Download - Vitalis 2016 FHIR Introduction
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Introduction to HL7® FHIR®
Ewout KramerFHIR Core team (and software developer) Furore (Amsterdam, NL)
email: [email protected]: http://thefhirplace.com
http://fhir.furore.comskype: ewoutkramer
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Health Level 6
Health Level 7
Health Level 8
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GELLO
“v2”
“v3”
CCOW
EHR-SFM
PHR-SFM
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Fast Relative – No technology can make integration as fast as we’d like
HealthcareInteroperabilityThat’s why we’re here
ResourcesBuilding blocks – more on these to follow
The Acronym
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1.0, 2.2, 2.4 3, 3.1, 4.0
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HL7 v2.0
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?
3.xHL7 v3
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Focus on implementersKeep common scenarios simpleLeverage existing technologies
Make content freely available
Invoke the community
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If your neighbour 's son can’t hack an app with
<your technology X> in a weekend…..
you won’t get adopted
Focus on implementers..
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THE RISE OF THE APIBackground
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Your “Mobile” device becomes the Big Aggregator and Coordinator of data and functionality
What I want from my healthcare app
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The API economy
Where companies expose their (internal) digital business assets or services in the form of (web) APIs to third parties with the goal of unlocking additional business value through the creation of new assets
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3rd-party becomes the norm
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2012
The Rise of the API
2016
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So what about HL7 & FHIR? With FHIR, HL7 joins the ranks of the API troopers.
But other than Twitter, Facebook etc. HL7 has no “services” or “functionality” to offer
FHIR is just a set of flexible standardized models and best-practices that others can use to create healthcare API’s
3rd-party (app/software) developers can then seamlessly connect to your FHIR API.
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App marketplace…
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NO: Region Helse-Vest
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EHR Vendors…
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COMPONENTS OF FHIRIn-Depth
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Divide health care data in discrete “building blocks”
MedicationPrescription Problem
A FHIR ‘Resource’
• Cover “the 80%”• Unit of exchange• Maintained & documented independently• Have a textual description
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Resources - example
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Example – Patient Resource
References to otherResources
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References between resources
A web of resources that can tell any story
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Clinical Scenario
First consultation Complaining of pain in the r) ear for 3 days with an
elevated temperature. On examination, temperature 38.5 degrees and an inflamed r) ear drum with no perforation. Diagnosis Otitis Media, and prescribed Amoxil 250mg TDS for 5 days
Follow up consultation 5 days later returned with an itchy skin rash. No
breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changed to erythromycin and advised not to take penicillin in the future.
Condition
Observation
Med
Allergy
Encounter
5 year old boyPatient
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Resource view
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Extending Patient
References to otherResources
Yes, but where are: • citizenship• mothersmaidenname, • us-core-race
Don’t worry, you can add extensions: your own elements – FHIR even defines a few favorite ones!
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+ =
Cover the 80% out of the box…
Everyone needs extensions…
Simple choice – design for absolutely everything or allow extensionsEveryone needs extensions, everyone hates them!
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Resource Anatomy
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Resource Anatomy
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Exchange Patterns
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REST
Documents Messages
Services(API)
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REST:“Repository” model of healthcare
Hospital System
CreateRecord
CreateEncounter
FHIR server
Patient ObservationPatient Patient
Order ObservationObservation
Notify newLab results
UpdatePatient
data
Lab System
PostLab resultQuery
Lab orders
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FHIR Messages
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Used to inform or instruct Patient Admitted Lab result
available Similar to v2
messaging
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FHIR Documents
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Use for ‘point in time’ record Discharge Summary Referral
Similar to CDA
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FHIRRepository
Regardless of paradigm, the content is the same
Lab System
FHIR Message FHIR Document
NationalExchange
REST
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Questions?
(and then small break!)
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WHY (UNIVERSAL) STANDARDIZATION IS HARD
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1st: Ego’s
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2nd: Cost
“Communicate first, standardize later”“I need to be ready next month”
“Standardize first, communicate later”“This needs to be done right, takes time”
CHAOS?
“He who ships code, wins”
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Interoperability
Interoperability: A model is agreed to that allows all systems to exchange what needs to be exchanged, without requiring any design changes to the way their systems works.
Well known deficiencies of this: semantic scalability, fragmentation etc.
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Intraoperability
Rework the core structures of the systems to function in an agreed way. Because all the systems work the same way, then exchange between the systems is easy and straight forward.
Intraoperability has fewer deficiencies, but they are much bigger: it’s much harder to get agreement…
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3rd: Different communities and timelines
GP System – Uses Prescriptions
Cancer Center – Uses Prescriptions
Regional collaborations – share prescriptions
Other regions – trying the same thing
Early Top-down consensus
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What can we do promote interoperability Produce basic building blocks everyone needs. Quickly! Cooperate with your region/countries biggest players to
get them adopted Open up a (FHIR, openEHR) registry to promote reusable
profiles, patterns & practices. Let everyone publish their specialized “dialect” of FHIR Re-integrate when need arises (= there’s interest and
money)
Promote, facilitate. Much more successful than enforcement and subsidized projects.
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“… the mad dreamers who tried to build a perfect language” (terminology, information model)
A history lesson…
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FHIR PROFILINGAdapting FHIR
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The need for profiling
Need to be able to describe adaptations based on use and context Which resources and elements are used? Which API features are used? Which terminologies are used? How to map these to local
requirements/implementations?
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Layered profiles
Country adapts a national profile
Regions or specialties may develop specialized versions of national profile
Profile with use-case specific constraints
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Constraining a resource
Demand that the identifier uses your national patient identifier
Limit names to just 1 (instead of 0..*)
Limit maritalStatus to another set of codes that extends the one from HL7 international
Add an extension to support “RaceCode”
Note: hardly any mandatory elements in the core spec!
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Extensions
50 Note: could be JSON as well
Key = location of formal definition
Value = value according to definition
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In v3 CDA…”text-based”
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openEHR ADL
…computable!
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FHIR: StructureDefinition
Computable expression: as a Resource, just like Patient!
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Adapting the API
FHIR ServerFHIR REST
Complex Operations
ReadUpdate Search
Check Drug Interaction Merge
Patient
ExpandValueSet
Validate
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Conformance
Conformance Resources
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“Implementation Guide”
StructureDefinition
SearchParamDefinition
ValueSet
ConceptMap
NamingSystem OperationDefinition
Forge
ExcelImplementation
Guide
TestScript
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Implementation GuidePour in your Conformance resources and add human narrative:
Functional Requirement and Use case(s) Data definitions Actors and Interactions Examples Technical Implementation Guidance Security Help Contact Information
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Publish!
Author & Store
Guide
Implement
Publish
http://simplifier.nethttp://registry.fhir.org
Test & Validate
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FHIR Registry
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FUTURE PLANS
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FHIR Timeline
2012 20162014 2018 2020
FirstDraft
2011 20152013 2017 2019
1st
DSTU2nd
DSTU3rd STU Normative
FirstConnectathon!
Update 1
Updates every18-24 months
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October 2015 – DSTU2
ConformanceValueSet, Conformance, StructureDefinition, OperationDefinition
SchedulingAppointment, Schedule, Slot
Workflow / PCCarePlan, Goal, Episode, Alert, Communication, ReferralRequest, DiagnosticOrder
IHE XDS (MHD)DocumentReferenceDocumentManifest
IHE PCDDeviceComponentDeviceMetric
DICOMImagingStudy, ImagingObjectSelectionAuditEvent (ATNA)
W3CProvenance
> 1.000 requests for changes processednumber of resources more or less doubled to just over 100
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During the year…
20172016
DSTU 2 STU 3
OctMayJan
WorkgroupMeeting
WorkgroupMeeting
WorkgroupMeeting
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October 2016 – STU3
New resources & support around: Clinical Decision Support Care coordination Workflow management Genomic data eClaims Provider directories CCDA profiles Consent management
250 requests for changes processed (so far)
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STU?
Standard for TRIAL Use
“Regardless of the degree of prior implementation, all aspects of the FHIR specification are potentially subject to change.”
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FHIR Maturity Model
Level 0: “Draft”, Just added to the spec for first review
Level 1: Ready for test implementation by pilotsLevel 2: Pilots exist and have interoperated with in realistic scenariosLevel 3: Meets quality guidelines, formal ballot resulting in changesLevel 4: Tested, verified and stable. Backw. compatibility becomes a prio.
Level 5: Widely implemented across scope and jurisdictions. Frozen.
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Going normative
Iterative process
First FMM level 4/5 in 2018
From 2018 updates every 18-24 months
More and more parts become level 4/5
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THE FHIR COMMUNITYBackground
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We exist now!
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Where in the world?2015 HAPI FHIR Test Server statistics
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New products every day
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HSPCArgonaut
SMART(on FHIR)
US Co-operations
FHIR
C-CDA 1.1FHIR Profiles(MU3)
Profiles, OIDC/OAuth
Services
Intermountain Healthcare, Veterans Affiars, IBM, Epic, Cerner, Mayo, Kaiser, …
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Gartner hype cycle
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At your service
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Connectathons
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FHIR foundation
Home of the community (not the SDO): Implementers chats Calender of events, webcasts Repository of Extensions and profiles Showcases, repo of FHIR projects Best-practices & patterns Open-source initiatives
Located at http://fhir.org
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FINALLY…
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Life on the FHIR core team
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Goal achieved?
It is fast to learn, implement and troubleshoot
It has a vibrant and open source community and has frequently held hackathons.
Matures because we get LOADS of feedback
Spontaneous adoption (of a standard!)
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But…
We can only make the technology bit easier
Interoperability is hard, and is a human problem of common process and understanding
FHIR cannot fix this. And it is no silver bullet.
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Questions?
(and then lunch!)
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Tutorials All the latest information on FHIR
Connectathon Meet fellow developers Put FHIR to the test
Networking FHIR experts and
authors on hand
http://fhir.furore.com/devdays