https www slideshare netmobileewoutkra mervitalis2016 fhirappdevelopment qid63626 df

https: //www. slideshare. net/mobile/ewoutkra mer/vitalis-2016 -fhir-appdevelopment? qid=63626 df 8 -0434 -4 c 76 -a 3 ca 37 a 02 d 94155 a&v=&b=&from_search=9 Access to health data Ewout Kramer FHIR Core team (and software developer) Furore (Amsterdam, NL) email: web: skype: e. kramer@furore. com http: //thefhirplace. com http: //fhir. furore. com ewoutkramer © 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.

Common Nordic Architecture for Telemedicine HL 7 FHIR Observation (CDG 2017 WAN-IF) Align to Continua TAN-IF, PAN-IF and LAN-IF ? SOAP (Green CDA) → FHIR ? HL 7 FHIR Questionnaire (CDG 2017 WAN-IF) © 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.

Personal Info Exchange “In many ways this overlaps with the innovation framework labeled ‘SMART on FHIR’” 3 © 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.

REST AND DOCUMENTS © 2014 HL 7 ® International. Licensed under Creative Commons. HL

Document-based data “Here is the patient’s pregnancy file” ““Pass the DICOM metadata of last visit’s MRIs” “My training diary entries for today” Strong notion of inter-human “bulk transfer” (of data, responsibility) © 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.

Beware of the document Document based transfer is popular: • • • C-CDA in the US XDS-based infrastructure on a national scale Aligns with practitioner-to-practitioner human communication But it does not fit every usecase! 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.

Longitudinal data © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7

Human/System interactions Helse Vest Self booking Project © 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.

Request/Response “I’d like to reschedule my appointment” “Which medication is the patient using? ” “Your new lab results are ready” Strong notion of fine-grained app-toserver “communication” (of events, facts, actions) © 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.

Warning! “The problem with this approach is that the CDA is really only a container for the information. ” “The recent introduction of FHIR by HL 7 is in JASON’s view a significant improvement over CDA. FHIR attempts to standardize the exchange of information through a set of modular components that are called Resources” “Data for Individual Health” – US JASON Taskforce, November 2014 © 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 about XDS in the Nordic countries? SE: (…) As a result, there is no national EHR database, nor is there a demand for a document exchange infrastructure NO: A possible future migration to XDS-based document exchange is being considered. DK: The future for clinical exchange (…) is basically based on XDS based document exchange. Source: Towards a Nordic Reference Architecture for Personal Connected health and care Technology Lars Kristian Roland, Architect at the Norwegian Directorate of e. Health; Johan Eltes, Deputy CTO Inera AB, Thor Schliemann, Architect at the Danish Health Data Authority. 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.

Integrating in the EMR SMART ON FHIR 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.

Objective In early 2010, Harvard Medical School and Boston Children’s Hospital began an interoperability project with the distinctive goal of developing a platform to enable medical applications to be written once and run unmodified across different healthcare IT systems. The project was called Substitutable Medical Applications and Reusable Technologies (SMART). © 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.

Motivation…. Turn bright ideas into real apps Take away the technology burdens 14 © 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.

Why ? App choice (substitutability) for users Low barriers to entry for developers Apps can run in systems by different vendors Apps can run in different contexts (e. g. EHR and Patient Portal) © 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.

SMART The App Platform for Healthcare Standard formats and protocols for healthcare data Open source development tools and resources Public gallery to connect apps and users © 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.

SMART = FHIR + … 17 © 2014 HL 7 ® International. Licensed under

SMART Authorization Based on OAuth 2 standard Two launch workflows EHR/Portal Launch – user picks an app from within EHR (EHR can pass along context like encounter and patient) Standalone Launch – user launches app and picks an EHR server (can run from mobile devices) © 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.

SMART Authorization Slightly simplified - details at: http: //docs. smarthealthit. org/authorization/ © 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.

Agree on actual codes 20 © 2014 HL 7 ® International. Licensed under Creative

Additional constraints 21 © 2014 HL 7 ® International. Licensed under Creative Commons. HL

App Gallery 22 © 2014 HL 7 ® International. Licensed under Creative Commons. HL

Growth analyzer 23 © 2014 HL 7 ® International. Licensed under Creative Commons. HL

Run a demo… © 2014 HL 7 ® International. Licensed under Creative Commons. HL

Launch context © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7

© 2014 HL 7 ® International. Licensed under Creative Commons. HL 7 & Health

CDS-Hooks EMR Events in the EMR External services hooked to the events Medicationprescribe Order-review Patient-view 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.

Source: https: //github. com/cds-hooks/wiki © 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.

Live demo Try: http: //hooks. fhir. me/#{"activity": "medication-prescribe"} © 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.

Uses for CDS hooks Opening patient record prompts action in trial selection system Placing a medication order prompts (pricing/interaction) guidance in EHR Placing a medication order returns medication info in foreign language of patient Opening a patient adds links to apps with detailed genomic results © 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.

Common theme SMART and CDS-hooks open up the EMR as a platforms in which 3 rd-parties can become part of the workflow 3 rd party suppliers can provide more specialized functionality than an EMR would every implement 32 © 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.

Argonaut Project Initiative to get FHIR and SMART ready for broad use by testing standards with widely adopted EHR systems Founding organizations: EHR Vendors: Healthcare Organizations and Companies: athenahealth, Cerner, Epic, Mc. Kesson, MEDITECH, Surescripts Beth Israel Deaconess Medical Center, Intermountain Health, Mayo Clinic, Partners Healthcare System, SMART at Boston Children’s Hospital Informatics Program, The Advisory Board Company, Accenture Implementation program – free to participate 20+ vendors Series of development sprints © 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 QUESTIONNAIRES 34 © 2014 HL 7 ® International. Licensed under Creative Commons. HL

What is Questionnaire for? Questionnaires are a typical means for capturing information from humans Both within and outside of healthcare Provide great control over data capture What data is requested How question is phrased Constraints on allowed responses In what order questions are presented Under what circumstances information is needed © 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.

Item-group Item/question 36 Nested Item/question © 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.

Questionnaire(Response) Questionnaire: The “Definition” of the content to be captured Questionnaire. Response: A completed (or partially) completed instance of a Qnnaire 37 What questions(items) are to be asked when and how? There may be hundreds (or thousands) of Questionnaire. Responses for one Questionnaire. Responses can exist without a Questionnaire at all (paper, legacy) © 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.

Questionnaire model Nests! status: Is this questionnaire still active? date: When did this status become effective subject. Type: What must Questionnaire. Response. subject be? concept: Code for the overall questionnaire Linkid: ties questionnaire and response Required: yes/no Repeats: yes/no 38 © 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.

Item types There are 3 main types of items in a questionnaire: display – Cannot have an answer or nested items – just text for display group – Cannot have an answer and must have nested groups and/or questions question (abstract) – Can have an answer, but may also have nested items 39 © 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.

Questionnaire. Response Here’s link. Id again! Author, source and subject! Answer can point to a real Resource! 40 © 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 Questionnaire / Response workflow 41 © 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.

Standard FHIR services Questionnaire/$populate Generate a Questionnaire. Response for a specified Questionnaire, optionally filling in data from a local or submitted data Requires business logic in server to know “how” to populate 42 © 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.

Usage Forms in apps US ‘Structured Data Capture’ (SDC) project Pre-population of forms from CDA R 2 data http: //wiki. siframework. org/Structured+Data+Captu re+Initiative http: //hl 7. org/fhir/sdc. html 43 © 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.

Render-a-Questionnaire http: //smartq. azurewebsites. net/Home/Sel ect Survey 44 © 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.

C 3 -PRO + Research. Kit 45 Source: http: //c 3 -pro. chip. org/architecture. html © 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.

Caveat 46 There is overlap between Questionnaires and other Resources Questionnaire's flexible structure can easily be misused to capture any data Choice between Questionnaires or Resources may be dictated by the procedure of collection and recording No binary choice! © 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.

DEVICE OBSERVATION – A PROFILE 47 © 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.

The Observation © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7

Points of Interest Subject: the Patient and/or the Device effective[x] and issued Component versus Related Device and Device. Metric 49 © 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 instance http: //spark. furore. com/fhir/Observation/sat. O 2? _format=xml http: //hl 7. org/fhir/observation-examplesat. O 2. html Take a look at the xml! 50 © 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.

Continua WAN Uses IEEE 11073 and IHE-PCD Profile Semantically equivalent to FHIR Device. Metric. Observation profile (FHIR will be used in 2017 CDG WAN-IF? ) 51 © 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.

IEEE 11073 in FHIR Device. Component Resource (any medical device that does not represent a metric, e. g. MDS, VMD, or Channel) 52 © 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.

IEEE 11073 in FHIR Device. Metric Resource (mandatory static properties that characterize a direct or derived, quantitative or qualitative biosignal measurement, setting, or calculation produced by a medical device) 53 © 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.

Device. Metric Observation Constrained version of Observation Subject: only Patient or Device No: Encounter link, “issued”, “data. Absent. Reason”, specimen Mandatory: effective. Date. Time (not Period) Mandatory link to Device. Metric (not to Device) 15 x “Must Support” Let’s try this in Forge Define Sp. O 2 Device. Metric. Observation… 54 © 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.

PATIENT ACCESS OR PATIENT IN THE CENTER? 55 © 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.

Your “Mobile” device becomes the Big Aggregator and Coordinator of data and functionality © 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.

In the financial sector… 57 © 2014 HL 7 ® International. Licensed under Creative

Apple Research. Kit 59 © 2014 HL 7 ® International. Licensed under Creative Commons.

Where is the Portal? PHR? © 2014 HL 7 ® International. Licensed under Creative

Reality? 61 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7

Reality? 62 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7

FINALLY… 63 © 2014 HL 7 ® International. Licensed under Creative Commons. HL 7

Tutorials Connectathon 64 All the latest information on FHIR Meet fellow developers Put FHIR to the test Networking FHIR experts and authors on hand http: //fhir. furore. com/devdays © 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.