Key Takeaways from the 2025 IHE North America Plugathon

The 2025 IHE North America Plugathon, held in Toronto from February 5^th to 7^th, was a pivotal event dedicated to advancing healthcare interoperability.

Hosted by Canada Health Infoway in partnership with IHE USA and IHE Canada, and supported by IHE Catalyst, IHE International, HIMSS, and RSNA, the event brought together industry leaders and experts to collaborate on innovative solutions in digital health. Akinox's Interoperability Lead, Erik Uittien, participated in this gathering, contributing to discussions and exploring initiatives that support the future of healthcare interoperability.

In this blog, we explore three key highlights from Erik's participation:

• Collaborative efforts in harmonizing interoperability standards during the working group sessions
• Insights on FHIR from Grahame Grieve's presentation
• An in-depth look at the HALO project and its implications for digital health solutions

Let’s dive into these key learnings and discuss how they will shape our work at Akinox.

Collaborative Efforts in Harmonizing Interoperability Standards

One of the main themes of the Plugathon was the ongoing efforts to harmonize interoperability standards across Canada. Currently, multiple pan-Canadian standardization initiatives utilize different subsets of FHIR resources within various Implementation Guides (IGs). However, conflicts can arise when these standards are tailored for specific use cases. The need for harmonization ensures that conforming to one IG does not restrict the use of another and makes it less painful for vendors to implement.

A prime example of this is the integration of the Care Service Directory (CA:CSD) with the eReferral/eConsult (CA:eReC) framework. The HealthcareService resource plays a crucial role in both contexts—defining available services within CA:CSD and specifying requested services in CA:eReC. By streamlining these standards, interoperability will become more seamless, benefiting healthcare providers and patients alike.

Reflecting on this, Erik Uittien noted:

"Meeting in person with industry leaders from Canada and beyond was an incredible opportunity to witness firsthand the shared passion for improving healthcare quality and efficiency through better health data exchange. Interoperability has made significant strides in recent years, with FHIR becoming a globally recognized standard. However, as we see real-world use cases emerging across different jurisdictions in Canada, it is clear that guidance and harmonization are essential to prevent divergence in specifications."

Future of FHIR: Insights from Grahame Grieve

Grahame Grieve is the architect behind HL7’s Fast Healthcare Interoperability Resources (FHIR), a global standard designed to enable seamless data exchange between electronic health records (EHRs). As FHIR continues to evolve, his presentation shed light on what’s ahead. The long-anticipated FHIR R6 promises greater stability and a more robust set of normative resources. One significant improvement is the incorporation of terminology as part of the release process, addressing challenges faced by implementers.

Some key takeaways from Grieve’s talk include:

• Obligations Backport from R6 to R4: Most implementation guides currently rely on the mustSupport single flag. However, the new Obligations feature enables greater modularity depending on the actor or use case. For example, a client application may require support for fewer elements than a server handling the same FHIR resource. 
• AdditionalBindings: Managing terminology ValueSets has often been a struggle, especially when constraints or variations are needed based on different use cases. AdditionalBindings will introduce more flexibility when using a ValueSet in a specific context, for example, the list of SNOMED CT complications within a specific care setting.

HALO Project: Exploring the Business and Technical Perspectives

One of the most promising initiatives discussed at the Plugathon was the HALO project, which aims to streamline access to interoperable applications for primary and community care providers. Demonstration from British Columbia showcased how easily clinical applications can be enhanced using this framework.
The HALO project:

• Seeks to simplify access to digital tools through interoperable applications that integrate seamlessly into existing clinical systems.
• Utilizes technology that makes it easier for vendors to develop and deploy these tools.
• Supports a broad spectrum of SMART on FHIR applications, ranging from simple calculations and trending analyses to complex clinical workflows populated with FHIR-based patient data.
• Provides a standardized framework for adding SMART on FHIR applications to jurisdictional catalogs.

For Akinox, this aligns perfectly with our vision of launching SMART on FHIR applications that enable providers to access structured data capture (SDC) forms directly within their EMRs. This functionality enhances eReferral and eConsult workflows, improving efficiency and patient care.

Driving the Future of Interoperability in Canada

Participating in the IHE North America Plugathon reaffirmed that our interoperability strategy at Akinox aligns with broader pan-Canadian initiatives. Additionally, we gained valuable insights that will enhance our use of FHIR and terminology concepts both at the local level and within Canada Health Infoway working groups.

By embracing these advancements, we continue to push the boundaries of digital health innovation in Canada, ensuring that our solutions empower healthcare providers and improve patient outcomes. Stay tuned as we implement these learnings to further enhance interoperability in healthcare.

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