🎙️ Out of the FHIR Podcast: Part 2 with Joshua Kelly – Highlights
🚀 What’s Joshua Excited About?
Payer-to-Payer Exchange
A pivotal shift enabling payers to consume data—not just expose APIs—transforming how charts are transferred and reducing manual burden. Huge potential impact on chart chase inefficiencies and member onboarding.FHIR-Specific AI Model Evaluations (FIRE Evals)
Joshua outlines Flexpa's work on evaluating LLMs for FHIR tasks like:Extracting structured data from FHIR resources
Generating FHIR bundles from text
Using reinforcement learning with verified rewards (not RLHF) to improve smaller, private models that outperform general LLMs in FHIR use cases
FHIR
validateoperation as a reward signal in reinforcement learning, opening the door for better automated resource generation.
💡 Underrated Innovations
Smart Health Cards & Links
Joshua sees these as massively underutilized. He envisions paper-based lab results with QR codes enabling seamless data transport—a simple but transformative workflow for patients and providers.Patient “Sneaker Net” as an Interop Hack
Patients as the natural transport layer—bringing their own data (e.g., via QR codes or printed links) could rival national HIE efforts in utility.ChatGPT for Patient Insight
Real-world use: Eugene shares how he used GPT to interpret his child’s lab results. This is already happening—users are moving ahead of systems.
🏦 Financial Interop Lessons for Healthcare
OAuth Success
Healthcare learned from fintech, starting with OAuth, unlike fintech’s slow rollout.Why Plaid’s Model Doesn’t Fully Translate
Fewer, more cohesive accounts in finance (e.g., Amex, Chase)
Healthcare data is fragmented across insurers, providers, labs, often with confusing branding (e.g., the "Blue Cross problem")
The Real Challenge? Data Locator Confusion
Even insiders can’t always identify where data lives. This limits the utility of personal health apps or wallets—too niche for mass adoption.
🔧 Tech That Needs More Love
SQL-on-FHIR
Joshua ranks this as his #2 underrated tech (after Smart Health Cards). While not truly “SQL,” it simplifies FHIR's nested structures into tabular formats—crucial when working with bulk FHIR data.Flexpa’s Open Resources
https://my.flexpa.com
: Free tool to access your health plan data
Flexpa's Payer Directory: Public directory of payer APIs, location access endpoints, etc.
🔚 Final Thoughts
The promise of interoperability is not just connectivity—it’s actionable insight, better care, and easier access.
More orgs should share implementation experiences like Flexpa does to reduce duplication across the FHIR ecosystem.
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