connecting the world for better health

2

Global Goods FHIR

Discussion

July 2019

Agenda

• Digital Square Announcements – Amanda BenDor, Digital Square

• Introduction of Speakers – Amanda BenDor, Digital Square

• Overview of FHIR – James Agnew, Smile CDR

• Global Goods applying FHIR for data exchange

• OpenIMIS – Uwe Wahser, GIZ

• OpenMRS – Kamil Madej, Soldevelo

• OpenLMIS – Josh Zamor, Village Reach

• OpenCRVS – Ryan Crichton, Jembi Health Systems

• FHIR Discussion – facilitated by Carl Fourie, Digital Square

3

Announcements

Digital Square Announcements

• Notice D Update

• Digital Square RFI on Digital Financial

Services

• Upcoming Digital Square Webinars:• August Global Good Community Manager Discussion

• September Global Good Webinar – WHO Accelerator

Toolkits Overview

5

Digital Square Announcements Continued

• Guidebook updates• Please use the Global Goods

Guidebook Feedback Smartsheet

to provide updated information on

your global good entry and

general feedback.

• We’ll confirm receipt and follow

up with you by November 4,

2019.

6

Speakers

Introduction to Webinar Presenters

• James Agnew

• Kamil Madej

8

• Uwe Wahser

• Josh Zamor

• Ryan Crichton

Presentations

FHIRThe Emerging Global Standard for Data

Exchange and Community Building

Jul 2019 - http://bit.ly/2M7m4Zs

SMAR

TFHIR

FHIR

Fast Healthcare

Interoperability Resources

HL7 FHIR

What is FHIR?

● A set of data models for healthcare

● A set of API specifications for exchanging those data

models

● A set of tools and servers to building and interacting with

those APIs

● A global community

HL7 FHIR: The Data Models

Designed with Humans in Mind

Easy to navigate

Easy to read

FHIR != Top-Down Specs.

FHIR == Bottom-Up

Community.

Connectathon Event - US

Connectathon Event - Vietnam

SMART

SMART

SMART: OAuth2

http://apps.

smarthealthit.

org

This is only the beginning...

openIMIS Interoperabilitythrough HL7 FHIR Standards

Uwe Wahser, PATH FHIR Webinar

25.07.2019

openIMIS Playground

25

Beneficiaries

Provider

Payer

25.07.2019Uwe Wahser: openIMIS Interoperability

UHC

USP

From MS IMIS to openIMIS

26

2012

IMIS for Tanzania CHFby SwissTPH,

Exact Software,MicroInsuranceAcademie 2014

IMIS Customization

for Nepal

2013

IMIS Customization for Cameroon

2016

openIMISInitiative

(SDC & GDC)

2018

openIMISCommunity

2017

openIMISMaster Version

(TZ+CM+NP)

2019

Modular Architecture

Transformation

25.07.2019Uwe Wahser: openIMIS Interoperability

openIMIS

Modular Transformation (current)

27

Web User Interface

Business Logic

Data Access Layer

Data Base

monolithic

openIMIS

Web User Interface

Business Logic

Data Access

Data Base

modular

Claims

WUI

Claims

DB

DA

Mz

25.07.2019Uwe Wahser: openIMIS Interoperability

Claims

MS IMIS

Slow Transition (Roadmap)

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Framework openIMIS

Claiming

Module X

Module Y

Indicator Dashboard

April 2019 October 2019 April 2020

25.07.2019Uwe Wahser: openIMIS Interoperability

Releases:

(Fraud Detection - AI)

BAHMNI

Integrating into OpenHIE

25.07.2019Uwe Wahser: openIMIS Interoperability

29

openIMIS

Odoo

OpenHIM

DHIS2

OpenMRS

OpenELIS

BlueSquare

SolDevelo

Possible Health

HISP India

OpenMRS

Vision: Integrated Workflows (Example: Claiming)

30

Insurance Mgmt

Insurance Adjudication

openIMIS

FHIR Data Store:Hearth

Interop Layer: OpenHIM

2

EMR:OpenMRS

1

3

Client Registry: Medic CR

5

25.07.2019Uwe Wahser: openIMIS Interoperability

Source: Carl Leitner @ AEHIN Conference 2018

API Design

25.07.2019Uwe Wahser: openIMIS Interoperability

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Digital Development Principles:Use Open Standards

openIMISRESTful APIs1 - Legacy System 3 - Implementers

2 - Standards

• Existing Data• Existing API

• Notice C calls• Business needs

• FHIR STU 3 (v3.0.0)

• Joint Learning Network (JLN)

Standard: Joint Learning Network (2012)

25.07.2019Uwe Wahser: openIMIS Interoperability

32

Working Group from 10 Countries:• Requirements Analysis• Glossary• Process Map

Documents:Original report @ JLNWorkspace @ OpenIMIS Wiki

Wordings for Module:• JLN: Process Groups with Business Processes• Developers: openIMIS Plugins

Update Workshop:• Kathmandu, June 2019

Join our Discussions

• Getting started …

• Weekly Meetings

• Monthly Gumzo (next Monday)

• Some channels – Ways to contribute

25.07.2019Uwe Wahser: openIMIS Interoperability

33

SolDevelo FHIR work

● OpenMRS Sync 2.0 module - synchronization between different OpenMRS

instances via FHIR API

● OpenIMIS FHIR module - separate module for new OpenIMIS version

which exposes data via FHIR API

● OpenMRS FHIR module - module converting and exposing OpenMRS API.

It is used in Sync 2.0 and will be used in OpenMRS Claim module which will

be connected with OpenIMIS

openIMIS -Business Logic

(relational DB)

FHIR Data Store(multiple choices of data store,

relational + document)

DHIS2

OpenMRS

Bahmni

openIMIS FHIR

API

openIMIS

FHIR

module

OpenMRS instance

OpenMRS instance

Sync 2.0 module -

synchronization via FHIR API

OpenMRS

FHIR module starter pack

● At the start of FHIR implementation, it would be great to always have a

person with really good domain knowledge.

● Prepare mapping documentation accepted by product community

● Communication with the community is very important.

● Adding resource one by one

● Acceptance tests after added resource

● It would be great to create FHIR module implementation process

● FHIR documentation - https://www.hl7.org/fhir

Challenges

● Lack of project model knowledge.

● Choosing FHIR version

● CDA to FHIR converters not easy to use

● FHIR extensions - we do not use it. Problem with FHIR compatibility

● FHIR module performance. Converting data without FHIR database.

● Python vs Java. It is much easier to write FHIR module in Java.

OpenLMIS and FHIR

Master Data Alignment Interoperability with the HL7®

FHIR® standard

JOSH ZAMOR • July 25, 2019

Interoperability - A Source of Truth

• Source of Truth

– A Registry in HIE

– A peer system

– Self, OpenLMIS (an OpenLMIS Service)

• Derived Data & Enrichment

– Derived data is when I hold data for which another system is

the source of truth for that data.

– I may enrich that data with more data by adding to and linking

other data to.

– It’s very rare that we need to change a source of truth - most

data is derived, enriched, and published.

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Interoperability - Wider lens

● Launch OpenLMIS we consider:

○ Is it by itself

○ Does a Registry exist

○ Does another system exist, is it a source of truth

Above all else we need to agree on the basics: there is a facility.

We don’t “sync” data. We see data as published, we can enrich it,

and optionally re-publish it.

Data provenance should be clear. Versioning and unique URI’s go a

long way.

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Interoperability - Locations

• Locations– Place stock is stored, supplied/received by

– Needs to link to GS1 Global Location Number (GLN)

– Enriched with supply-chain information

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FHIR

Location Facility

Create from

Supply Hierarchy

Supplied from

OpenLMIS

Enrichment

FHIR

Location

Interoperability – CCE Inventory

• Cold Chain Equipment (CCE) Inventory

– Refrigerators, Freezers, cold boxes, etc

– FHIR Device.location captures CCE installed (inventory) at a Location

43

L

CCE CCE

L

CCE CCE

Alert

OpenLMIS ColdTraceSource of Truth:

Locations and CCE Inventory

Interoperability – DHIS2

44

● FHIR Measure defines a Metric or Indicator

● FHIR MeasureReport is a published set of metrics or indicators for a Location

● Measure and Location can store additional identifiers to aid in mapping data between systems

and establishing meaning.

Next Steps

• Support:

– FHIR Website: http://hl7.org/fhir/

– OpenLMIS API docs: http://docs.openlmis.org

• Areas to improve:

– Need an administrative area concept, support hierarchy and shapes.

– Communicate Program through MeasureReport.

– Better on-boarding for concepts such as sources of truth, derived

data, enrichment and publishing. Communicate the big picture to

avoid mistakes.

– FHIR support for supply chain concepts (e.g. Inventory and

Consumption), which work with existing efforts (e.g. GS1)

– Product Master Data: New tool to assist in the works:

https://gitlab.com/pcmt/pcmt/wikis/home to which standards work

should apply.

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FHIR in action.

How FHIR is used in OpenCRVS and other projects at Jembi

OpenCRVS.- Why FHIR?

1. OpenCRVS is a civil registration tool supporting birth and death - in

future marriage, divorce and adoption

2. Closely tied with health events - birth and death

3. Therefore, need to interoperate with health systems as they will often

be first know about the event

4. FHIR gave us an easy way to interoperate with health systems and a

data model on which to base our application

OpenCRVS exposes a FHIR

based API and uses a FHIR based

data store for primary data

storage.

From the web-based UI we

choose to use GraphQL to

communicate with a gateway that

transforms the request to FHIR.

This is because it is much easier

to use GraphQL in the browser as

it allows you to fetch all data in a

single request and it solves some

performance issues where we

have to resolve multiple

references in FHIR.

Hearth

OpenCRVS API +

micro services

3rd party

Health

systems

OpenCRVS

UI

GraphQL

gateway

FHIR

FHIR

GraphQL request

Other uses of FHIR

1. Jembi is using FHIR in a number of other places, example include:

a. A perioperative questionnaire tool for anesthetists

b. In general interoperability work, even when other system don’t

speak FHIR it provides a good canonical language to use

c. As our go-to standard when setting up HIE registries as it

provides a base level of interoperability in an easy to use format

for developers

1. You still need to profile FHIR to be

truly interoperable, we need some

common profiles for LMIC

2. Better tooling/libraries for

developing FHIR clients

3. Continued support and investment

into existing tools, everyone is still

catching up

4. Standardization and adoption of

supporting technologies - e.g. an

auth strategy

1. Easy for developers to pickup

2. Provides a canonical format to use

3. Easy to use from any application

type

4. Mostly good documentation

5. Becoming a defacto standard

The good. The bad.

jembi.org

Discussion

Discussion

• What are examples of other use cases in the

community?

• What are the challenges?

• How do we as a community address gaps?

• What kinds of support or engagement on FHIR

would you like to see at upcoming events such as the

OpenHIE meeting in November?

• How can Digital Square support you in harnessing

FHIR for data exchange?53

digitalsquare@path.org

connecting the world

for better health

www.digitalsquare.org