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How Do We Balance Improved Outcomes with Protecting Personal Information?

Posted on July 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s an interesting article by the Pacific Standard (never heard of them before now) about the “hidden market” of medical data that exists. The final paragraph provides a great summary of the challenges we face when it comes to health data:

There is no perfect way to balance the competing priorities of using big data for improved health outcomes and protecting our personal information. Opinions on which interests should come first will differ—and should. But the debate cannot be open, honest, or effective if major companies like Walgreens or Safeway are secretive about what they do. People are often generous when it comes to volunteering personal data for the purpose of advancing medicine. They are less so when it comes to enriching sellers of information. Either way, the proper course of action is disclosure. Simply put, if our medical data is being bought and sold, we deserve to know it—and have a say. Perhaps making our data available to others is as helpful to medicine as IMS claims. But shouldn’t that be up to us?

That’s the best summary of balancing improved outcomes and personal information that I’ve ever read. We all want better outcomes and I think that most of us believe that the right healthcare data will get us to better outcomes. We also all want our data to be protected from people who will use it inappropriately. The balance between the two competing priorities will never be perfect.

The reality is that there’s going to be more and more healthcare data available about all of us. Much of that data is going to be shared with a large number of organizations. Most people are just fine with that sharing assuming they believe the sharing will help them receive better care. However, there does need to be some mechanism of transparency and disclosure about when and how data is used. That doesn’t happen today, but it should happen.

The challenge is that pandora’s already out of the box. The data is already flowing a lot of places and putting in accountability now will be a real challenge. Not that I’m against challenging things, but we’re kidding ourselves if we think that accountability and transparency around where and when are data is shared is going to be easy to accomplish. First, companies are going to be dragged kicking and screaming to make it happen. Some because they know they’re doing some things that are at least in the grey area and some are totally shady. Others aren’t doing anything inappropriate, but they realize the costs to implement transparency and accountability for the health data they share is going to be very high. A high cost project that doesn’t add any more revenue is a hard business proposition.

While I’m not hopeful that we’ll see a widespread transparency about what health data’s being shared where, I do think that some forward thinking healthcare companies could push this agenda forward. It will likely happen with some of the companies who have avoided the grey and shady areas of health data sharing that want to create a competitive advantage over their competitors and build trust with their users. Then, some others will follow along.

What do you think that could be done to make health data sharing that’s happening today more transparent?

Healthcare Standard Proliferation Comic

Posted on July 24, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday and I’m in Utah where today is a state holiday (think a second July 4th party). What does all that mean? It’s time for another Fun Friday post. I thought this comic that Dan Munro shared would be perfect:

I think the only modification we need is to have it say “See: Healthcare.” If you want to make this educational, the comic does point out some other places we could look to see where standard proliferation has been a problem. Or you could just enjoy the humor and head for the weekend. Either way, Happy Friday!

Eyes Wide Shut – Making the Most of Meaningful Use, for Healthcare Providers, Insurers, and Patients

Posted on July 21, 2015 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

When I ask a room of 100 health plan leaders, “how many of you know what HL7 is,” and only a third raise their hands, I realize there had been a “Meaningful Use” for my recent travels through the healthcare provider system and its maze of regulatory and payer mandates. I navigated change management hell in order to inform my future endeavors. I came out on the other side of an attestation nightmare with the knowledge to educate others who are embarking on extensions of that journey. This “Eyes Wide Shut” series has come full-circle.

For those who have followed this series, a quick update on the fate of the IDN highlighted throughout earlier posts: they have not yet successfully attested to all Meaningful Use Stage 2 measures across all the inpatient facilities and ambulatory practices. However, the continuing changes to attestation criteria (specifically, the engagement measures that caused so much consternation) may allow them to squeak in under the wire in fiscal year 2016 before penalties kick in. Although I’m no longer directly involved in the IDN’s pursuit of multi-EMR integration excellence, I am a “beneficiary” of those encounter data normalization efforts, as I am back to working with payer clients who are leveraging this clinically-integrated network. And I’m still having to adjust for inconsistencies in identity management rules, coding practices, and clinical workflow differences across each of the offices (and departments within offices), as I integrate their information with the insurer’s data ecosystem.

I began this series on my (woefully neglected) personal blog, almost 2 years ago: Eyes Wide Shut: Seeing the Dark Side of Health IT Mandates and Meaningful Use. Coming from the health insurance world, I had no idea of the magnitude of healthcare provider process impacts resulting from regulatory and payer demands (nee, mandates). I was insensitive to the plight of the independent general practitioner, and the size of the budget required to implement a certified EMR, let alone populate it with any patient history or integrate it with existing scheduling or billing processes. I didn’t realize that my request for chart data to support HEDIS measures would involve more work than simply clicking an indicator in an EMR configuration screen to suddenly send me my heart’s desire of data elements. I would never have believed that certified software would not be tested for conformance to code-level specifications (only visual output tests).

To all my clinician and provider office-worker friends: I am sorry for all the ways in which this ignorance may have contributed to the new reality forced on practitioners of medicine to also be data-entry clerks/contract lawyers/IT experts. Personally, I want my doctor to be my doctor. So, I’m dedicating the next leg of my career journey aligning all healthcare system actors to what should always have been our higher purpose: contributing positively to the health and well-being of the individuals and populations we serve.

When I initially began writing this post, I thought I’d be using it to end the series.

Instead, I’m just embarking on a new chapter: the post-provider world of healthcare actor convergence.

FHIR Optimism – Is It Misplaced?

Posted on July 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’ve all seen the optimism around FHIR. I even wrote the cheeky post titled FHIR is on Fire. I think that observation is still accurate. If you mention the word FHIR, then people start listening. I saw a number of sessions at HIMSS on FHIR and there was a lot of interest. I actually think that many people were (and are) still trying to figure out how FHIR is different from all the previous HL7 versions, but there was a definite interest in learning about it.

Admittedly, I’m still working to understand FHIR as well. However, in all the learning I’ve done, FHIR feels like more of the same. Certainly it’s a step forward from previous HL7 iterations. I think that it has much more robust capabilities. There is a lot to like about FHIR and I don’t want to thwart people’s efforts to bring it to light.

As I’ve thought about this more though, I don’t think FHIR is the coming of interoperability. Here’s what I asked in today’s #KareoChat:

I think most would agree that the reason we don’t have healthcare data interoperability yet has almost nothing to do with the technology. It has everything to do with political and economic reasons why healthcare organizations didn’t (and many still don’t) want to share data. I’m quite sure that if there was a political and financial reason to share data it would happen very quickly.

Assuming you agree with this premise, why then do we think that a new tech standard (FHIR in this case) will change those dynamics? Will FHIR be so plug and play obvious that healthcare executives will start being embarrassed for not sharing data when it’s so easy? My past experience with healthcare standards say that won’t be the case. FHIR will be a technical improvement over what we have today, but still will require a lot of effort.

I’d love to be proven wrong on this. Do you have a different view? I’d love to learn in the comments.

Starting with Small and Simple Changes

Posted on June 26, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I had the chance to talk with Dr. Adam Sharp, CMO of par8o. While I’d followed at a very high level Dr. Sharp and Dr. Daniel Palestrant’s move from Founding Sermo to the launch of par8o, this was the first time I’d had a chance to really learn what they were doing in their new venture. I’d say that par8o’s core product now is managing the referral process, but they’ve built referral management on a platform that could facilitate all sorts of communication and data sharing across many parts of healthcare.

I love the way they’re approaching healthcare IT because I’ve long believed that many healthcare IT companies are trying to bite off more than they can chew. Many healthcare IT companies have really big visions of how they’re going to solve healthcare’s problems (of which there are many). They raise a bunch of money to go after those problems and then they never really solve anything. In most cases, the healthcare establishment kicks against such massive changes and so it makes it almost impossible for a health IT company to sell such a massive solution.

One reality of life is that we all hate change. This is true even when we know that change is the right thing to do. So, it shouldn’t be any wonder when a healthcare IT company comes in and wants to massively change what we’re doing that they find resistance. I consider that a failed strategy that I’ve seen far too many healthcare IT startup companies employ.

What I heard from par8o is that they’ve taken the opposite approach. They’re focused on a small change that can provide value to a healthcare organization. In this case it’s referral management. When you hear what they’re doing to make the round trip referral and response process electronic, you ask yourself why we haven’t been using technology to do this forever.

I’ve seen over and over again in healthcare IT that these small, simple and almost obvious solutions often make the biggest impact. They make a big impact because healthcare organizations actually adopt them. Dr. Sharp told me that even the small changes they’re introducing often meet resistance from their users. They have to invest a lot of time and effort to overcome that resistance. If even small changes are resisted, you can imagine why massive changes to an organization’s process are flat out refused.

What’s most interesting about this approach is that by successfully implementing these small changes, it opens the door for a company to eventually help a healthcare organization make much larger changes. I’ve often asked healthcare IT companies, what’s your gateway drug? (ie. What feature of your product do they really want to buy that gets them started with you?). Once you get them hooked on a specific feature, then you have the relationship and trust built to be able to offer broader changes.

It seems like par8o has taken the right approach to building trust in and providing value to their customers in referral management. I’ll be interested to watch how they leverage that trust and their healthcare communication and data sharing platform (they call it a healthcare operating system) to optimize other healthcare processes. In a fee for service world many healthcare organizations profited from a lack of optimization. In a new value based care world those optimizations are going to become extremely important.

Knotty Problems Surround Substance Abuse Data Sharing via EMRs

Posted on May 27, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As I see it, rules giving mental health and substance abuse data extra protection are critical. Maybe someday, there will be little enough stigma around these illnesses that special privacy precautions aren’t necessary, but that day is far in the future.

That’s why a new bill filed by Reps. Tim Murphy (R-PA.) and Paul Tonko (D-N.Y.), aimed at simplifying sharing of substance misuse data between EMRs, deserves a close look by those of us who track EMR data privacy. Tonko and Murphy propose to loosen federal rules on such data sharing  such that a single filled-out consent form from a patient would allow data sharing throughout a hospital or health system.

As things currently stand, federal law requires that in the majority of cases, federally-assisted substance abuse programs are barred from sharing personally-identifiable patient information with other entities if the programs don’t have a disclosure consent. What’s more, each other entity must itself obtain another consent from a patient before the data gets shared again.

At a recent hearing on the 21st Century Cures Act, Rep. Tonko argued that the federal requirements, which became law before EMRs were in wide use, were making it more difficult for individuals fighting a substance abuse problem to get the coordinated care that they needed.  While they might have been effective privacy protections at one point, today the need for patients to repeatedly approve data sharing merely interferes with the providers’ ability to offer value-based care, he suggested. (It’s hard to argue that it can’t be too great for ACOs to hit such walls.)

Clearly, Tonko’s goals can be met in some form.  In fact, other areas of the clinical world are making great progress in sharing mental health data while avoiding data privacy entanglements. For example, a couple of months ago the National Institute of Mental Health announced that its NIMH Limited Datasets project, including data from 23 large NIMH-supported clinical trials, just sent out its 300th dataset.

Rather than offer broader access to data and protect individual identifiers stringently, the datasets contain private human study participant information but are shared only with qualified researchers. Those researchers must win approval for a Data Use Certification agreement which specifies how the data may be used, including what data confidentiality and security measures must be taken.

Of course, practicing clinicians don’t have time to get special approval to see the data for every patient they treat, so this NIMH model doesn’t resolve the issues hospitals and providers face in providing coordinated substance abuse care on the fly.

But until a more flexible system is put in place, perhaps some middle ground exists in which clinicians outside of the originating institution can grant temporary, role-based “passes” offering limited use to patient-identifiable substance abuse data. That is something EMRs should be well equipped to support. And if they’re not, this would be a great time to ask why!

What’s the Story on 21st Century Cures Legislation?

Posted on May 21, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I just saw that the 21st Century Cures legislation passed the house committee process. Word on the street is that Congress probably won’t take this up even if the house passes it this summer. The legislation looks pretty interesting for those of us in healthcare IT. Blair Childs, Premier’s senior vice president of public affairs, offered the following statement on the legislation:

Members of Premier wish to thank House Energy and Commerce Chairman Fred Upton (R-MI) and Representative Diana Degette (D-CO) for their leadership to advance interoperability standards as part of the landmark 21st Century Cures legislation. With today’s vote, the vision for a fully interoperable health information technology ecosystem is one step closer to becoming a reality.

We also wish to thank Committee members Joe Pitts (R-PA), Frank Pallone (D-NJ), Gene Green (D- TX), Michael Burgess (R-TX) and Doris Matsui (D-CA) for their support of interoperability standards in the legislation, and for their efforts to ensure that the technology systems of the future will be built using open source codes that enable applications to seamlessly exchange data/information across disparate systems in healthcare.

Today’s vote is an essential step to optimize HIT investments, improve the quality of care across settings and avoid the cost burdens associated with the work around solutions that are needed today for systems to “talk” to one another. We strongly urge the full House of Representatives to support these interoperability standards and to vote in favor of moving the legislation forward as it stands today.

Many of the comments he offers about ensuring interoperability is open source and support for standards of healthcare interoperability are great things. Although, as I think we learned with the meaningful use regulations, the devil is in the details and the 21st Centure Cures legislation is not simple. I’d love to hear from people who are following the legislation. Is this a good piece of legislation? Should it be passed? Are their hidden land mines? What are the unknowns or uncertain outcomes of the legislation?

When I saw this legislation hit my email inbox it has me asking how people keep up with legislation. Not to mention, what’s the process for creating this legislation? Just thinking of the process makes me tired and overwhelmed. Is it any wonder that lobbyists are so powerful? It really takes someone whose full time job it is to track and influence legislation to really get something done. The process and legislation is so complex that a casual follower just can’t keep up. I think that’s really unfortunate. I’m not sure the solution though either.

Will We Be Maintaining Our Genomic Health Record?

Posted on May 4, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’re interested in Genomic Medicine like I am, be sure to check out my article on EMR and EHR called “When Will Genomic Medicine Become As Common As Antibiotics?” That’s a really interesting question that’s worth considering. We’re not there yet and won’t get there for a couple years. However, I think that genomic medicine will become as common as antibiotics and will have a massive impact on healthcare the way antibiotics have as well.

The article mentioned links to a genomics whitepaper that talks about a person’s genomic health record. I’d never heard the term before, but I’m definitely intrigued by the idea of everyone having their own genomic health record.

We’ve talked forever about people having a personal health record which they need to collect and maintain. Some people store it in a PHR on the web and others store it on a mobile phone. However, we’ve never really seen the personal health record take off. This is true for a number of reasons. The first is that it’s still quite difficult to aggregate your entire health record across multiple providers. I even read of one PHR that was paying doctors to provide them a patient’s record. The second problem is that patients don’t know what to do with all the records once they have them. Even if they go to their doctor and say they have their full patient record, the doctor hands them a stack of health history forms to fill out. Best case, they file a copy of the patients records in the chart (usually in some sort of PDF or paper copy).

Now let’s think about those challenges from the perspective of a genomic health record. If you’ve paid thousands of dollars for genomic tests and analysis, are you going to want to pay that again to the next doctor you see? No, they’re going to ask you for your copy of their genomic record and use that as part of your care. Patients won’t want to pay for another genomic test and it will be easier to get their record, so they’ll be more motivated to get and maintain it than they were with a simple personal health record. It’s pretty compelling to consider.

Some challenges and questions I have about how this will evolve. Will your PHR start to include your genomic health record or will it be something that’s stored separately? Will their be a standard for the genomic health record so that the doctor can easily use that record in the work they’re doing? Will the genomic health record be so large that it will have to be stored in the cloud?

What do you think of the concept of a genomic health record?

Telemedicine Startup Offers Providers A Shot At Equity

Posted on April 22, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Over the last couple of years, the number of telemedicine vendors out there fighting for business has exploded.  These include DoctoronDemand, GoTelecare, HealthTap, MDLIVE, American Well and many, many more.

Health plans are jumping on the bandwagon too. For example, United Healthcare  has been running a popular national television campaign advertising its “virtual clinic” services. UHC is my plan, so I can attest that this service — shown as embedded in its member site — hasn’t been rolled out yet, but that only makes its desire to get out in front of the trend more noteworthy.

Telemedicine models in play include companies that recruit providers and sell them to consumers, vendors who enable telemedicine via proprietary platforms and firms that lead with community building. At present the direct-to-consumer players seem to be somewhat ahead, simply because they’ve already begun developing a national brand, but the story doesn’t end there.

Though consumer-facing telemedicine companies probably have a viable business model, they’ll have to build a memorable consumer brand to make it, something that takes a great deal of  time and money.  On the other hand, vendors that offer white-label telemedicine technology to hospitals and health plans have at least as much to gain, without having to win the loyalty of fickle consumers.

One telemedicine player doing just that is Nashville-based PointNurse, which has developed a distributed collaboration and communications platform providers can use to deliver telemedicine services. I just spoke to CEO Cyrus Maaghul, who gave me a company overview, and was interested to hear that his venture is taking things in some new directions.

PointNurse is different than most companies in the telemedicine space for a few reasons.

For one thing, the platform includes block chain capabilities, which allow providers to accumulate credits for both community participation and actual care delivery. (In case you aren’t familiar with block chain technology, which powers crypto currency Bitcoin, you may want to click here.)

These credits aren’t just for fun. Eventually, when providers accumulate enough credits, they get a pro-rata share of a dedicated pool of equity.

Consumers, for their part, are given a multi-signature wallet which stores both their personal and clinical information, resulting more or less in a PHR with added capabilities. PointNurse hasn’t yet devised a way to share the data with provider EMRs, but that’s a short-term goal.

A wide range of providers can participate in PointNurse, including not only MDs but also nurse practitioners, pharmacists, RNs, LPNs and elder advocates.

A sister venture, HealthCombix, will license the technology underlying PointNurse to hospitals and payers. HealthCombix will provide APIs and tools to build their own distributed applications.

As Maaghul sees it, it’s critical for providers to realize more than a short-term benefit from participating in telemedicine. “I wanted to make providers feel highly motivated — that they can gain from this [arrangement],” Maaghul said. “This creates value for the patient.”

Of course, there’s no proof yet that this or any particular telemedicine business model is going to capture its market niche.  In fact, it’s not even clear what niches will emerge in this space; after all, though it’s moving fast it’s far from mature.

That being said, this approach has some intriguing aspects. I’ll be interested to see whether its business model and and unusual underlying technology work out.

Some High Level Perspectives on FHIR

Posted on April 20, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Before HIMSS, I posted about my work to understand FHIR. There’s some great information in that post as I progress in my understanding of FHIR, how it’s different than other standards, where it’s at in its evolution, and whether FHIR is going to really change healthcare or not. What’s clear to me is that many are on board with FHIR and we’ll hear a lot more about it in the future. Many at HIMSS were trying to figure it out like me.

What isn’t as clear to me is whether FHIR is really all that better. Based on many of my discussions, FHIR really feels like the next iteration of what we’ve been doing forever. Sure, the foundation is more flexible and is a better standard than what we’ve had with CCDA and any version of HL7. However, I feel like it’s still just an evolution of the same.

I’m working on a future post that will look at the data for each of the healthcare standards and how they’ve evolved. I’m hopeful that it will illustrate well how the data has (or has not) evolved over time. More on that to come in the future.

One vendor even touted how their FHIR expert has been working on these standards for decades (I can’t remember the exact number of years). While I think there’s tremendous value that comes from experience with past standards, it also has me asking the question of why we think we’ll get different results when we have more or less the same people working on these new standards.

My guess is that they’d argue that they’ve learned a lot from the past standards that they can incorporate or avoid in the new standards. I don’t think these experienced people should be left out of the process because their background and knowledge of history can really help. However, if there isn’t some added outside perspective, then how can we expect to get anything more than what we’ve been getting forever (and we all know what we’ve gotten to date has been disappointing).

Needless to say, while the industry is extremely interested in FHIR, my take coming out of HIMSS is much more skeptical that FHIR will really move the industry forward the way people are describing. Will it be better than what we have today? I think it could be, but that’s not really a high bar. Will FHIR really helps us achieve healthcare interoperability nirvana? It seems to me that it’s really not designed to push that agenda forward.

What do you think of FHIR? Am I missing something important about FHIR and it’s potential to transform healthcare? Do you agree with the assessment that FHIR very well could be more of the same limited thinking on healthcare data exchange? I look forward to continue my learning about FHIR in the comments.