Out of the FHIR Podcast - Episode 5 - Joshua Kelly - Part 2

🎙️ Out of the FHIR Podcast: Part 2 with Joshua Kelly – Highlights

🚀 What’s Joshua Excited About?

* Payer-to-Payer ExchangeA 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 validate operation as a reward signal in reinforcement learning, opening the door for better automated resource generation.

💡 Underrated Innovations

* Smart Health Cards & LinksJoshua 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 HackPatients 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 InsightReal-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 SuccessHealthcare 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 ConfusionEven 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-FHIRJoshua 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.