Gender Participation in the #FHIR Community

May 17, 2019

This is post #3 in my series about why to participate in the FHIR standards process. A few weeks ago, I attended the AIIA awards night at the kind invitation of the eHealth team from CSIRO. One of the speakers was the Victorian Minister for Small Business, the Hon Philip Dalidakis. The presentation was the day after the sad passing away of another Victorian minister, Fiona Richardson, and in her memory, he made an inspired plea for us all to actively consider whether there’s anything that we can or should do to improve the gender imbalance that’s typical in IT.

HL7 - and the FHIR community - does have the gender imbalance that’s characteristic of IT communities - though it’s also a health community, and so the gender divide is not as stark as it is in some communities. But it’s not anywhere close to 50:50, and his words made me wonder whether we/I are in a position to do anything more about that. After the presentation, I spoke to Minister Dalidakis about what levers we might have in an open standards community to encourage more balanced participation - they’re different to those you can/should use in a commercial setting.  He graciously gave me several pieces of advice, and since then I’ve been discussing this with the FHIR team, and particularly with our female leaders in the community.

FHIR and HL7 are great communities to be involved with, and that’s particularly true if you’re a woman - that’s what our female leaders tell me.

They say this is because:

  • We have a strong governance model that is good at managing contention (we have a fair bit of it to manage!)
  • Everyone is treated equally, and mostly treated well (theissues mentioned here are gender neutral)
  • Our discussions are thoughtful and respectful
  • The healthcare vertical is inherently non-confrontational, non-violent

And FHIR is a great place to contribute. Paula Braun says:

Many of the important indicators about our health…e.g., blood pressure, abnormal lab results, etc…are invisible to us. Without access to this data, we and the professionals we entrust to take care of us, are operating in the dark. The older, outdated ways of accessing and exchanging health information have an “I know better than you” feel to them. It was the equivalent of somebody saying, “Hey there girl, don’t worry your pretty little head about how this all works. It’s much too complicated for you.” FHIR is different. FHIR is a community where motivated people self-select to un-break healthcare…at least the IT part of healthcare. I don’t consider myself a “techie” but I choose to participate in the FHIR community because of the possibilities that FHIR enables, the professionalism that is maintained, and, most importantly, because its fun to be part of a movement that is transforming the dominant assumptions and expectations about healthcare

Michelle Miller (who is rightfully one of the Health Data Management’s 2016 Most Powerful Women in Health Care IT) says:

I participate in the FHIR community because:

  • Even with my bright pink “First-Time Attendee” ribbon, I quickly learned that my input was valued.
  • HL7 FHIR has a focus on those who adopt and implement the standard specification, such that implementer involvement and input is very much respected and encouraged.
  • After getting energized by the fantastic collaboration that occurred during the HL7 work group meetings, I started attending weekly work group conference calls to continue the discussion
  • I feel strongly that all changes, big and small, help make the FHIR specification that much better for the next implementer or developer to adopt.  Adoption is what makes a specification a standard because without adoption, we haven’t really achieved interoperability
  • I have been so impressed with the knowledge, collaboration and overall friendliness of the HL7 FHIR community. The discussion is always thoughtful and respectful, such that I have high confidence in FHIR’s ability to maximize interoperability. In sum, it is energizing for me to collaborate with such knowledgeable experts on a subject (healthcare) that is so meaningful and impactful (bigger than just me, my job, or even my country).  Despite the diversity in our perspectives (country, vendor, government, technical vs clinical etc.), the FHIR community is genuinely interested in reaching the best conclusion because adoption is what makes a specification a standard and achieves interoperability

Michelle has a full write up about her involvement on the Cerner Blog.

So the FHIR community is a great place for women who want to make a difference to contribute. If you’re thinking about it - we’d love to have you involved; please get in contact with me, or one of:

(though there’s many other valued contributers as well).

Still, there’s plenty we can do to improve:

  • One particularly pertinent issue around gender participation is about time requirements. HL7 is both good and bad here - most participation is remote, and really flexible in terms of hours and location -that’s a big deal. But there’s also face to face meetings that require travel - that can be a real problem, and HL7 has struggled to find a practical solution around remote participation (it’s an inherently hard problem).
  • There’s general agreement that we could do a lot better with regard to welcoming, induction, and initial training procedures - these are actually issues for both genders - so that’s something that we’re going to work on
  • We need to communicate better that the FHIR community is not just engineers and hackers (who lean male) - it’s about health, and clinicians and nurses (and business managers) are just as much implementers with valuable contributions to make. Of course, the FHIR community is comprised of both genders across all these roles
  • Good consultative leadership is hard to find, and we need/want more of that
  • We have good leaders - we need to recognize the ones we have.
  • We could keep an eye on statistics around assignment of administrative duties (“housework”) at HL7 - but we don’t

Note that all these are really about maximizing our human capital. So, we have plenty of potential, but we aren’t really capitalizing on it. Increasingly, we are investing in human capital as our community grows, so watch this space.

Btw, this image from the Madrid meeting shows that we can do better on balance (though, in fact, we are on the whole more balanced than this particular photo):

Contributers recognized for contributions way beyond expectations to getting FHIR R3 published -featuring both Melva and Michelle

p.s. A note about the FHIR and HL7 communities: these are tightly related communities with a good % overlap, but they are also different in nature, processes, and composition, so we had to consider them both.