Architecture of Participation in Healthcare

In general, I have a lot of positive things to say about HL7 FHIR, an emerging healthcare standard with deep roots in both Web-oriented Architecture (WOA) and the HL7 Reference Information Model (RIM). Along with a focus on REST, URLs, granularity and so forth, one idea that typifies WOA is a term coined by Tim O'Reilly back in 2004, the Architecture of Participation, in which he describes the participatory nature of the Worldwide Web, which was successful because it expanded participation in technology and information sharing far beyond the insular community of software developers. It worked because participation was expanded to include anyone. And this is important because without participation, there can be no success.

You may ask, can you apply this principle of Architecture of Participation to Healthcare? Good question, and I think this is where the "a-ha" moment comes in, and why when people start to think about HL7 FHIR, they kick themselves and say "well, it's about time," because the fact is, the Architecture of Participation is built right into the RIM: first day on the job with  HL7, someone hands you a primer and explains that it's very simple, the RIM describes Entities in Roles Participating in Acts.  These are the RIM base classes, and it's right there in the centre: Participation. HL7 describes clinical workflow, and workflow is performance. It is Entities and it is Acts, and the associations between these are mediated by Roles.

And there in the middle is Architecture of Participation.

View Source. Blue Button. Ten years' worth of knowledge in the RIM. Which is why I am excited for the next ten years.