An interview with the inventor of FHIR, who fell into healthcare by accident and is trying to make patient outcomes better through data sharing.
Whenever there’s a digital health panel about interoperability you’ll probably see Grahame Grieve with a microphone in hand, and for good reason.
Mr Grieve invented FHIR (Fast Health Interoperability Resources) and is product director for HL7. His last passport fell apart from overuse.
Dictionaries are often consulted when speaking with Mr Grieve, so here’s a shortcut:
Interoperability – a world where all medical software and devices have been built to standards that enable easy, real-time data sharing of patient information. Think of banking and how transactions can be easily made between different banks. It’s like that except in healthcare, with consumers and clinicians being able to securely share data.
FHIR – Standards that Mr Grieve invented that enable interoperability of healthcare information.
HL7 – The organisation that creates and nurtures communities of healthcare software vendors to implement FHIR standards. HL7 is also the name of an older set of healthcare standards.
What’s keeping you busy right now?
The mega-big project is moving forward the HL7 FHIR community in all of its different manifestations and sub-communities. That means tooling development and relationship development, developing procedures and policies and troubleshooting.
It’s a bit like throwing balls in the air and trying to keep up with them all. It also means visiting communities around the world to press the flesh and make an impression locally.
Are there any low-hanging fruit?
Australia is low-hanging fruit.
It’s been so long since we got the first version of My Health Record. It’s been so long since we’ve asked the infrastructural question, “How do we actually fix healthcare as opposed to how do we force the system to make use of what we designed?”
Now we have a federal health minister who is actually asking those questions and we have an opportunity. This is the low-hanging fruit – to make as much difference as we can here in Australia.
The other low-hanging fruit for me is Africa. There’s so much healthcare need and very little healthcare IT. So, they’re kind of starting with saying “We have to get the information flow correct at the start because we can’t afford anything else”. That’s why I’m focusing on going to Africa this year.
Where in Africa?
I’ve already been to Tanzania and will be going to Rwanda. We’re helping build a Pan-African HL7 community that believes in better health coordination, believes that they can solve their own problems by sharing common information exchange pathways. They don’t have a lot of healthcare in Africa but they still have the same problems.
What keeps you awake at night?
What keeps me awake at night is overstimulation. Just the constant, never-ending stimulation of doing what I’m doing; knowing that there’s always those balls in the air to chase. It never stops.
We have a lot of obstacles: process, politics, wealth and inertia make for really difficult politics and relationships. Sometimes I’m trying to decide what’s the right set of actions to bring most people on board, and align their ideas, knowing that there’s always some people we won’t get on board.
You’re really good at building alliances with people – what’s the key?
One is that I’m not really personally ambitious. I could have tried to leverage what I’m doing for more money, and set up a company to profit from FHIR, but I really want the bigger outcomes that FHIR can deliver.
I also try to go into every relationship I’ve got with the purpose of giving more to the relationship than the other party does, in the spirit of trying to make them the winner within a whole servant leadership approach. Those things don’t get everybody onside but most people respond to them.
How do you give more and still get your own outcomes?
Generally, we choose to have relationships with people where it’s mutually beneficial. Having a good relationship is the not the primary goal – it’s the primary means by which we get the actual goals. Getting people to agree.
There are, however, a few things we won’t compromise on. Deceit and underhanded goals – we’re happy to help people make money but they have to be honest and transparent. That has stopped some relationships but those people were either fly-by-nighters or come back after reflection and play with a straighter bat.
What can FHIR do for healthcare?
The opportunity is massive. If we can get better healthcare coordination, we can get better preventative care. We can keep people out of hospitals and keep people healthier for longer.
We know that information management technology – which FHIR is about – doesn’t solve the healthcare coordination problem itself, but it lets other people solve the problem, and so our focus is on empowering clinical champions to do that.
All of those things will lead to better health outcomes which leads to better economic outcomes and a happier, wealthier nation.
Have you ever regretted sharing FHIR intellectual property for free?
No. I have really good relationships everywhere. People respect what we’re doing and want to be a part of it.
Healthcare information blockages and deficits have hurt people in my family and I had the opportunity to actually make a difference. It’s a decision that we made as a family and it’s how we measure our goals – can we say some people’s morbidity or mortality has been improved because of better information flow that led to better coordination of healthcare.
I want to able to say, when I retire, that I really made a difference in those ways.
In some ways, my daughters have worn the price of it because we could have had more money than we do. But we have a house and the kids are in private school so once you have enough, what do we need more money for? People who choose to live their lives always focusing on money, building businesses to try to get richer, will never have enough.
Wildcard question: did you expect you’d be doing this job when you were a kid?
No. I thought I was going to be a farmer.
I grew up outside Wellington in New Zealand and we had market gardens around us. My family had a little market garden and I was good friends with a farmer who also did plant breeding research with the local university.
So, I did botany and biochemistry at university but accidentally landed a job in a hospital and I said “Healthcare – that’s where I really belong”.
Now I’ve accidentally ended up leading the HL7 FHIR community. It is really the result of a whole chapter of accidents, each of them totally unexpected and not premeditated. I’ve just fallen into challenges, taken them on, worked hard and built alliances with other people. That’s just how it happened.
