FHIR Overview
for executives
René Spronk (Ringholm)
FHIR Developer Days
November 26, 2014
http://www.slideshare.net/DevDays2014/fhir-architecture-overview-fornonprogrammers-ren-spronk
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
2
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
3
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
4
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
What does FHIR stand
for?


F – Fast (to implement)
H – Health



That’s why we’re here
I – Interoperable
R – Resources

Building blocks – more on these to follow
5
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Design Philosphy of
FHIR
Focus on Implementers
Target support for common scenarios
Leverage cross-industry web technologies
Require human readability as base level of
interoperability
Make content freely available
6
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Contextual drivers for
FHIR




Shift in healthcare
patient in control, sharing data across organizations
Shift from off-line to on-line
shift from PC to tablet, from web to app, from desktop to
cloud
Shift towards data transparency
FHIR acts as an ‘open API’ to access data in these silolike EHR’s.
Shift towards analytics
FHIR uses data structures that allow one to easily slice
and dice the data for analytics.
7
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
What is a FHIR ‘Resource’ ?

Small, discrete concepts that can be
maintained independently



Akin to HL7v2 segments, DICOM IEs.
Resources are smallest units of transaction
Built-in extension mechanism

Elements used by 80% of implementers are part of
the base resource.


All other elements are handled as extensions
Resources have a ‘textual description’
8
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR Resources
9
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Example – Patient Resource
References
to other
Resources
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Data types



Based on cross-industry data types (w3c schema and ISO
data types)
Stick to the “80% rule” – only expose what most will use
Data types can have extensions
11
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Extension with
reference to its definition
Human Readable
Summary
Standard Data
Content:





MRN
Name
Gender
Date of Birth
Provider
12
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Narrative
13
Note: could be JSON as well
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Extensions
14
Note: could be JSON as well
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR references
15
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
RESTful FHIR Examples
GET http://myfhirserver.com/patient/123
GET http://myfhirserver.com/encounter/904?_include=patient
PUT http://myfhirserver.com/encounter/707
{XML or JSON Resource expression}
GET http://myfhirserver.com/document/800511
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR Messages
17
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR Documents
18
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR profiles

Resources have nearly no restrictions.
Parties exchanging data define the way
they want to use resources

Profiles define what ‘your jurisdiction’
needs to communicate and store when it
comes to Resources and their extensions.
19
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
StructureDefinition
Resource (profile)
“After”
“Before”
GET http://myfhirserver.com/StructureDefinition?xxxxxxxxxxxxx
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
OperationDefinition
Resource (Profile)
Read
Search
Standard
Update
FHIR REST
Custom
Operations
Check Drug
Interaction
Merge
Patient
Search on
Maiden name
21
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Computable Profiles
GET http://myfhirserver.com/Conformance
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Summary: What does
FHIR provide?



Resources (building blocks)
Extensions
Methodology




Bundles, Profiles, Conformance
Syntax (XML, JSON)
Human readability
Support for multiple Paradigms

REST, Messaging, Documents, Services
23
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Application of FHIR

FHIR is suitable for application in a variety
of settings:





the classic in-institution exchange of data between
systems
in a regional setting (Regional Health Information
Organizations)
on a national scale, e.g. in national health hub’s or EHR's
in social media and mobile applications
FHIR is expected to be initially used for
social media and mobile application usecases.
24
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR

Is being implemented right now:
(US) ONC, SMART, Intermountain, (UK) NHS,
(NZ) Orion Health, (NO) Helse Vest (NL)
Mental health apps
 IHE Profiles
 70 implementations, 20 countries (2014)

25
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR

Is easier and cheaper than other
comparable standards:
It is faster to learn, implement and troubleshoot
 It has a vibrant and open source community
and has frequently held connectathons.
 It uses modern technologies, the same as
used by e.g. Facebook, Twitter and Google.
 There are more people familiar with these
technologies (thus less expensive consultants).

26
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR

Is likely to significantly impact Health IT:
 scales well from simple to complex
 flexible
 free and fully open
27
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Questions?
28
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR Example
for clinical users
René Spronk (Ringholm)
FHIR Developer Days
November 26, 2014
Modified from a presentation by David Hay, Orion
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Theme: a mobile
application


A mobile application for a clinician
Collect and present clinical information about
a patient






Previous encounters, Lab Data, Documents
Record details of an encounter
Schedule encounters
Make orders for Labs, meds etc.
Get Decision support
Save a summary in a Document Repository
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Assumptions





Requirements known
Data Sources known and
available
Not considering security
Not considering app
architecture
System Architecture
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Main Clinical resources







Observation / Condition (Problem) / Alert
DiagnosticReport
MedicationPrescription (and others)
AdverseReaction / ContraIndication /
AllergyIntolerance
Immunizations / ImmunizationRecommentation
Assessment / RiskAssessment / CarePlan
Questionnaire / QuestionnaireAnswers
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Important Supporting
Resources







Patient / Practitioner
List
Encounter / EpisodeOfCare
Order / OrderResponse / ReferralRequest
DocumentReference
Provenance
Appointment / AppointmentResponse / Availability / Slot /
HealthcareService
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Local Notes - Clinical
Scenario
5 year old boy

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
Patient
Encounter
Condition
Observation

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 changes to erythromycin and
advised not to take penicillin in the future.
Med
Adverse
Reaction
Allergy
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Looking at the relationships
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Lists of things

Examples









Medication list
Problem List (Conditions)
Allergies
Past Medical History
Past Social History
Social History
‘Organizer’ in Document
Manage ‘points in time’
and changes
Explicit ‘none known’
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Scheduling patients






Appointment / AppointmentResponse
Availability
Slot
HealthCareService
Recalls (care plan)
Alerts
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Ordering stuff


Order / OrderResponse
Detailed resources in request



MedicationPrescription
DiagnosticOrder
Referral
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Medications


Medication
MedicationPrescription


MedicationAdministration





Order / OrderResponse
Provenance
MedicationDispense
MedicationStatement
AllergyIntolerance
ContraIndication
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Viewing investigations




Diagnostic report
Imaging Study
Specimen
Attachment
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Decision Support





ContraIndication
AllergyIntolerance
Alert
OperationDefinition
ImmunizationRecommendation
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Doing things to people



Procedures
Specimen
DiagnosticReport
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Referrals


Order/OrderResponse
ReferralRequest

Many resources as
content
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Data collection

Forms


Questionnnaire / QuestionnaireAnswers
Free form
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Creating a summary
document

ddd
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Returning to the App…

Interact with Local Server



Query document repository (XDS-ish)




Create resource graph
Submit as transaction
Decision Support


RESTful query
Record Clinical data


Use DocumentReference against Registry
Simple GET for documents
Query data repositories (eg Lab)


RESTful exchange of resources
Local server will mediate other services
Send a Message to the DSS, get a bundle back
Update the document repository

Create a FHIR document and submit via FHIR transaction to repository
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Winding Up
FHIR is fit for (clinical) purpose
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Questions?
48
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.