vitalis 2016 fhir introduction

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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

http://fhir.furore.com/


Health Level 6

Health Level 7

Health Level 8


GELLO

“v2”

“v3”

CCOW

EHR-SFM

PHR-SFM


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


1.0, 2.2, 2.4 3, 3.1, 4.0


HL7 v2.0


?

3.xHL7 v3


Focus on implementersKeep common scenarios simpleLeverage existing technologies

Make content freely available

Invoke the community


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..


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


2012

The Rise of the API

2016


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.


App marketplace…


NO: Region Helse-Vest


EHR Vendors…


COMPONENTS OF FHIRIn-Depth


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


Resources - example


Example – Patient Resource

References to otherResources


References between resources

A web of resources that can tell any story


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


Resource view


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!


+ =

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


Exchange Patterns

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REST

Documents Messages

Services(API)


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


FHIR Messages

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Used to inform or instruct Patient Admitted Lab result

available Similar to v2

messaging


FHIR Documents

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Use for ‘point in time’ record Discharge Summary Referral

Similar to CDA


FHIRRepository

Regardless of paradigm, the content is the same

Lab System

FHIR Message FHIR Document

NationalExchange

REST

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.35

Questions?

(and then small break!)


WHY (UNIVERSAL) STANDARDIZATION IS HARD

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1st: Ego’s


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…


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


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.


“… the mad dreamers who tried to build a perfect language” (terminology, information model)

A history lesson…


FHIR PROFILINGAdapting FHIR


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


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!


Extensions

50 Note: could be JSON as well

Key = location of formal definition

Value = value according to definition


In v3 CDA…”text-based”


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


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

http://simplifier.net/

http://simplifier.net/

http://registry.fhir.org/


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FHIR Registry


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


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)


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


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, …


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

http://fhir.org/


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.

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.81

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