As we are gathering together for our first ever WGM+, it's exciting to see and feel how our integrated approach to standards development and implementation is becoming part of the fabric of HL7. The interplay of health data policy and interoperability standards are continuing to drive advancements in clinical care, administration, research, and public health around the globe.

Your participation in our shared work here at HL7 ensures that your perspective on the world, your expertise, and your lived experiences are reflected in the interoperability advances that are transforming the health of people everywhere.

Year to date: Standards publications

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In total, we have published (or reaffirmed) 22 specifications so far in 2023. These specifications represent the culmination of consensus building among stakeholders about how they want to address a particular interoperability problem.

Looking closely at this publication summary, a few notable things stand out...

FHIR R5!

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As a community, we celebrate the significant milestone of FHIR Release 5, published. FHIR R5 reflects our collective progress and implementation experience, and represents the monumental effort of the FHIR community.

FHIR R5 contains thousands of incremental updates, corrections, and enhancements that improve the overall quality and capability of the standard.

Although it's impossible to cover all of the enhancements, some of the key ones include:

• Capabilities for topic-based subscriptions are now part of the core specification, enabling proactive event notifications based on data changes in the source system.
• Significant revisions to the Medication Definition resources to better support the needs of manufacturers and regulators and use in drug catalogs and pharmacopoeias.
• More than a dozen new resources defining structures for different types of health-related information. FHIR now defines 157 different resource types.
• New operations are defined for efficiently managing large resources such as Groups and Lists
• Several changes to the specification's infrastructure further enable management of coded terminologies as well as extensions to be managed more appropriately alongside the core FHIR
  specification

Also, because R5 is now the base standard published at hl7.org/fhir, be sure to point out to your friends that there is an easy way to see the R4 (or other prior) version of any page in the spec. Just look for the handy yellow info bar near the top of the page:

A Global FHIR publishing ecosystem

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The other notable trend in this year's publication history was the slight pause from mid-January to February. No, it wasn't a winter sabbatical. We have continued to evolve and improve our publishing infrastructure in support of the global FHIR community.

Behind the scenes we were working to make some significant improvements in the FHIR IG Publisher's file transfer performance, as well as providing additional logging capabilities for debugging purposes. Although this created a bit of temporary queue in our IG publications, we've developed a more reliable approach that improve future performance.

In addition, the FHIR pipeline and infrastructure development team have made a continual set of performance and feature improvements to the IG Publisher, FHIR Validator, and validator.fhir.org.

Our auto-build pipeline is used round-the-clock to publish continuous integration builds of specifications under development by HL7 International, HL7 Affiliates (11 or so of them), and many others. There are now more than 280 implementation guides connected to the auto-build pipeline!

Enabling interoperable exchange of US Core Data for Interoperability (USCDI) content

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With continued financial support from the ONC (#75P00120C00078), we are pleased to share the recent publications of FHIR® US Core IG Release 6.0.0 and the CDA® R2 IG: C-CDA Templates for Clinical Notes STU Companion Guide Release 4. These new releases add support for exchange of USCDI v3 content, and reflect ongoing feedback from the implementation community.

2023 Consensus-making

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Bringing a specification from idea through to publication is a significant accomplishment. And it takes many people playing different roles to make our communal process succeed. The process of seeking, receiving, and incorporating community (and expert, test, and real-world experience based) feedback is the circulatory system of our collective progress.

It takes sustained, ongoing commitment from each of you in the HL7 community to keep this forward momentum.

Here's what 2023 has looked like in terms of the number of resolved issues each day across all of our specifications.

Welcoming New Participants to HL7

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Since 2021, we've had 621 people submit comments on HL7 specifications. How wonderful. I'm particularly pleased to share that for 2023, of the 217 issue submitters so far, about a quarter of those were new.

Fresh new updates to registry.fhir.org

In collaboration with our friends at Firely, we're please to announce a whole set of new updates to the FHIR Package Registry (launching today). Starting off, you'l be treated to a fresh new look and feel that both matches HL7's branding and is mobile responsive!

We've also updated the search capabilities so that you can search both for packages with instances of FHIR resources as well as profiles of particular FHIR resources. For example:

• Find ValueSet instances related to COVID
• Has anyone profiled the Evidence resource already?
• Or, find an example Condition instance about "food insecurity" (shown below 👇)

Then, if you click-through from a resource on this search page, you'll be brought right to that resource in the package. 

And, from here if you want to see all the resources in the package (in this case the SDOHCC IG has 110 resources), just click the clear filters link.

We're excited about these new features and always welcome your feedback on how we can make the FHIR Package Registry better!

Infrastructure Improvements

Earlier this year we welcomed a new web developer, Chad Neale, to the HL7 team. Some of the projects the IT team worked on have come online, including: a re-working of the Ballot Desktop (for some things that glitched with the transition to the Fonteva association management system) and updating the Conference Call Center software to remove outdated ASP.NET code. We also migrated the mailing list server from an on-prem machine to the cloud, which should enable a more reliable infrastructure for this core HL7 service.

More good things coming in 2023

As we look ahead to projects in store for 2023, we're also continuing to press ahead on on our Specification Lifecycle Management project, which is optimizing and redesigning our existing paper and Confluence-based forms into a semi-automated Jira (issue tracking) workflow. The Product Family Management Council is reviewing the design and requirements analysis to help plot the course ahead.

As we turn the page into a new year, it's a delight to look back what our community has accomplished in 2022. From my perspective, three big things stand out:

1. We created an integrated approach to standards development and implementation that has now become part of the routine decision-making and long term strategy for the organization
2. We transformed the re-envisioning recommendations into HL7's 3 Year Plan for strategic action
3. We continued to cultivate a global community that delivered world-class standards to the industry

2022 Standards Development

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In total, we published (or reaffirmed) 64 new specification versions!

2022 Consensus-making

S10

Bringing a specification from idea through to publication is a significant accomplishment. And it takes many people playing different roles to make our communal process succeed. The process of seeking, receiving, and incorporating community (and expert, test, and real-world experience based) feedback is the circulatory system of our collective progress. It takes sustained, ongoing commitment from each of you in the HL7 community to keep this forward momentum.

Here's what 2022 looked like in terms of the number of resolved issues each day across all of our specifications.

Over time, this adds up to steady cumulative progress. In total, we resolved more than 6,100 issues across all of our specifications.

Welcoming New Participants to HL7

S04 S07

Since 2021, we've had 568 people submit comments on HL7 specifications. How wonderful. I'm particularly pleased to share that for 2022 almost half of the issue submitters were new since 2021.

A Global FHIR Publishing Ecosystem

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We have continued to evolve and improve our publishing infrastructure in support of the global FHIR community. With major contributions from Grahame Grieve , Lloyd McKenzie , David Otasek , Josh Mandel and many others, we continue advancing this pipeline to support the community's continuous development of FHIR-based specifications.

Here's an summary of the commit history for 2022 of our core publishing software components:

We've also launched an initial version of a Swagger UI for validator.fhir.org.

Our auto-build pipeline is used round-the-clock to publish continuous integration builds of specifications under development by HL7 International, HL7 Affiliates (10 or so of them), and many others. There are now more than 280 implementation guides connected to the auto-build pipeline.

CDA and C-CDA Web Publishing

Over the last year, a team led by Gay Dolin Jean Duteau  and Brett Marquard have been working hard to build the infrastructure, techniques, and content representation for a publishing C-CDA using FHIR's StructureDefinition and tooling suite to produce a C-CDA replica of the June 2019 errata package. This publication is now out for community review prior to the next ballot of C-CDA (January 2024) which is intended to be produced using the FHIR StructureDefinition (SD) tooling:

http://hl7.org/cda/stds/ccda/draft1/

In addition, there is a first draft of the CDA Version 2.0.1 using the FHIR Type Definition Framework available here:

http://hl7.org/cda/stds/core/draft1/ 

Linking the Global Ecosystem of FHIR Specifications

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fhir.org/guides/stats/

As the ecosystem of published FHIR specifications grows, we want to continue to make it easy to re-use and build on each other's work. We have some great tools like registry.fhir.org to find existing work, but it can be hard to see similarities and differences at the profile level. Grahame Grieve has built some draft tools to help navigate the global ecosystem of FHIR specifications.

This site (fhir.org/guides/stats) organizes (by realm) FHIR specifications, their profiles, dependencies, and similarities/differences.

If you drill down, for example, to look at its page for the IPS profile on Observation for laboratory results, you can see which profiles have it as a target, and which other profiles are based on it.

You can also look at all the profiles, say, on the AllergyIntolerance resource. The table rendering on that page shows which of the 14 profiles have added constraints on which data elements. Pretty cool!

projectlifedashboard.hl7.org

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This project is creating a dashboard for tracking specifications through their lifecycle. With support from the ONC (contract #75P00120C00078), we have developed a prototype dashboard that's now live. It contains an easy to navigate overview of key HL7 specifications that updates as they progress from early drafts to mature standards.

The super exciting part is that underneath the clean design is a modern open source content management system (Wordpress) with API functionality that will serve as the basis for a major hl7.org platform revamp we're planing for the future.

More good things coming in 2023

As we look ahead to projects in store for 2023, there's a lot cooking!

In the near future we'll be migrating the mailing list server from an on-prem machine to the cloud. This transition should be seamless for you, but in the background we'll have a much more reliable infrastructure for this core HL7 service.

Early in 2023 we'll begin work first to patch the Ballot Desktop (for some things that glitched with the transition to the Fonteva association management system) and then to plot its complete redesign. This is being coordinated with our bigger efforts to modernize our main web platform, which is a strategy in HL7's 3 Year Plan.

We'll also pick up again on our Specification Lifecycle Management project, which is optimizing and redesigning our existing paper and Confluence-based forms into a semi-automated Jira (issue tracking) workflow.

Oh, and of course we are eager to work through the community feedback received on the FHIR R5 ballot and bring that to publication.

Thanks for your personal efforts in HL7. Together, we keep striving to cultivate a diverse, equitable, and inclusive community where everyone can experience the deep satisfaction of contributing their unique perspective towards the common goal of interoperability.

It's a real treat to gather for HL7's first in-person Annual Plenary and Working Group Meeting since the start of the COVID-19 pandemic. We see (again) how the true value of HL7 is not the specifications we produce (as lovely as they are), but rather the diverse global collective of people who commit to working together instead of on their own.

As an organization, we recognize our need for a perpetual learning mindset as we transform to meet the evolving interoperability needs of the industry. Here I'll summarize some highlights of how we're continuing to advance standards for interoperability and the ways in which we produce them.

Year to Date: Standards Publications

As we head into Fall, we've now published 40 new specification versions.

Did you know that you can get notified of new HL7 standards publications via an RSS feed from standups.hl7.org?

Year to Date: Consensus Making

Getting to publication is no small feat. It takes significant contributions from project teams, Work Groups, Management Groups, HL7 staff, and others to make that happen. Along the way, the foundation of consensus-driven standards is soliciting and incorporating community feedback. This chart shows the cumulative number of submitted issues that we have resolved since the beginning of the year.

We've now resolved more than 4,440 submitted issues across all of our specifications.

Welcoming New Participants

Since 2021, we've had 535 people submit comments on HL7 specifications. This is wonderful. And I'm particularly pleased that newcomers are participating in the process:

163 new people submitted comments in 2022 that didn't in 2021.

Ballot Cycle

We just wrapped up our typical September ballot cycle, which contained 23 ballot consensus groups. And we've just opened up our late-September cycle which contains the ground-breaking Gender Harmony Project specification HL7 Cross Paradigm Implementation Guide: Sex and Gender Representation, Release 1 , HL7 Version 2.9.1, as well as HL7 FHIR® Release 5. These specifications exemplify the power of HL7's community convening process.

3157 change requests were applied to produce the FHIR R5 Ballot specification! Of those, 1486 were deemed substantive changes.

Working Together Better

As we apply our learning mindset in how we work together, we aim to keep refining our community habits, processes, tools, and roles to produce self-sustaining effectiveness and growth. Here I wanted to mention 2 important recent initiatives.

Goodbye Co-chair Webinars ... hello Technical Steering Committee (TSC) Updates!

For quite some time the TSC has held periodic update sessions for co-chairs in between the cadence of Work Group Meetings. Recognizing that the information and discussion was valuable to others in the HL7 community beyond those serving as co-chairs, the TSC has recently rebranded those sessions as TSC Updates. We welcome everyone to join. Typical topics include updates on tooling, infrastructure, process, and governance things, as well as open discussion on issues of the moment. Invites to future meetings will arrive in your inbox if you're subscribed to our main mailing list. Our inaugural session, held Aug 30, had a good discussion around...👇

Optimizing for Contributor Happiness

Out of the summer HL7 Board of Directors and TSC meeting came an initiative to consider and develop recommendations on how we might continue to improve the quality and process of the current Work Group structure. On the August TSC Update webinar we discussed initial ideas around reducing co-chair burden and the expanding frame of reference: optimizing for contributor happiness. There I've outline what I believe are four key guiding principles:

1. We're all in this together.
2. Eliminate. Automate. Allocate.
3. Rejuvenation, not exasperation.
4. Match the rigor with the readiness.

We welcome your comments on how we might work better together as a community. You'll notice that these ideas tie in directly with a key strategy in HL7's 3 Year Plan: S07 Develop and execute a contributor engagement plan.

Infrastructure and Tooling

Fonteva Association Management System

And as you've heard, HL7 HQ is pushing hard to complete the first phase of our new Association Management Software (AMS) called Fonteva. The AMS system is like the nervous system for running the organization, so this is a significant project that will have tremendous downstream benefits. As noted in our recent email to membership, we will go live on Fonteva before October 31, 2022. Watch your inbox for instructions on updating your password.

Single Sign On

If you're active in the HL7 community, no doubt you've realized that each of our tool platforms (hl7.org, Atlassian, chat.fhir.org, hl7fundamentals.org, etc) has a separate login. This is stinky both for users and for HL7. We're really excited that with support from our cooperative agreement with ONC (#90AX0019/01-06), we've put in place the foundation for single sign on services across these platforms. You'll barely notice it, but when Fonteva goes live in October, the main hl7.org website will authenticate using this new mechanism. Over time, we'll be rolling out this functionality to the other platforms. Stay tuned for more on this in the future.

Reference Implementations

As the HL7 leadership works towards a seamless interplay between standards development and implementation, we believe that open source reference implementation software for HL7 specifications are crucial for world-class standards development. They provide mechanisms for demonstrating implementability, testing various actors in exchange scenarios, and for learning how a standards-compliant service behaves.

In addition to our transitioning of the Logica Sandbox, we are excited about recent developments (also funded by the cooperative agreement #90AX0019/01-06) to advance open source reference implementation software and sample data for testing cohort definitions in OMOP and FHIR (with an initial focus on Digital Quality Measures) and the International Patient Summary. We are pleased to make these available to the community for testing and exploration, and look forward to having them as a component of the emerging FHIR Foundry (HL7 3 Year Plan strategy S03 Create a platform for discovery and testing of our specifications).

Extending our Collaboration with the U.S. Office of the National Coordinator for Health Information Technology (ONC)

From September 2017 to September 2022, HL7 and ONC work together under a cooperative agreement (#90AX0019/01-06) titled Closing the Gap between Standards Development and Implementation - Maturing the Consolidated Clinical Document Architecture (C-CDA) and Fast Healthcare Interoperability Resources (FHIR) Standard. This agreement enabled HL7 to develop key tools and standards development infrastructure that HL7 makes freely available to the public, and also directly contributed to the development of HL7 standards that are now foundational to many interoperability solutions.

We are pleased to announce that ONC has awarded HL7 with a follow-on 5-year cooperative agreement (#90AX0035/01-00) from September 2022 to September 2027, with the same aim: Closing the Gap between Standards Development and Implementation - Maturing the Consolidated Clinical Document Architecture (C-CDA) and Fast Healthcare Interoperability Resources (FHIR) Standard. Under this agreement, HL7 and ONC will work together to enhance the infrastructure and processes for standards development and implementation that help improve the implementation consistency and readiness of current and new versions of HL7 standards. Accomplishing these objectives will advance interoperable health IT and better position HL7 to support the continued evolution of the health ecosystem’s needs.