Presented By:Jeff McGeath, Sr Vice President, Software SolutionsIatric Systems

FHIR – What’s all the FHUSS?

Agenda

Goals

Overview of FHIR

Capabilities and benefits of FHIR

What FHIR means to you, and how it can help your organization

How to leverage legacy systems to change the way we deliver healthcare with FHIR

Goals What you’ll learn today:

• This session will help you understand what a FHIR Resource is and how it can be used

• FHIR is designed for the web, so this session will explain how those simple XML or JSON structures that are accessed via an http-based URL can be used in a MEDITECH environment that is still using traditional HL7 v2.x messaging 

• This session will also cover a few easily obtainable use cases to show that the new FHIR standard can be used to accelerate 3rd party application integration

QuizOne of the goals of FHIR is to help solve the following Healthcare challenge.

16 letters, 8 syllables

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ R PT

Hint: If you Google this word, you’ll get 13,900,000 results. It is also is a top concern for healthcare IT leaders.

LR IA IE O YI EN B T

Credit: XKCD.com -- HTTP://XKCD.COM/927/

FHIR – Is it a Standard?

Poll Question

What is driving your interest in FHIR?

A: Want to make our interfaces easier to manage

B: Moving toward what we think will be the national standard

C: Want to take advantage of the web services 

D: Other (or Don’t know)

FHIR Overview Fast Healthcare Interoperability Resource (FHIR)

Essentially HL7 v4

HL7.org initiative (Grahame Grieve, Ewout Kramer, Lloyd McKenzie)

FHIR Prioritizes Implementation Core principle that the standard must maintain implementability

REST / JSON based

80 / 20 rule – just define what is absolutely needed, extend the other 20%. The needs in that 20% are covered by “extensions”.

ONC Interoperability Roadmap Timeline

Comparison to HL7 v2.x

Think of segments (PID, PV1, OBX, etc.) as URLs https://www.CompanyABC.com/Patient/M234556

• You can see the value of REST here. No state is expected to be stored before, between, or after calls to this URL.

• URLS will exist to get data, create data, update data (delete data is possible)

• Remember Z Segments?? Think Extensions now• Traditional HL7 messaging bundled concepts into a single

message via segments FHIR supports messaging (bundled resources)

An AnalogyFHIR Server

Order Forms Observation

Forms

Patient Resource

File Clerk• search: Search through the folders for ones that meet a set of search criteria• read: Get a copy of one a specific folder in one of the cabinets• create: Add a new folder to the appropriate cabinet (with a new number)• update: Add a new page (version) to the contents of a specific folder• delete: Remove a folder from the cabinet (or more accurately, put a sticker on it

saying "do not open")• history: Look at all the pages in a single folder (or in some cases a particular file

cabinet or even the whole room - though that's more for technical purposes than clinical purposes)

• transaction: Give the server a bunch of folders all at once to update

The actions in red represent FHIR RESTful API endpoints that you can think of as URLS. For example:https://www.myhospital.com/Patient/M12345 -- would be an example of a read from the list below.Patient

Forms

So… again, what’s all the FHUSS?

● The focus on implementation ease● RESTful Web Services – embraced by many industries

● Underpinnings are not new technologies● REST● JSON● Web API

● Generation Y companies come to healthcare quicker● mHealth technologies are easier to connect, resulting in

advancement of a patient centered health care system● The Argonaut Project

● Not a competitor, an accelerator● Focused on mapping to the Common Meaningful Use

Data Set

FHIR: Capabilities and Benefits

● If someone is building a new iOS healthcare app (and thousands are), what standard do we point them at?

● If someone wants to provide a cloud based health app that integrates with social networks, what standard should they use?

● If a vendor wants to provide a simple to use standards based API to cloud based health integration services, what standard should they extend?

● If a government wants to implement a national EHR, who should they talk to?

FHIR: Capabilities and Benefits(tempered with the current state of the standards work)

Currently at DSTU1 (Draft Standard for Trial Use) DSTU2 expected this year

Gartner Hype Cycle Companies starting to implement FHIR architecture Great companies will not build deep specifics (yet) VERY possible that FHIR becomes a defacto API for MU3

Where the experts “think” we are at

What FHIR Means to YouHow it can help your organization

Opens the marketplace for new Healthcare IT entrants

DIY productivity tools are simple to create

Opens access to your EHR data (MU3 API?)

Accelerator for the healthcare consumer movement

How to leverage existing systems using FHIR

EHR

Data Repository

Meditech DR

OR…

FHIR Serve

r

Mobile

TeleHealth

PopulationHealth

WorkflowImprovement

FHIR Consumers

Area of interest

Iatric Systems - In place today

FHIR Use Case

Create: Actor Resources (for patient, provider, service, and location)

Search: Schedule Resources for all actors, looking for available Slots. Allow pagination through schedule weeks.

Create: Appointment Resource with desired parameters Read: AppointmentResponse Resource Display confirmation to end user device, integrate with

personal calendar (Not FHIR)

Patient Engagement workflow:A patient receives a push notification that their annual physical is due. It is suggested in the notification that the patient schedule and complete a calcium heart scan procedure before the visit. The patient is then presented with buttons to schedule the heart scan as well as the annual physical.

FHIR Use Case

Search: Patient Resource (given barcode scan, or manual patient ID entry)

Search: Order Resource for the given Patient Resource History: Order Resource to determine outstanding orders Phlebotomist is able to confirm if his printed orders are still

up to date, and if not get the most current specimen collection activities completed (Not FHIR)

Hospital workflow, process improvement:A phlebotomist is currently rounding in clinical units obtaining patient specimens. Before he takes his next draw on a patient, he scans the patient wristband to initiate a query/response workflow to determine if the current order set on his clipboard is the most current, alleviating the need to visit the bedside and stick the patient a second time hours later.

FHIR – What’s all the FHUSS?

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