FHIR architecture overview for non-programmers by René Spronk
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Transcript of FHIR architecture overview for non-programmers by René 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.
FHIR Architecture Overview
for non-programmers
René Spronk (Ringholm)
FHIR Developer Days
November 26, 2014
© 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 Overviewfor executives
René Spronk (Ringholm)
FHIR Developer Days
November 26, 2014
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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© 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.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.
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
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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
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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 silo-
like EHR’s.
Shift towards analytics
FHIR uses data structures that allow one to easily slice
and dice the data for analytics.
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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’9
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FHIR Resources
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Example – Patient Resource
References
to other
Resources
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Data types
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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
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Human Readable
Summary
Standard Data
Content: MRN
Name
Gender
Date of Birth
Provider
Extension with
reference to its definition
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Narrative
14 Note: could be JSON as well
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Extensions
15 Note: could be JSON as well
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FHIR references
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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
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FHIR Messages
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FHIR Documents
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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.
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StructureDefinitionResource (profile)
“Before”
“After”
GET http://myfhirserver.com/StructureDefinition?xxxxxxxxxxxxx
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OperationDefinitionResource (Profile)
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Standard
FHIR REST
Custom
Operations
Read
Update
Search
Check Drug
InteractionMerge
Patient
Search on
Maiden name
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Computable Profiles
GET http://myfhirserver.com/Conformance
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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
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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 use-
cases.25
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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)
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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).27
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FHIR
Is likely to significantly impact Health IT:
scales well from simple to complex
flexible
free and fully open
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29
Questions?
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FHIR Examplefor clinical users
René Spronk (Ringholm)
FHIR Developer Days
November 26, 2014
Modified from a presentation by David Hay, Orion
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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
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Assumptions
Requirements known
Data Sources known and available
Not considering security
Not considering app architecture
System Architecture
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Main Clinical resources
Observation / Condition (Problem) / Alert
DiagnosticReport
MedicationPrescription (and others)
AdverseReaction / ContraIndication /
AllergyIntolerance
Immunizations / ImmunizationRecommentation
Assessment / RiskAssessment / CarePlan
Questionnaire / QuestionnaireAnswers
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Important Supporting Resources
Patient / Practitioner
List
Encounter / EpisodeOfCare
Order / OrderResponse / ReferralRequest
DocumentReference
Provenance
Appointment / AppointmentResponse / Availability / Slot /
HealthcareService
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Local Notes - Clinical Scenario
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
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.
Condition
Observation
Med
Adverse
Reaction
Allergy
Encounter
5 year old boyPatient
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Looking at the relationships
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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’
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Scheduling patients
Appointment / AppointmentResponse
Availability
Slot
HealthCareService
Recalls (care plan)
Alerts
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Ordering stuff
Order / OrderResponse
Detailed resources in request
MedicationPrescription
DiagnosticOrder
Referral
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Medications
Medication
MedicationPrescription Order / OrderResponse
MedicationAdministration Provenance
MedicationDispense
MedicationStatement
AllergyIntolerance
ContraIndication
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Viewing investigations
Diagnostic report
Imaging Study
Specimen
Attachment
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Decision Support
ContraIndication
AllergyIntolerance
Alert
OperationDefinition
ImmunizationRecommendation
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Doing things to people
Procedures
Specimen
DiagnosticReport
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Referrals
Order/OrderResponse
ReferralRequest
Many resources as
content
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Data collection
Forms
Questionnnaire / QuestionnaireAnswers
Free form
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Creating a summary document ddd
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Returning to the App…
Interact with Local Server
RESTful exchange of resources
Local server will mediate other services
Query document repository (XDS-ish)
Use DocumentReference against Registry
Simple GET for documents
Query data repositories (eg Lab)
RESTful query
Record Clinical data
Create resource graph
Submit as transaction
Decision Support
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
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Winding Up
FHIR is fit for (clinical) purpose