Comment by _corym | Hacker News Reader

Comment by _corym | Hacker News Reader

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Health care is by nature very complicated and any attempt at standardization is going to be sophisticated. Just look at how many ICD-10 codes there are.

HL7 is complicated but I see a lot of work being done to conform with the FHIR standards. FHIR has only been around since 2014 and release 3 was only completed last year. I do have hope for standards to take precedence in the EHR realm but it will take time. Most EHR software was created in the late 80's and there's a lot of legacy code, client customization, and regulations to go through in order to release this code. Healthcare doesn't leverage itself to an agile "move fast and break things" ideology.

In addition the Commonwell alliance was supposed to help alleviate these problems, but the fact that Epic didn't join really ruined things there.

Yes, but FHIR was the result of many years that had previously been wasted with HL7 v3, which was so convoluted that at some point some people in the community gave up on it and came up with FHIR to get things done. The clock did not start ticking in 2014. HL7 already wasted a lot of time and effort, to the very real detriment of many patients around the world.

It's easy to criticize in hindsight but FHIR wouldn't have been possible without the lessons learned from HL7 V3 so there was really no wasted time. Sometimes the only way to learn is to make mistakes.

FHIR by itself is no panacea; it has some nice improvements, and makes implementations significantly cheaper and more efficient but it doesn't enable any fundamental new use cases. HL7 V3 standards such as CDA R2 are actively used today to deliver patient care all over the world.

ICD-10 contains thousands of codes, but unfortunately even with all those sometimes it still isn't complicated enough! There are important diagnostic concepts that can't be expressed with sufficient detail in ICD-10, so we end up having to supplement it with additional code systems such as SNOMED-CT.

Thank you for your insight, Cory. :full-moon-with-face:

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