FHIR Overview for executives Ren Spronk Ringholm FHIR

FHIR Overview for executives René Spronk (Ringholm) FHIR Developer Days November 26, 2014 http: //www. slideshare. net/Dev. Days 2014/fhir-architecture-overview-fornonprogrammers-ren-spronk © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

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What does FHIR stand for? F – Fast (to implement) n H – Health n Ø That’s why we’re here I – Interoperable n R – Resources n Ø Building blocks – more on these to follow 5 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Contextual drivers for FHIR n n 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

What is a FHIR ‘Resource’ ? n Small, discrete concepts that can be maintained independently Ø Akin to HL 7 v 2 segments, DICOM IEs. Resources are smallest units of transaction n Built-in extension mechanism n Ø Elements used by 80% of implementers are part of the base resource. n n All other elements are handled as extensions Resources have a ‘textual description’ 8 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR Resources 9 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Example – Patient Resource References to other Resources © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Data types n n n Based on cross-industry data types (w 3 c schema and ISO data types) Stick to the “ 80% rule” – only expose what most will use Data types can have extensions 11 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR references 15 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR Messages 17 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR Documents 18 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR profiles n Resources have nearly no restrictions. Parties exchanging data define the way they want to use resources n Profiles define what ‘your jurisdiction’ needs to communicate and store when it comes to Resources and their extensions. 19 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Structure. Definition Resource (profile) “After” “Before” GET http: //myfhirserver. com/Structure. Definition? xxxxxxx © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Operation. Definition Resource (Profile) Read Search Standard Update FHIR REST Custom Operations Check Drug Interaction Merge Patient Search on Maiden name 21 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Computable Profiles GET http: //myfhirserver. com/Conformance Pu ia pl m o C e c n bli ca tio n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Summary: What does FHIR provide? Resources (building blocks) n Extensions n Methodology n Ø Bundles, Profiles, Conformance Syntax (XML, JSON) n Human readability n Support for multiple Paradigms n Ø REST, Messaging, Documents, Services 23 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Application of FHIR n FHIR is suitable for application in a variety of settings: Ø Ø n 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR n Is being implemented right now: (US) ONC, SMART, Intermountain, (UK) NHS, (NZ) Orion Health, (NO) Helse Vest (NL) Mental health apps Ø IHE Profiles Ø 70 implementations, 20 countries (2014) Ø 25 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR n Is easier and cheaper than other comparable standards: It is faster to learn, implement and troubleshoot Ø It has a vibrant and open source community and has frequently held connectathons. Ø It uses modern technologies, the same as used by e. g. Facebook, Twitter and Google. Ø There are more people familiar with these technologies (thus less expensive consultants). Ø 26 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

FHIR n Is likely to significantly impact Health IT: Ø scales well from simple to complex Ø flexible Ø free and fully open 27 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Questions? 28 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 n Collect and present clinical information about a patient n Ø Previous encounters, Lab Data, Documents Record details of an encounter n Schedule encounters n Make orders for Labs, meds etc. n Get Decision support n Save a summary in a Document Repository n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Assumptions n n n Requirements known Data Sources known and available Not considering security Not considering app architecture System Architecture © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Main Clinical resources n n n n Observation / Condition (Problem) / Alert Diagnostic. Report Medication. Prescription (and others) Adverse. Reaction / Contra. Indication / Allergy. Intolerance Immunizations / Immunization. Recommentation Assessment / Risk. Assessment / Care. Plan Questionnaire / Questionnaire. Answers © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Important Supporting Resources n n n n Patient / Practitioner List Encounter / Episode. Of. Care Order / Order. Response / Referral. Request Document. Reference Provenance Appointment / Appointment. Response / Availability / Slot / Healthcare. Service © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Local Notes - Clinical Scenario 5 year old boy n First consultation Ø n 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 250 mg TDS for 5 days Follow up consultation Ø 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. Patient Encounter Condition Observation Med Adverse Reaction Allergy © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Looking at the relationships © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Lists of things n Examples Ø Ø Ø Ø n n Medication list Problem List (Conditions) Allergies Past Medical History Past Social History ‘Organizer’ in Document Manage ‘points in time’ and changes Explicit ‘none known’ © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Scheduling patients Appointment / Appointment. Response n Availability n Slot n Health. Care. Service n Recalls (care plan) n Alerts n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Ordering stuff Order / Order. Response n Detailed resources in request n Ø Ø Ø Medication. Prescription Diagnostic. Order Referral © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Medications n n Medication. Prescription Ø n Medication. Administration Ø n n Order / Order. Response Provenance Medication. Dispense Medication. Statement Allergy. Intolerance Contra. Indication © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Viewing investigations Diagnostic report n Imaging Study n Specimen n Attachment n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Decision Support Contra. Indication n Allergy. Intolerance n Alert n Operation. Definition n Immunization. Recommendation n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Doing things to people Procedures n Specimen n Diagnostic. Report n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Referrals Order/Order. Response n Referral. Request n Ø Many resources as content © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Data collection n Forms Ø n Questionnnaire / Questionnaire. Answers Free form © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Creating a summary document t. R oo t ddd Do cu m en n © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Returning to the App… n Interact with Local Server Ø Ø n Query document repository (XDS-ish) Ø Ø n Ø Create resource graph Submit as transaction Decision Support Ø n RESTful query Record Clinical data Ø n Use Document. Reference against Registry Simple GET for documents Query data repositories (eg Lab) Ø n RESTful exchange of resources Local server will mediate other services Send a Message to the DSS, get a bundle back Update the document repository Ø Create a FHIR document and submit via FHIR transaction to repository © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & 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 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.

Questions? 48 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U. S. TM Office.