Time Capsule: Healthcare Standards
A full health tech multimedia blast from the not at all distant past
Note: This is a repost of the original Substack article. Recommend reading/subscribing over there, but not going to keep you from
🚨Short Piece Alert🚨
In an effort to:
* provide consistent content to you, the people, hungry for written word and new knowledge
* make this Substack a hub for that endeavour in regards to that healthcare technology learning
* write with more frequency but less effort, because I’ve already put the work in previously
This is a shorter piece calling your attention to content that’s been out there for a while that you may have missed and adding some light commentary.
Return yourself, if you would, to the start of the year 2020. The world was on the precipice of an unprecedented event, a pandemic that would reshape society, cripple nations, and accelerate generational change. Tiger King had not yet redefined Hollywood and the American Dream. Most troubling of all, I was still strongly convinced that the beard worked.
The world changes. But standards are forever*. Thus, we held this webinar to explain really, finally and definitively what standards are and how to think about them. I’d highly recommend giving it a listen, but decided to further dig in with some Director’s Cut highlights and commentary.
*This is not true. Standards iterate and expand. There are 9 versions of HL7v2. It just sounded catchy
The Long-Awaited Keeler Cut Commentary:
“Maximus Principle” — 0:35 — Gladiator was a sick movie. I need to go back and watch it pronto. There’s doubtlessly a countenance of healthcare newsletter relevant insights, or at least meme material.
“Standards are a product” — 4:04 — Imagine you’re a product manager. You get together with your competitors’ product manager and hash out a product brief/design. You post it to the internet and hope that people adopt. It’s kinda bonkers, but this is literally how standards happen. There are good ones and those get picked up and built. There are bad ones and those live on in failed specifications and implementation guides. On top of that, you have limited to no visibility into the adoption of the standard like you might for a regular product one sells and deploys. You’re relying on word of mouth and public announcements to know.
“Vendor proprietary methods” — 8:15 — Proprietary has such a negative connotation to it and I’m not sure that’s warranted these days. It’s interesting to think about the rise of unique health services that offer API formats that aren’t easily shoehorned into a standard. As long as their documentation is open and their developer tools are excellent, we all win. I’d much rather use an API with open docs, a Postman collection, and some SDKs than have anything to do with X12 with specifications behind a paywall and terrible tooling.
Lion King Meme — 16:23 — I’m still proud of this. So many dead standards out there, steering Simba and Nala (young startups) down the wrong path.
Sniffling — 17:01 — Not sure if I was crying or something before this presentation. Hearing yourself speak on a recording is always the worst.
Competitive differentiator — 20:26 — It’s easy to pigeonhole standards as burdensome from a regulatory / compliance viewpoint. That’s not wrong, but at each regulatory inflection point, companies have a huge opportunity, too. Regulatory inflection points that include technological requirements are a mass extinction event for vendors, forcing consolidation. We’ve seen this with Meaningful Use; we’ll see it with ONC Cures. So every company should be thinking not only about compliance but about how to take aggressive advantage of the new capabilities.
History of Standards — 32:25 — Another embedded reference to a previous article. Some new memes. I’m not sure why I thought it was funny to date myself a bit or trash the 1970s, which seems from a outsiders’ perspective like a rad decade.
REST and JSON — 47:15- The way certain people talk about APIs and REST and JSON, you’d think they were invented in the 1970s. Hot take — I don’t think healthcare is honestly that laggard. it’s only slow when you compare apples to oranges, looking at proprietary formats like Facebook’s API or Stripe’s API. A better comparison is how fintech is still using prehistoric standards under the hood and their new revolutionary standard is…XML. Or how edtech standards are a disparate contentious mess (also XML).
Even if you do compare apples to oranges, health tech still holds up pretty well. FHIR is a really robust standard, with cutting-edge authentication (Stripe or Plaid have pretty simplistic authentication by comparison) and features that make a developer’s life a heck of a lot easier (as my colleague Nick Hatt explains here) that just don’t exist elsewhere.
Future of integration — 51:12 — If you’re curious how FHIR can be useful for you in the future, this is the section for you. Discussion of FHIR for provider apps, organization-to-organization exchange, and patient-facing applications deserves a deeper dive, so this seems ripe for a longer article to come.
With that, we can call it a wrap and get back to your regularly scheduled programming of long-form health tech commentary with memes.
Shout out again to my doppelganger Colin again for editing.