“Everybody should use and implement FHIR the way I do.”
Every couple of weeks someone leaves a comment on one of my posts that hints at the above. They don’t quite say it, but they come close as they lay out in strong and confident terms why their way is the best way and why no one should be thinking about doing things differently.
It’s understandable why people feel this way.
Years of your working life can be spent implementing a detailed FHIR solution in a distinct area of healthcare data — often driven by regional and domain specific regulations. Quite often there IS a “best way” of doing what you’re doing. Sometimes it’s even mandated.
But this “best way” only applies when the use case matches or comes close to matching your own.
Smart-on-FHIR is a great example.
If your solution relies on Smart-on-FHIR for controlling access to individual patient records, it’s easy to see no other way of managing authentication and authorization.
One of the big surprises for me in my recent survey was the response to this question:
Have you implemented Smart-on-FHIR for your FHIR server?
Almost 50% of respondents said no — their solution does NOT implement Smart-on-FHIR.
FHIR discussions around authentication and authorization always circle back to Smart-on-FHIR. It’s the default answer and it often drives technical architects and their teams who are new to FHIR down the wrong rabbit hole — sometimes for months before they realize it’s not the best solution for them.
When the patient is not a user of your solution, Smart-on-FHIR is not always the answer.
System to system, RBAC, element level access control — there are so many reasons why Smart-on-FHIR would NOT be the default choice for access management, and the survey results bear this out.
I’ve been involved with many projects where Smart-on-FHIR was not used at all. In some cases weeks or months of developer time was lost trying to make it fit because the team thought they had to. They thought it was “the only way.”
There is no “one size fits all” with FHIR, no matter how passionate and articulate the person saying so is.
Every solution is different. Every use case is different.
[Metadata about the survey and the list of questions is here.]
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