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The strawman version of FHIR was developed outside of HL7, and its copyright was Grahame Grieves's. Grahame was willing to bring it to HL7 if HL7 promised to do something it hadn't done before, which is to make it freely available. His motivation for this requirement was two fold:

• a practical driver: FHIR introduced something that is radically new, in a very established insular community, that had poored a lot of money into existing solutions. In order to prevent entrenched interests from blocking FHIR, adoption outside of the traditional HL7 community was necessary, which meant it has to be free for non members.
• an ethical driver: health information should be free, and it can't be free if the standards by which its made available aren't free.

FHIR was initially published with an ad-hoc open license that was copied from somewhere and an agreement was reached with HL7 that FHIR would be free for non HL7 members up to the first normative version. The license that was used wasn't really a perfect license, and after consultation with a copyright lawyer HL7 ended up going for a creative commons 0 (CC-0) license, which means FHIR was placed into the public domain. Once something is published with a CC-0 license, then it can never be withdrawn.

The open source license challenged the business model of HL7 and caused HL7 to reflect on its value proposition. The introduction of a CC-0 standard to HL7 caused it to radically overhaul its business model (generating revenue from the sale of standards), and caused other standards bodies to reconsider their licensing as well.

The cc-0 license has worked out well and helped to re-establish the value of HL7 as a community-of-implementers. During its initial years HL7 was comprised of real-world HL7 version 2 implementers, but somehow that focus was lost in the drive to create ever more complex standards (notably HL7 version 3).

-Rene

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Index of columns:

• EHDS Governance Models (May 06, 2026)
• Get ready for EHDS implementation - EHDS-on-FHIR training course (Apr 10, 2026)
• EHDS will have an impact well before 2029 (Feb 13, 2026)
• EHDS checklist for application vendors and provider organizations (Nov 11, 2025)
• New EHDS-on-FHIR training course (Oct 26, 2025)
• Gender Identity in Interoperability Standards (Aug 25, 2025)
• FHIR and Narrative content (Jun 11, 2025)
• 6 Rules for Successful Interoperability Projects (Feb 13, 2025)
• Deploying FHIR at Scale (Dec 18, 2024)
• 9 Key Problems When Connecting to 400+ Servers (Sep 25, 2024)
• FHIR for HL7v2 experts (Aug 18, 2023)
• The FHIR open license (Feb 18, 2022)
• Bye bye IHE XDS and CDA. (Sep 01, 2021)
• Combining the best of IHE XDS with HL7 FHIR (Jun 27, 2019)
• FHIR DevDays and the year in review (Dec 27, 2018)
• Creation and Curation of FHIR Profiles - process and governance (Dec 14, 2017)
• Impact of the GDPR on the use of interoperability standards (Jun 27, 2017)
• Next XDS Release (Oct 27, 2016)
• Five years of FHIR (Aug 11, 2016)
• Update from the trenches on CDA R2.1/R3 and HL7v2. (Oct 15, 2015)
• Most often implemented IHE Profiles (Jun 08, 2015)
• Mapping HL7v2 messages to FHIR. (Apr 13, 2015)
• Recent and Future developments of the DICOM standard (Mar 06, 2014)
• Documenting the history of HL7 (Sep 03, 2013)
• Interoperability Standards - the no-sales pitch (Jul 09, 2013)
• CDA Implementation Guides - (not) invented here (Apr 17, 2013)
• Usage of IHE Profiles (Feb 25, 2013)
• 10 year anniversary - Dutch Ringholm HL7 v2 training courses. (Feb 19, 2013)
• HL7 Connectathons (Sep 09, 2012)
• Frequency of use of HL7 message types (Jul 24, 2012)
• Reflections on the HL7 membership model - the affiliate life cycle (Dec 28, 2011)
• RFH (Resources for Health): HL7 version 3 taken to the next step (Aug 18, 2011)
• Timezone Hotel (Mar 29, 2011)
• The changing role of HL7 country organizations (Jul 16, 2010)
• How to lower the hurdle for HL7 v3 implementers (Jan 21, 2010)
• The HL7 roadmap for CDA R3 and the CCD (Jan 17, 2009)
• HL7 based Tree inventory system (Jan 30, 2007)
• Workflow Bribery (Sep 15, 2006)

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Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
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