Episode 13 - Bill Lakenan & Benji Graham

Guests: Bill Lakenan & Benji Graham – FHIR evangelists & innovators at Bellese

Where We’re At

* CQL maturity: Finally stable enough to calculate without different engines giving different answers. But DEQM (Data Exchange for Quality Measurement) is still a labyrinth powerful, but too flexible and waiting for industry alignment.

* QI Core vs reality: Full QI Core adoption is a fantasy today. The pragmatic move is USCDI+ Quality subsets stop boiling the ocean, start with buckets.

* NCQA & CMS pressure: Both are turning the screws. NCQA’s push for FHIR-only HEDIS reporting and CMS’s signals on hospital quality programs mean “claims-only” days are numbered.

The Payer/Provider Dilemma

Legacy organizations face two doors:

* Stand up a FHIR-native system

* Slap a FHIR façade on legacy infrastructure

The advice: don’t wait. Off-the-shelf solutions exist, but the hurdle is domain expertise and data quality. Bad data = garbage measures. As Gene put it, we’re “building a new house while still living in the old one” but you still have to start building.

Holy Grail Moments Ahead

Two tipping points will define the dQM journey:

* When digital quality becomes cheaper and easier than today’s bloated admin burden.

* When FHIR measures double as care gap alerts in real time. Imagine a doctor getting an instant ping “you’re overdue for a colonoscopy” instead of an end-of-year spreadsheet.

And let’s not forget the patient. Today’s care gap lists never reach them. The new paradigm? Agents, APIs, and FHIR empowering patients to close their own gaps.

FHIR + AI = Frenemies or Besties?

* Bill’s take: AI won’t kill standards it’ll sharpen them. Use LLMs to craft better, transparent measures.

* Benji’s take: AI + FHIR are a perfect match. FHIR’s granular, graph-like structure is exactly what agents and LLMs love. The future is FHIR-fueled AI workflows, not black-box medicine.

Industry Spice

* TEFCA & endpoint discovery: The dream is making FHIR directories “as trivial as Google Maps.” Until then, duplicative tests will keep costing patients pain and payers billions.

* Gene’s personal mic drop: waiting two weeks for a CD-ROM of med records in 2025. That’s why interoperability still sucks.

Final Notes

* Benji is launching a FHIR for Business Analysts course this fall finally, something for the non-technical crowd.

* Bill continues running DMV “FHIRside dinners” and teaching internal FHIR courses.

* And the trio is hyped for the Pittsburgh Connectathon, where theory meets war stories in real time.