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FHIR: 
Clinical Resources 
(from the perspective of a Clinical App developer) 
Dr. David Hay 
Chair HL7 New Zealand 
Co-Chair FHIR Management Group 
Board Member HINZ 
Member HISO 
Information Architect, Orion health 
www.fhirblog.com
Agenda 
• A sample application 
– Choosing a standard… 
• Thinking in Resources 
• Thinking Clinically with Resources 
• Clinical Connectathon 
Page 2 • HL7 New Zealand
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 
Page 3 • HL7 New Zealand
Assumptions 
• Requirements known 
• Data Sources known and available 
• Not considering security 
• Not considering app architecture 
• System Architecture 
Page 4 • HL7 New Zealand
What exchange Paradigm 
• Options 
– Document 
– Message 
– REST 
– Service 
• Need all 
– REST for usual operation 
– Document to save a summary 
– Message when creating an order 
– Services less likely 
Page 5 • HL7 New Zealand 
Messages Documents 
REST 
Services
What data format/model to use 
Page 6 • HL7 New Zealand 
• FHIR because: 
– Light weight 
• Supports JSON 
– Web based 
– Commonly available tooling 
– Includes model 
• Can be extended 
– Emerging Standard 
• Large Community 
• Active development 
– Supports all paradigms 
– I can understand the spec! 
• Options: 
– CDA 
– HL7 v2 
– Bespoke 
– FHIR 
So we need to learn 
more about FHIR…
Thinking in Resources
Resources 
• “Resources” are: 
– Small logically discrete units of exchange 
– Defined behaviour and meaning 
– Known identity / location 
• (usually) 
– Smallest unit of transaction 
– “of interest” to healthcare 
Page 9 • HL7 New Zealand 
9
Page 10 • HL7 New Zealand
Structure of a Resource 
Page 11 • HL7 New Zealand 
Resource 
Metadata 
Narrative 
Elements 
Extensions Extensions
Page 12 • HL7 New Zealand
Resource as a bag of DataTypes 
Page 14 • HL7 New Zealand
References between resources 
Page 15 • HL7 New Zealand
Other things about resources 
• Profiles and Extensions 
• Collections (bundles) 
– Query result 
– Transactions 
– Documents 
– Messages 
• Versioning 
• Tools 
– XML Editor 
– REST client 
– Libraries 
– Test Servers 
33, v12 – 2012-12-04 
33, v13 – 2012-12-05 
33, v14 – 2012-12-08 
Page 16 • HL7 New Zealand 
Patient/33/_history/12 
Patient/33/_history/13 
33, v15 – 2012-12-09 
Patient/33/_history/14 
Patient/33/_history/14 
Patient/33
Thinking Clinically
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 
Page 18 • HL7 New Zealand
Main Clinical resources (DSTU-1) 
• Observation 
• Condition (Problem) 
• DiagnosticReport 
• MedicationPrescription (and others) 
• AdverseReaction / AllergyIntolerance 
• Immunizations / ImmunizationRecommentation 
• CarePlan 
• Questionnaire / QuestionnireAnswers 
• Alert 
Page 20 • HL7 New Zealand
Important Supporting Resources 
• Patient 
• Practitioner 
• List 
• Encounter / EpisodeOfCare 
• Order / OrderResponse 
• DocumentReference 
• Provenance 
Page 21 • HL7 New Zealand
Resources to come (DSTU-2) 
• Appointment / AppointmentResponse / Availability / Slot / 
HealthcareService 
• Assessment 
• ReferralRequest 
• ContraIndication 
• RiskAssessment 
Page 22 • HL7 New Zealand
Specific Scenarios
Finding external documents (XDS-ish) 
Page 24 • HL7 New Zealand
Local notes 
• Encounters 
• EpisodeOfCare 
• Observations 
• Conditions 
• Assessment 
• Lots of clinical resources 
Page 25 • HL7 New Zealand
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. 
Page 26 • HL7 New Zealand 
Encounter 
Condition 
Observation 
Med 
Adv Rean. 
Allergy 
5 year old boy 
Patient
Looking at the relationships 
Page 27 • HL7 New Zealand
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’ 
Page 28 • HL7 New Zealand
Scheduling patients 
• Appointment / AppointmentResponse 
• Availability 
• Slot 
• HealthCareService 
• Recalls (care plan) 
• Alerts 
Page 29 • HL7 New Zealand
Ordering stuff 
• Order / OrderResponse 
• Detailed resources in request 
– MedicationPrescription 
– DiagnosticOrder 
– Referral 
Page 30 • HL7 New Zealand
Medications 
• Medication 
• MedicationPrescription 
– Order / OrderResponse 
• MedicationAdministration 
– Provenance 
• MedicationDispense 
• MedicationStatement 
• AllergyIntolerance 
• ContraIndication 
Page 31 • HL7 New Zealand
Viewing investigations 
• Diagnostic report 
• Imaging Study 
• Specimen 
• Attachment 
Page 32 • HL7 New Zealand
Decision Support 
• ContraIndication 
• AllergyIntolerance 
• Alert 
• OperationDefinition 
• ImmunizationRecommendation 
Page 33 • HL7 New Zealand
Doing things to people 
• Procedures 
• Specimen 
• DiagnosticReport 
Page 34 • HL7 New Zealand
Referrals 
• Order/OrderResponse 
• ReferralRequest 
– Many resources as content 
Page 35 • HL7 New Zealand
Data collection 
• Forms 
– Questionnnaire / QuestionnaireAnswers 
• Free form 
Page 36 • HL7 New Zealand
Creating a summary document 
• ddd 
Page 38 • HL7 New Zealand
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 
Page 39 • HL7 New Zealand
Clinical Connectathon
Purpose of Clinical Connectathon 
• Resource coverage 
• Resource detail 
• Patterns of use 
– Eg condition vs observation 
Page 43 • HL7 New Zealand 
http://198.199.94.37:9001/main.html
Winding Up 
• FHIR is fit for (clinical) purpose 
– Guide in the right direction 
• As a clinical app developer I will: 
– Become familiar with the spec 
– Interact with the community 
– Play with the test servers 
– Play with the Clinical Connectathon tooling 
– Get started! 
Page 44 • HL7 New Zealand 
Thanks for listening!

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FHIR for clinicians

  • 1. FHIR: Clinical Resources (from the perspective of a Clinical App developer) Dr. David Hay Chair HL7 New Zealand Co-Chair FHIR Management Group Board Member HINZ Member HISO Information Architect, Orion health www.fhirblog.com
  • 2. Agenda • A sample application – Choosing a standard… • Thinking in Resources • Thinking Clinically with Resources • Clinical Connectathon Page 2 • HL7 New Zealand
  • 3. 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 Page 3 • HL7 New Zealand
  • 4. Assumptions • Requirements known • Data Sources known and available • Not considering security • Not considering app architecture • System Architecture Page 4 • HL7 New Zealand
  • 5. What exchange Paradigm • Options – Document – Message – REST – Service • Need all – REST for usual operation – Document to save a summary – Message when creating an order – Services less likely Page 5 • HL7 New Zealand Messages Documents REST Services
  • 6. What data format/model to use Page 6 • HL7 New Zealand • FHIR because: – Light weight • Supports JSON – Web based – Commonly available tooling – Includes model • Can be extended – Emerging Standard • Large Community • Active development – Supports all paradigms – I can understand the spec! • Options: – CDA – HL7 v2 – Bespoke – FHIR So we need to learn more about FHIR…
  • 8. Resources • “Resources” are: – Small logically discrete units of exchange – Defined behaviour and meaning – Known identity / location • (usually) – Smallest unit of transaction – “of interest” to healthcare Page 9 • HL7 New Zealand 9
  • 9. Page 10 • HL7 New Zealand
  • 10. Structure of a Resource Page 11 • HL7 New Zealand Resource Metadata Narrative Elements Extensions Extensions
  • 11. Page 12 • HL7 New Zealand
  • 12. Resource as a bag of DataTypes Page 14 • HL7 New Zealand
  • 13. References between resources Page 15 • HL7 New Zealand
  • 14. Other things about resources • Profiles and Extensions • Collections (bundles) – Query result – Transactions – Documents – Messages • Versioning • Tools – XML Editor – REST client – Libraries – Test Servers 33, v12 – 2012-12-04 33, v13 – 2012-12-05 33, v14 – 2012-12-08 Page 16 • HL7 New Zealand Patient/33/_history/12 Patient/33/_history/13 33, v15 – 2012-12-09 Patient/33/_history/14 Patient/33/_history/14 Patient/33
  • 16. 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 Page 18 • HL7 New Zealand
  • 17. Main Clinical resources (DSTU-1) • Observation • Condition (Problem) • DiagnosticReport • MedicationPrescription (and others) • AdverseReaction / AllergyIntolerance • Immunizations / ImmunizationRecommentation • CarePlan • Questionnaire / QuestionnireAnswers • Alert Page 20 • HL7 New Zealand
  • 18. Important Supporting Resources • Patient • Practitioner • List • Encounter / EpisodeOfCare • Order / OrderResponse • DocumentReference • Provenance Page 21 • HL7 New Zealand
  • 19. Resources to come (DSTU-2) • Appointment / AppointmentResponse / Availability / Slot / HealthcareService • Assessment • ReferralRequest • ContraIndication • RiskAssessment Page 22 • HL7 New Zealand
  • 21. Finding external documents (XDS-ish) Page 24 • HL7 New Zealand
  • 22. Local notes • Encounters • EpisodeOfCare • Observations • Conditions • Assessment • Lots of clinical resources Page 25 • HL7 New Zealand
  • 23. 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. Page 26 • HL7 New Zealand Encounter Condition Observation Med Adv Rean. Allergy 5 year old boy Patient
  • 24. Looking at the relationships Page 27 • HL7 New Zealand
  • 25. 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’ Page 28 • HL7 New Zealand
  • 26. Scheduling patients • Appointment / AppointmentResponse • Availability • Slot • HealthCareService • Recalls (care plan) • Alerts Page 29 • HL7 New Zealand
  • 27. Ordering stuff • Order / OrderResponse • Detailed resources in request – MedicationPrescription – DiagnosticOrder – Referral Page 30 • HL7 New Zealand
  • 28. Medications • Medication • MedicationPrescription – Order / OrderResponse • MedicationAdministration – Provenance • MedicationDispense • MedicationStatement • AllergyIntolerance • ContraIndication Page 31 • HL7 New Zealand
  • 29. Viewing investigations • Diagnostic report • Imaging Study • Specimen • Attachment Page 32 • HL7 New Zealand
  • 30. Decision Support • ContraIndication • AllergyIntolerance • Alert • OperationDefinition • ImmunizationRecommendation Page 33 • HL7 New Zealand
  • 31. Doing things to people • Procedures • Specimen • DiagnosticReport Page 34 • HL7 New Zealand
  • 32. Referrals • Order/OrderResponse • ReferralRequest – Many resources as content Page 35 • HL7 New Zealand
  • 33. Data collection • Forms – Questionnnaire / QuestionnaireAnswers • Free form Page 36 • HL7 New Zealand
  • 34. Creating a summary document • ddd Page 38 • HL7 New Zealand
  • 35. 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 Page 39 • HL7 New Zealand
  • 37. Purpose of Clinical Connectathon • Resource coverage • Resource detail • Patterns of use – Eg condition vs observation Page 43 • HL7 New Zealand http://198.199.94.37:9001/main.html
  • 38. Winding Up • FHIR is fit for (clinical) purpose – Guide in the right direction • As a clinical app developer I will: – Become familiar with the spec – Interact with the community – Play with the test servers – Play with the Clinical Connectathon tooling – Get started! Page 44 • HL7 New Zealand Thanks for listening!

Editor's Notes

  1. What clinicians need to know about FHIR
  2. Requirements – assume that want to get data (including docs) from external services & contribute to those repos
  3. Implementers: Specification is written for one target audience: implementers Rationale, modeling approaches, etc. kept elsewhere Multiple reference implementations from day 1 Publicly available test servers Starter APIs published with spec Delphi, C#, Java – more to come Connectathons to verify specification approaches Instances you can read and understand  Lots of examples (and they’re valid too) -------- Web tech XML, JSON, Atom, api’s like google, twitter security – Oauth, SSL,
  4. To understand FHIR, you need to think in resources
  5. Concept of resource as building block Narrative extensions
  6. How to read the spec
  7. From perspective of Clinician (not population) Managed lists : when empty
  8. Not all of them – the ones that clinicians should be familiar with
  9. Needed to support clcinial activity
  10. Export and import