Act or just react?

In the midst of all the problems of the present, we forget that in many places the main issue at present is the future. Decisions in the here and now set the course, and the question of a uniform, binding standard for the exchange of health data is one of them. 

The whole world is “on FHIR” – and in Germany just one little light is flickering. That’s all it really takes to summarize the current topic of a possible standard for the exchange of health data. Now this is not a new development, so why FHIR as a topic for Quo Vadis Digital Health in October?

Quite simply, Israel has just announced via Yoel Ben-Or, Head of the Digital Health Department at the Israeli Ministry of Health, that the country will be taking its cue from the US in choosing a health data exchange standard, in short, FHIR. At this point, it should be emphasized once again that the Israeli Ministry of Health has its own department for digital health – but maybe we’ll get there.


Let’s first analyze what is so exciting about this news – which has actually received hardly any media attention. To do this, we first need to understand what makes FHIR – short for Fast Healthcare Interoperability Resources – so special. The healthcare industry has had an immense treasure trove of data for many years, but it has been locked away in proprietary structures for at least as long. For healthcare providers, payers and patients, this means that data and information are transmitted in a time-consuming manner using outdated technologies. One example that everyone is familiar with is a referral to a specialist or a clinic. Patients usually receive these physically and have to pass them on in the same way as their patient information. Or the fact that individual selected information cannot be passed between care providers. If anything, documents like the physician’s letter are transmitted out of the systems to answer a physician’s request for specific health information. This makes both searching within the data and transmitting it complex, time-consuming, and also doesn’t help build good solutions that support decisions.

FHIR is a different story. The standard is agile, modern, supports mobile architectures, and connects patients to their data regardless of location – but it’s just not the only standard. However, FHIR is the standard that is catching on in the US. Ben-Or, like many other experts, also expects the entire U.S. market to use FHIR as the standard. First, because FHIR is based on an open source license and is also easy for developers to learn and implement. In addition, TLS/SSL encryption is required for all data exchanged via FHIR, which gives the standard an edge over other HL7 standards, for example, in terms of security. And then there is the issue of resources: FHIR uses uniform data components and formats called “resources”. The smallest realizable transaction unit in FHIR is a resource, which provides significant data about a known identity. This is another reason why the standard is so versatile – from mobile application to communication in the cloud or server communication in large healthcare facilities.

The Americans set the tone

For the Israelis, however, it is not (only) the advantages but the advance of FHIR in the USA that has now persuaded them to make the standard mandatory. Initially, incentives were used to establish FHIR in Israel as well, but now it has become clear that this is not enough. As the Tagesspiegel reported in its backgrounder, Ben-Or said at the second Digital Health Roundtable of the German Israeli Health Forum for Artificial Intelligence that while there is a lot of digital data available in Israel, they started without any enforcement of standards. Thus, the status quo is a big mess when it comes to data exchange, which they now want to solve with the FHIR obligation. And since the U.S. is the most important market in terms of innovation, it is also the place to look.

And we in Europe?

The challenge we face with health data has at least also been recognized in Europe and is to be addressed with the European Health Data Space, or EHDS for short. But the regulation does not include a standard like FHIR. Nevertheless, gematik’s Interop Council has already approved the use of FHIR as a standard for Germany. This is an important step, but it is probably not enough, as the Israeli example should make clear to us. So we are also heading for a mess – not to say: We are already in the middle of it.

It will therefore also be exciting to see what the German Ministry of Health makes of the EHDS regulations, which – like all laws at the EU level – must be converted into national law. Expectations are high for the German health data utilization law that is currently being drafted. It must be designed with foresight and ensure that Germany remains internationally compatible. What does not help here is the data protection cudgel, which is already being used at least verbally in one place or another. In a statement, for example, the German Medical Technology Association is concerned that there could be “contradictions and different national legal interpretations, particularly with regard to the European General Data Protection Regulation,” which must be avoided at all costs.

And that is precisely why the topic for Quo Vadis Digital Health is “on FHIR” in October. I don’t understand why there isn’t a louder and clearer call for a binding standard in this country, especially since other countries are – once again – showing us the way. We have not yet been left behind; we still have a realistic chance to play a role in shaping the future and to take action. And in some places we have very good approaches, such as ISiK, the abolition of interfaces as a business model through the KHPflEG, or the switching interface in the outpatient area. However, it is becoming more and more apparent that we are only following behind and reacting to what others are doing – because we are not setting binding standards, as is now the case in Israel. In the Handelsblatt you can read about the new power of the monopolies. And Senior Editor Hans-Jürgen Jakobs puts forward the thesis that “for a long time now, there has been a trend toward the concentration of power in all the important production factors of the modern information society – data, capital, raw materials. If things continued like this, Europe would eventually only have the choice of whether it would rather be dependent on private, state-supported U.S. monopolies (Amazon, Microsoft & Co) or on state-supported, private monopolies of China.” So let’s make sure together that it doesn’t continue like this!