HL7 FHIR - School of Engineering

HL7 FHIR - School of Engineering

HL7 FHIR Ewout Kramer [email protected] HL7 Norway, april 1st, 2014 http://www.slideshare.net/ewoutkramer/hl7-fhir Our common problem Avoid speaking between lunch and afternoon coffee No one is interesting to listen to for more than 45 minutes So.Please

Ill break the presentation in 45 minutes State your questions at anytime Read your e-mail if you need to Fast (well, thats relative) Healthcare Interoperability (thats what we need) Resources (the web technology bit)

Why have something new? STARTING A FHIR Why something new? How can I get data from my server to my iOS app? How do I connect my applications using cloud storage? How can I give record-based standardized access to my PHR? If your neighbour s son cant hack an app with in a

weekend.. you wont get adopted 10 REST WHATS IN THE BOX? Slice & dice your data into resources MedicationPrescription Cover 80% - Context independent

Problem - Unit of exchange/storage Thousands of examples Patient MRN 22234 Patient Ewout Kramer 30-11-1972 MRN 22235 Amsterdam Olaf Olafsson 01-01-1994 Bergen

Organization ACME Hospital Organization National Drive 322 Orlando, FL ACME Hospital National Drive 322 Orlando, FL Consistent documentation Structure of a Resource (XML example)

Human Readable CDA taught HL7 a very important lesson Even if the computers dont understand 99% of what youre sending, thats ok if they can properly render it to a human clinician This doesnt just hold for documents important for messages, services, etc. In FHIR, every resource is required to have a human-readable expression Can be direct rendering or human entered How many resources? Currently: about 40 Next upstill about 100 to go

Administrative Scheduling Patient, Location, Encounter, Organization, Clinical Concepts AllergyIntolerance, Questionnaire, Observation Infrastructure ValueSet, Composition, Profile, Conformance

- Appointment, Availability, Slot Financial - Claim, Account, Coverage Consent Everything to cover C-CDA Cover all usecases - (n)ever Specific Generic HL7v2

openEHR RM HL7 CDA HL7v3 RIM HL7v3 CMETS openEHR Archetypes FHIR openEHR Templates C-CCD IHE PDQ

Cover the 80% out of the box + = Patient MRN 22234 Ewout Kramer 30-11-1972 Amsterdam +

Haircolor BROWN Organization You can extend: - Resources - Elements of Resources - FHIR Datatypes ACME Hospital National Drive 322 Orlando, FL +

Taxoffice Id NLOB33233 Extending a multiple birth Key = location of formal definition Value = value according to definition 3.x ? Package & publish: The Profile My First Profile V1.0 by Ewout

Support Bottom-up re-use Document from the resource to the wire HTTP/1.1 HTTP/1.1 200 200 OK OK Content-Type: Content-Type: application/json;charset=utf-8 application/json;charset=utf-8 Content-Length: Content-Length: 627 627

Content-Location: Content-Location: /fhir/person/@1/ /fhir/person/@1/ history/@1 history/@1 Last-Modified: Last-Modified: Tue, Tue, 29 29 May May 2012 2012 23:45:32 23:45:32 GMT GMT ETag:

ETag: "1 "1 "Person":{"id": "Person":{"id": {"value":"1"},"identifier":[{"type": {"value":"1"},"identifier":[{"type": {"code":"ssn","system":"http:// {"code":"ssn","system":"http:// hl7.org/fhir/sid hl7.org/fhir/sid Packaging & transport Message CORBA

SOAP Document REST Yes, v2 style messaging is also supported! Yes, v3 CDA style documents are also supported!

? IN SUMMARY FHIR Manifesto (abridged) Focus on implementers Keep common scenarios simple Leverage existing technologies Make content freely available

Implementer support In Summary Basic 80% Resources Extension mechanism Publication mechanism for specs (profiles)

Package as Message, Document or REST XML/JSON/HTTP protocol for transport Examples, documentation, APIs, connectathons Whats Next? January 2014 First Draft Standard for Trial Use ballot (DSTU1) Semi-stable platform for implementers Additional DSTU versions roughly annually to make fixes, introduce new resources May 2015 Second Draft Standard for Trial Use ballot (DSTU2) Additional (C-CDA) resources, more workflow support, work on validation, community feedback Normative is around 3 years out We want lots of implementation experience before committing to

backward compatibility 31 Questions? INTERLUDE: SOURCE OF FHIR Source of FHIR Straight from the HL7 SVN code respository at gforge.hl7.org Publication process .INI

Website Validation Schemas examples Publication tool (org.hl7.fhir.tools.jar) Resource Examples UML DictXml Java, C#, Delphi

Resource profiles eCoreDefinitions.xml Combining resources into useful exchanges PLAYING WITH FHIR Its all about combining resources . . . htt p :// pa

t.r e http://lab.hospitalA.org/Observation/3ff27 g is try . Organization org /P ati e

Observation nt/ Patient223 Diagnostic http://lab.hospitalA.org/DiagRep/4445 Report http://hospitalA.org/Organization/1 Practitioner http://hospitalA.org/Practitioner/87 37 Diagnostic

Report Patient Practitioner Observation In REST: Possibly distributed FHIR server @ pat.registry.org subject ing er

ag man FHIR server @ hospitalA.org Organization/1 Practitioner/87 Organization 39 Diagnostic result Report Practitioner

per for m Patient/223 Patient FHIR server @ lab.hospitalA.org DiagnosticReport/4445 Observation/3ff27 Observation http://fhirblog.com/2014/01/24/modellingencounters-with-fhir/ Repository model of healthcare

Hospital System Create Update Lab System Create Update Query Organization Patient

Patient Patient FHIR server Create Query Subscribe Update Diagnostic Report Observation Observation Observation

Atom: New reports in the mail FHIR Document Discharge Discharge Summary Summary Composition Composition Chief Complaint section Physical section

Medications section Dr. Bernard Dr.Practitioner Bernard or h t au subject Patient

Mary Patient Mary Patient Practitioner Patient Kidney Stones Kidney Stones Condition Condition

content content content Vital VitallistSigns Signs Pulse Pulse Observation entry

list Observation BP BP Observation Observation Discharge Meds Discharge Meds

list list entry Dyclofenac Dyclofenac MedicationPrescription MedicationPrescription Tamsulosin Tamsulosin MedicationPrescription

MedicationPrescription 43 Regardless of paradigm the content is the same Receive a lab result in a message FHIR Message FHIR Repository FHIR Document Lab System T

RES National Exchange Package it in a discharge summary document http://fhirblog.com/2014/03/31/referrals-orders-and-fhir/ Very short intro to Profiles CONTROLLING THE FHIR The need for Profiles Many different contexts in healthcare, but a single set of Resources

Need to be able to describe restrictions based on use and context Allow for these usage statements to: Authored in a structured manner Published in a repository Used as the basis for validation, code, report and UI generation. Constraining cardinality 1..2 1..1 0..0 Limit cardinality to 1..2 (e.g. to at maximum your

organizations identifier + the national one) Limit names to just 1 (instead of 0..*) Forbid any telecom elements Note: something thats mandatory in the core definition cannot be made optional in a profile 48 Limit value domains If deceased is given, it must be a dateTime, not a boolean OrganizationNL =true

49 Fix value: Only allow active Patients Use our national codes for MaritalStatus Use another profiled Resource Basic Document Practitioner Practitioner Composition Composition

0..1 or h t au 0..1 subject Patient Patient 0..* Section content

Any Any Resource Resource 50 Discharge Discharge Summary-NO Summary-NO Composition Composition 1..1 Complaint

section 0..1 Physical section 1 ho r t u ..1 a Condition Condition

content content section section Patient-NO Patient-NO 1..1 subject 1..1 Medications 0..1 Home situation

Practitioner-NO Practitioner-NO Document-NO Profile! content Vital VitallistSigns Signs list Discharge Meds

Discharge Meds list list 0..* entry Observation Observation 0..* e ntry Medication Medication

Prescription-NO Prescription-NO 51 Whats in a profile? http://hl7.no/Profiles/patient-no orts p p su binding ExtensionDefn

Resource Extension url Identifier Name, Version Publisher Description, Code Status Date (of publication) Constraints tag

Metadata Conformance ValueSet Tagging a Resource Patient http://hl7.org/fhir/tag/security MRN 22234 Ewout Kramer 30-11-1972

Amsterdam Im a VIP - My information cannot yet be disclosed http://hl7.org/fhir/tag This is TEST data! Dont use! http://hl7.org/fhir/tag/profile Im an Organization as defined in the Norwegian Profile see http://hl7.no/Profiles/patient-no (Distributed) validation Apps server

le X eY fi l o fi r P Pro Store & Validate Va lida

Profile X Country validation server te Y lo wn Do Profile Y &

ad ate lid Va Profile Y Some examples from early-adopters THE FHIRSTARTERS 1. Form Request + Patient data in FHIR Form Filler

Empty Questionnaires ted a l u op aire p e r 2. P stionn Que

Completed Questionnaires Form Repository 3. Filled out form Form Client FHIR FHIR Patient & Provider registry National Patient Portal ce s r

u o Res Do FHI cu R me Hospital System nts References nts e m cu o

D PDF CCD Documents INTEROP WITH V2/V3 V2 to FHIR bridge v2 ges Messa FHIR message processor

FHIR Messages FHIR Repository FHIR REST Hospital System Note: Messages are events, REST exposes a repository Model of data Migration v2 and FHIR

Already have an integration engine that supports translation between v2 and FHIR messages Resources map to segments reasonably well As always, the challenge with v2 mapping is the variability of v2 interfaces Common mappings can be created, but they wont be one size fits all and v2 mappings Every Resource has v2 mappings specified, e.g.: http://www.hl7.org/fhir/patient-mappings.html#http://hl7.org/v2 Patient identifier name

telecom gender birthDate deceased[x] address maritalStatus PID-3 PID-5, PID-9 PID-13, PID-14, PID-40 PID-8 PID-7 PID-30 PID-11 PID-16

CDA to FHIR Document bridge A V3 CD s ent m u c o D FHIR Documents

FHIR Document processor FHIR Repository FHIR REST Hospital System A Note: Documents are compositions, No update semantics Context? Wholeness? Migration CDA and FHIR

Made more complex by human-readable nature Need to ensure text <-> entry linkages are retained Will best be handled on a template by template basis Likely start with important ones like C-CDA and v3 mappings Every Resource has v3 mappings specified, e.g.: http://www.hl7.org/fhir/patient-mappings.html#http://hl7.org/v3 Patient identifier name telecom

gender birthDate deceased[x] address maritalStatus multipleBirth[x] Patient ./id ./name ./telecom ./administrativeGender ./birthTime ./deceasedInd ./addr

./maritalStatus .multipleBirthInd FHIR & C-CDA C-CDA is mandated by Meaningful Use FHIR is a new specification FHIR is not a replacement for C-CDA (yet) Project to migrate C-CDA content to FHIR In the future, FHIR may gradually replace CCDA

66 (XDS) references A DocumentReference resource is used to describe a document that is made available to a healthcare system. It is used in document indexing systems, and are used to refer to: CDA documents in FHIR systems FHIR documents stored elsewhere (i.e. registry/repository following the XDS model) PDF documents, and even digital records of faxes where sufficient information is available Other kinds of documents, such as records of prescriptions.

IHE MHD This winter () the Volume 2 part of Mobile Health Documents (MHD) will be replaced with the appropriate content describing a profile of DocumentReference to meet the needs of MHD and the family of Document Sharing in XDS, XDR, and XCA. John Moehrke, august 16, 2013 So why use anything else? FHIR is brand new No market share Only recently passed DSTU ballot Little track record

Business case No-one dumps existing working systems just because something new is better Large projects committed to one standard wont change direction quickly (or even at all) Simple message Yes, FHIR has the potential to supplant HL7 v3, CDA and even v2 However Its not going to do so any time soon No one's going to throw away their investment in older standards to use FHIR until 1. The specification has a good track record 2. Its clear the new thing provides significant benefits

HL7 will support existing product lines so long as the market needs them http://www.forbes.com/sites/danmunro/ 2014/03/30/setting-healthcare-interop-onfire/ SMART DEMO http://smartplatforms.org/smart-on-fhir/ S F

M H A I R R T S F M H A I R

R T BlueButton F H I R Any FHIR Server (PHRs!)

Lets run a demo! Next Steps for you Read the spec at http://hl7.org/fhir Try implementing it Come to a (European?) Connectathon! [email protected] #FHIR Implementors Skype Channel

FHIR Developer Days (November 24 26), Amsterdam StackOverflow: hl7 fhir tag

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