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A FHIR Enabled Ecosystem for Health Information Sharing

Session 269, March 8, 2018

David Hay, Product Strategist, Orion Health

FHIR Management Group Co-Chair

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David Hay, MD

Currently employed at Orion Health

Conflict of Interest

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Learning Objectives• Analyze a FHIR enabled ecosystem

• Demonstrate the ability for health information sharing with a FHIR ecosystem

• Describe a secure FHIR ecosystem of information and services

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Agenda• The problem

• What is HL7® FHIR®?

• What is an ecosystem?

• FHIR components

• Apply to Use Case

• Final thoughts

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The clinical problem• Data and services are in many places

• Data becoming more complex – and more of it

• Clinical understanding improving

• Patients/Consumers expect more

• Single individuals or systems can’t know it all

• How to spread the load/simplify?

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Example Use Case: Thomas

• Elderly man

• Smoker, diabetic

• Chronic Lung Disease

• No family support

• Living on his own

• Hospitalized for pneumonia

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What is FHIR?

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Why FHIR• HL7 defines Interoperability Standards

• In 2011, the Board of HL7 noted:

– Interoperability requirements are increasing

– Need for real time access (API) – Mobile

– Vast increase in the amount, type and source of data e.g. Devices, Genomics

– Analytics, population health

– Implementer expectations

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Benefits of FHIR• Improved access to information - Clinician and Consumer

– Currently locked in silos of information

• Ability for Clinician to get involved

• Improved information quality

• Easier access to complex services

• Reduce duplication of services

– Reduced cost

• Ability to Innovate – as seen in finance & travel

– New models of Care

• Support Analytics & Decision Support

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Key parts of FHIR

• Resources

• Exchange definitions

– E.g. API

• Storage

• Community

– Assistance

– Tooling, Reference Implementations & libraries

ResourcesExchange definitions

Storage Community - Assistance

Community - Tooling

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Clinical Resources

General

AllergyIntolerance

Condition (Problem)

Procedure

ClinicalImpression

FamilyMemberHistory

RiskAssessment

DetectedIssue

Care Provision

CarePlan

CareTeam

Goal

ReferralRequest

ProcedureRequest

NutritionOrder

VisionPrescription

Medication & Immunization

Medication

MedicationRequest

MedicationAdministration

MedicationDispense

MedicationStatement

Immunization

ImmunizationRecommendation

Diagnostics

Observation

DiagnosticReport

ProcedureRequest

Specimen

BodySite

ImagingStudy

Sequence

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References between Resources

Patient

Diagnostic reportCondition

Subject

ReportReason

Encounter Performer

Encounter PractitionerLocation

PROCEDURE

Location

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clinFHIR: Visualizing FHIR

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Paradigms of exchange

REST

Storage

Messages Services

Documents

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Sharing resources

REST

Message

FHIR

Repository

Document

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Profiling: Defining the content

• Adapting base resources to specific Use Cases

– ’80% rule’

• Commonly

– Constrain base resource

– Add extensions

– Change ValueSets

• Machine readable ‘Conformance’ resources

• US Core, Argonaut

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A digital ecosystem

And how FHIR enables it

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A digital ecosystem is a distributed, adaptive, open

socio-technical system with properties of self-

organization, scalability and sustainability inspired

from natural ecosystems.

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Key technical components

Conformance

Registry

Terminology Provider/

Service

Registry

Record

Locator

Repository

(Db)

Decision

Support

WorkFlow Identity

FHIR API and Resources

Reporting

Example…

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Finding stuff• Locator services

– Eg Documents (IHE XDS equivalent)

– Endpoint resource

• Registries

– Patient

– Provider

• Capability Statement

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Clinical Data Repositories (CDR)• Exposed by FHIR API

– Any paradigm

– Any storage architecture

• ‘Transactional’ data

• Reconciled Lists

• Careplans

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Terminology• What is Terminology

• The value it brings

• FHIR Support

– Coded datatypes

– ValueSets

– Operations

Code System:

Defines a set of

concepts with a

coherent meaning

Code

Display

Definition

Value Set:

A selection of a

set of codes for

use in a particular

context

Resource:

Coded element

Element

Definition: Type

and Value set

referenceSelects

Refers to

Binds

Conforms

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Identifying the participants• Challenges

• Patient & Provider

• Organization

• Service

• Scheduling

• FHIR Support

Organization

Location

Healthcare

Service

Practitioner

RolePractitioner

Endpoint

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Decision Support• What is Clinical Decision Support (CDS)

• Why?

• FHIR Support

– Operations

– Definitional – including care planning

– CDS-Hooks

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Workflow

• Different Use Cases and Architectures

• FHIR Support

– Definitional

– Patterns of Use

– Operations

Draft

Active

Completed Cancelled

Suspended

Entered-in-error

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Analytics

• Population reporting

• Quality Measures

• FHIR Support

– Specific resources (Measure, MeasureReport)

– Data collection

– Data representation (different formats)

– Bulk Data Export

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Security and Privacy• Not a security standard

• ‘Physical’ security

• Privacy tag

• SMART

– OAuth2 profile

• Supporting FHIR resources

• Consent

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An example at FHIR Connectathon• Consumer Centered Data

Exchange

• Multiple Participants

– HL7

– MiHIN

– NATE

– DXC

– NewWave

– Humetrix

– Orion Health

Consumer

Data

RepositoryTerminology

Server

Consent Server

Data

Contributor

Data

Contributor

Audit

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Applying the Ecosystem

…to Thomas’ Story

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ED and Admission

Flow Components Used

Difficulty breathing

ED gather history Record Locator

Clinical Data Repository

Dx pneumonia Decision Support

Terminology

Medication List updated Clinical Data Repository

Admit for stabilization

PCP/Care co-ordinator &

daughter notified

Care Plan

Provider/service registry

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Discharge

Flow Components Used

Discharged after condition

stabilized

Continued on oral antibiotics Workflow

Medication List updated Clinical Data Repository

CarePlan updated Clinical Data Repository

Refer to PCP for follow up Provider/service registry

Workflow

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Allergic Reaction

Flow Components Used

2 days later develops a rash

Contacts Care Coordinator Provider/service registry

Diagnosis drug reaction Decision Support

Terminology

Advise stop med Clinical Data Repository

Make appointment to see PCP Provider/service registry

Workflow

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Wrapping up…

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Learning FHIR• Specification

• Blogs

• Tools

– clinFHIR

– Reference Servers

– Sample data

• Events

– HL7 training

– Connectathon

• Community

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Learnings from Connectathon

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Final thoughts• FHIR has achieved remarkable success so far

• An ecosystem way of thinking:

– Improves health data sharing

– Provides flexibility and choice

– Enables Innovation

• FHIR and related standards (SMART, CDS Hooks) underpin this.

• But: It is complicated!

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Questions

• Speaker:

• Dr David Hay

• E: david.hay@orionhealth.com

• Ln: https://www.linkedin.com/in/david-hay-423a519

• Please complete online session evaluation