[cmiles74]

While I agree that HL7 is a "not-for-profit", it's important to remember that their membership is not composed of not-for-profit organizations and you must purchase that membership. While this may not be an out-of-the-ordinary way to organize a standards body, it hopefully highlights why the standard is so fractured and interoperability is such a problem: this is the preference of that membership.

I've had to work with the spec, specifically to integrate different products, and it was an ongoing battle with the vendors and their consultants at every step. It's uncharitable to say that they would deliberately mis-interpret what little specification was in place solely to make integration expensive, but that was my feeling. In fact, I believe that one purpose of the specification is to keep competition out of the field.

Looking around, I'm having trouble finding an EHR that implements both importing and exporting data in the FHIR format. Instead I'm seeing products that take the FHIR data and then (presumably) emit HL7 messages aimed at an organizations interface engine (i.e. Cloverleaf or something similar).[0] If none of the big EHR support it, then it will remain an expensive "custom" add-on that will be challenging (and expensive) to support and it will end up another dead initiative like the "Blue Button".[1] With every upgrade to systems in the organization, the FHIR translator app will need to be updated as well. Will it support every vendor? Likely not, and now you may also have to foot some portion of the bill to add support for that vendor.

My fear is that people will see FHIR and Apple and assume that some progress is being made. This is a battle we've been fighting for years and even now, people walk from one office to another with a CD or DVD of data in the hopes that it can be read.

[0]: http://www.intersystems.com/au/our-products/healthshare/hl7-...

[1]: http://bluebuttonconnector.healthit.gov/

[nradov]

FHIR is relatively new and still in draft form. It would be a bit unreasonable to expect vendors to put a huge amount of effort into supporting a standard that's still in rapid flux.

Most of the major EHR vendors do now support a significant subset of FHIR resources through read-only APIs. And several of them have publicly committed to start offering limited write APIs by the end of 2018. We have to be a little bit patient.

As for purchasing memberships, well HL7 needs some revenue to keep the lights on. A small company can purchase an annual membership for as little as $1450, and individuals can join for even less.