restless patient and that manifests in every aspect of the industry. Within IT, there is considerable upheaval, centered primarily around the needs to share information more effectively, with fewer barriers, between all the interested actors. That can be as few as one — the patient alone — and as many as the entire population of the planet. All of the issues related to this are collapsed under the single moniker, Interoperability.
The great promise of Interoperability is of course that our healthcare information flows free as water from the kitchen sink, on/off, hot/cold, stream or spray. Modern plumbing infrastructure is a good model for Interoperability. But the building of these systems likely pre-dates our own collective memory: we were born, we bathed in bubbles, we ran through sprinklers on hot summer days, it was magical.
By now as adults we have come to understand, there is no magic, there is but grind and toil.
Slow Road to Thon One
FHIR® Connectathon #24 2020-05.
I jumped headlong into FHIR last year and just can’t quit it. It’s a problem solver’s delight. This was my first FHIR Connectathon, and due to current circumstances, it was virtualized. I was on the SANER (Situational Awareness for Novel Epidemic Response ) track. More information on the SANER project can be found here.
The project is one of several that leverages FHIR®. It’s focus is on public health and specifically that which its name describes. I have been a participant in the SANER project for a couple months now, which is to say, I have attended some of the meetings, and have a more than casual knowledge of its actors, transactions, and use cases.
I was as well prepared as I could hope to be and built more than 20 services available through APIs. I was not clear on the testing and validation procedures, but nonetheless figured it would be simple enough to ease in.
The first day had its share of false starts as the Implementation Guide was getting some last-minute revisions that left components out of sync and me in a quandary as to how to proceed.
I should back up a bit …
“I am an Intermediary”
To my left are the reporters of the data, the Measure sources: hospitals, care facilities, and organizations that need to report on the data we are interested in — items like COVID-19 patients in the hospital, on ventilators, number of hospital beds available, and the like.
To my right are the FHIR servers, the Measure consumers. They will persist the data. And a bit further to the right of them are those who need to access to those Measures: public health agencies and the public at large.
Connecting inside the paradigm of interoperability suggests there need be no broker in the middle. Tools are built for the sources and consumers and they get along fine without me.
Imagine a world where I can call the doctor anytime and don’t need to talk to an answering service, a receptionist, nurse or PA first.
“Just me and you, Doc, mano y mano. Give me those digits.”
In truth, though, the Intermediary can take on much of both the source and consumer roles. How data gets generated and consumed rarely occurs in a vacuum or along a straight line.
By Day 2 the revisions were settled, and systems were stable. I waited for requests, for my APIs to be tested and exercised and put through the paces, for others to discover the added value I offered.
And I waited.
And then it was over.
Fast Train to Two Thon
I had relatively little time to prepare for the MiHIN InterOpathon. I was anxious to see Interoperability Land™ since first hearing about it late last year, and this was my first opportunity.
The InterOpathon is set up rather differently than the FHIR Connectathon.
It is a team-oriented event with those teams assembled by the organizer to optimize the right mix of roles in order to give everyone a fair shot and completing their problem statements and components. In Interoperability Land, we had access to the ring of 14 FHIR pits (APIs) fronting various EHR, payer, pharmacy, and HiN applications with synthetic personas populating the backend datastores.
FHIR Accelerators — Gravity, DaVinci, CARIN, and Unify — were there, and the primary focus of the applications and APIs we would build to solve a problem that each team defined itself.
My team ended up without a developer, which put us in at a decided disadvantage. I had done sample SMART and Angular applications previously, but it’s been a while and with limited time, it was more important to work out the actual business logic than the presentation layer.
And besides …
“I am an Intermediary”
Which in my way of thinking really means, “I can do what I need to with my own tools.”
After all, I can interact with any API or application. I can meet them where they are instead of where they are going. I can get them where they need to be. I can be their API.
And so, we worked through our problem and I built as much as I could before my colleague pulled me down from the creaking tree branch that I had climbed out upon.
Every journey must end, become memorialized, relegated to memoirs, or lost in the fog of fuzzy memories … coda … ciao ... fin.
The Book of Thon (Juan)
The FHIR® Connectathon and MiHIN InterOpathon™ are little cities with much in common:
- The Mayor: (The most honorable) Interoperability
- The City Council: FHIR Implementation Guides
- The Denizens: Healthcare IT workers from all over the world
But they are quite distinct, too:
- In one, my life was more solitary and needed others for validation.
- In the other, I was thrown into a community but had little visibility into the affairs of other groups.
Our identities are forged in experiences like these. Many of us want to become more than we are — to be at once more than we formerly were. I felt a trembling touch of melancholy, and for a moment, I was paralyzed. An old poem I must have heard long ago, pinged inside my head.
"Is this all I am to be?
Just another autumn leaf,
For one brief moment, Ecstasy,
But at the price of Destiny"
The moment passed and the cryptic verse was pushed away, not so much by revelation as affirmation:
I am free to be whatever I need to be in this instance: an API, an App, a Service, an Integrator …
“I am, after all … an Intermediary!”