A Focus on Standards – Medtech’s ALEX is on FHIR

ALEX (Application Layer EXchange) is Medtech’s solution to interoperability. While it was partly introduced to address security and performance issues caused by third-parties connecting directly to databases in medical practices, ALEX’s primary purpose is to foster innovation around the important data sharing and capability for primary care systems.

Why choose FHIR as a standard?  

Ken Olsen said, “The nicest thing about standards is there are so many of them to choose from”. That’s true for the New Zealand healthcare sector.

Ministry of Health’s 2012 Reference Architecture for Interoperability focussed on IHE/XDS, with OpenEHR also considered. There were experiments with CDA, whilst HL7 V2 was unsuitable for the rich, robust, real-time behaviours consumers now expect.

Why were these interoperability options found wanting? What made FHIR so compelling? Why has FHIR been embraced and taken up universally?

FHIR is a practical and simple standard

For example, FHIR employs an 80/20 principle for the inclusion of data elements. Data is included in a resource if it is available in 80% of interoperating systems. Instead of becoming encumbered with extraneous attributes, the data model can be extended to include new elements.

Furthermore, FHIR follows the structures and conventions of modern, API-driven software development. Medtech were able to collaborate and outsource to organisations who lack healthcare experience, but still had no problem understanding and embracing FHIR.


Where systems need to exchange data outside the 80/20 principle, FHIR has built-in mechanisms that allow for extension, and resources that allow consumers of FHIR APIs to discover those extensions.

ALEX can present data that is particular to Medtech but of interest to partners and FHIR extensibility supports New Zealand-specific localisations like Enrolment status. Further extensions will satisfy future innovation.

FHIR is entirely open-source

Anyone can use FHIR. There is no requirement to belong to HL7.org (although all organisations should) or pay a license. There is no arduous and time-consuming compliance process.

HL7 themselves offer a wealth of free information, code, and tools. A huge community of skilled, international contributors provide even more.

The FHIR community has directly assisted with extensions for ALEX. Local experts obtained advice from international authorities. This process helped us adopt the “International Patient Summary” (or IPS) and from that, extend as required.

We used Microsoft’s open-source FHIR service on Azure. Our Odin NeXT middleware engine incorporates the open-source HAPI libraries. We have also used other open-source tools for auto-documenting and testing.

FHIR is being used everywhere by everyone

Interoperability standards and technology often create a chicken-and-egg situation. No-one wants to embrace an interoperability standard until everyone embraces it. The openness of FHIR meant the cost of the jump was small – so everyone got involved in FHIR.

For ALEX this means we can engage with new third-party offerings easily, whether they are local or international. Vendors in international markets will be ready to hook into FHIR.

For other PMS vendors – essentially competitors – ALEX provides an interface that’s recognised by their partners and doesn’t lock them into anything proprietary to Medtech.

FHIR enables a rich future for interoperability in health and for ALEX it means new features, new partners, new markets, new capabilities, and whole new paradigms.

For more information on ALEX please contact Medtech Global at:



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