Future Directions:
FHIR in New Zealand
(a personal opinion)
Dr David Hay
Chair HL7 New Zealand
Orion Health Product Strate...
Agenda
• Interoperability Architecture
• Progress
• (possible) place for FHIR

Page 2 • Copyright © 2013 Orion Health™ gro...
Interoperability Reference Architecture
Interoperability Reference Architecture
• Developed at the end
of 2011
• Supporting the Vision
– A patient
focused, integr...
Health Information Exchange

Regional Data
Store

FHIR Resources

FHIR
REST/Service

Clients:
Browser
Other system (HSA, G...
Progress since then
• Some completed projects
–
–
–
–
–

GP2GP
eReferrals
ePrescribing
Canterbury eSCRV (Shared repository...
Where FHIR could make a difference
Possible Use Cases for FHIR
• Will consider 3 possible scenarios for FHIR
– Identity Service
– XDS Document Registry / Rep...
Quick techie summary
• Examples using REST
– Real time interaction
– Would use messaging / documents where appropriate

• ...
1. Identity Service
• Existing Patient and Provider Registries
– Patient identity Service
• National Health Identifier (NH...
Architecture

Page 11 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Identity Service: possible FHIR interfaces
• Resource
– Use Patient resource with extensions (Iwi, Hapu...)

• Interfaces
...
2. Document Registry: IHE XDS
• An architecture to support distributed document repositories within an
‘affinity domain’ m...
The standard IHE Model

Page 14 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
Document Registry: FHIR Equivalent

Page 15 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
3. My List of Medicines
• Key importance of a common view of current medications and
medication history
• Some existing in...
Big Picture
Resources
• Medicine
• MedicationPrescription
• MedicationDispense
• MedicationAdministration

• Order
• Prove...
Interactions / Use Cases: Examples
• Get current list of medications (MLOM)
– GET /Patient/<patient ID>/List?code=meds (if...
Local Activity
• Vendors
– Orion Health
• Putting significant resources into FHIR developments
• Attendance at connectatho...
Conclusion
• The ‘shared repository’ model is established in NZ
• FHIR
–
–
–
–

Adds missing parts (especially the transpo...
www.orionhealth.com
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Ihic preso v2

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My presentation to the recent IHIC conference in Sydney, Australia with some personal thoughts on how FHIR could be valuable in the New Zealand context

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  • To change the image on this slide: Right click on the slide and select ‘Format Background’ In the ‘Fill’ Section, select ‘Picture or Texture Fill’ Click on ‘Insert from File’, navigate to the appropriate picture (corporate imagery can be found in the ‘Stock Images’ folder on the OMC at http://omc) and choose an appropriate image The background graphic will changeDo not click on ‘Apply to All’Do not select ‘Tile picture as texture’Please note: Product presentations must use medical images - landscapes can only be used in corporate presentations
  • Common Content ModelPatient, Problem, Allergy, ProcedureCore plus local (national) extensionsCommon RepresentationXML or JSON of resourceSmall number of regional repositoriesSynchronization between themReal time access for Patient Care Via web serviceCould support Messaging update &amp; queryWhen direct access not available
  • Profile: A Resource Profile - a statement of use of one or more FHIR Resources. It may include constraints on Resources and Data Types, Terminology Binding Statements and Extension Definitions.
  • Talk about secority
  • Ihic preso v2

    1. 1. Future Directions: FHIR in New Zealand (a personal opinion) Dr David Hay Chair HL7 New Zealand Orion Health Product Strategist October2013
    2. 2. Agenda • Interoperability Architecture • Progress • (possible) place for FHIR Page 2 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    3. 3. Interoperability Reference Architecture
    4. 4. Interoperability Reference Architecture • Developed at the end of 2011 • Supporting the Vision – A patient focused, integrated healthcare model, based on shared care • Scope of document – An architecture for inter-system exchange of Health Information Page 4 • Copyright © 2013 Orion Health™ group of companies • All rights reserved • 3 Pillars – CDA documents as units of exchange – XDS as the registry/repository infrastructure – openEhr Archetypes as models
    5. 5. Health Information Exchange Regional Data Store FHIR Resources FHIR REST/Service Clients: Browser Other system (HSA, GP PMS) Page 5 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    6. 6. Progress since then • Some completed projects – – – – – GP2GP eReferrals ePrescribing Canterbury eSCRV (Shared repository Clinical Data) Auckland testsafe (Shared Lab data) • Currently developing CDA ‘profiles’ – Highly constrained – Common templates – Medications & Allergies • XDS – Recent EOI – Not actual users at the moment • Archetypes – Pilot using CKM for medications (Thanks to Ocean Infomatics) Page 6 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    7. 7. Where FHIR could make a difference
    8. 8. Possible Use Cases for FHIR • Will consider 3 possible scenarios for FHIR – Identity Service – XDS Document Registry / Repository – Master List of Medicines • High level only – Eg security/privacy not discussed • Not official NZ policy! Page 8 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    9. 9. Quick techie summary • Examples using REST – Real time interaction – Would use messaging / documents where appropriate • HTTP Verbs (CRUD) – – – – – POST: Create GET: Retrieve (specific resource & search) PUT: Update DELETE: Deactivate OPTIONS: Conformance • Profiles – Statement of use • Conformance – What can a server support • FHIR supporting an ecosystem Page 9 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    10. 10. 1. Identity Service • Existing Patient and Provider Registries – Patient identity Service • National Health Identifier (NHI) • First established in 1993 • Recently re-platformed – IBM Initiate – Exposing some web services – Provider Identity Service • Health provider Identifier (HPI) • Part of the NHI re-platforming • Why FHIR – Simple lookup (90% of use) – Increase uptake – especially in community care • Current progress – Just an idea Page 10 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    11. 11. Architecture Page 11 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    12. 12. Identity Service: possible FHIR interfaces • Resource – Use Patient resource with extensions (Iwi, Hapu...) • Interfaces – Find (search for) a patient • GET /patient?name=eve – Get details for a known patient • GET /patient?identifier=PRP1660 – Notify of updates • PUT /patient?identifier=PRP1660 – Likely have workflow not direct update – Register new patient • POST /patient – Likely have workflow not direct update Page 12 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    13. 13. 2. Document Registry: IHE XDS • An architecture to support distributed document repositories within an ‘affinity domain’ managed by a single registry/index – Allows repositories to maintain stewardship with common governance – A number of existing repositories – Many ways to extend if needed • Well accepted internationally • In NZ, we only need 1 Registry – And we already have the Identity registry • Why FHIR – – – – ‘Native’ XDS interfaces are complex. FHIR interfaces are simpler to implement Other deployment possibilities Resource tags for fine grained privacy Other functionality – eg Notifications, Audit trail to consumers • Current progress – Current project to develop pilot Page 13 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    14. 14. The standard IHE Model Page 14 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    15. 15. Document Registry: FHIR Equivalent Page 15 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    16. 16. 3. My List of Medicines • Key importance of a common view of current medications and medication history • Some existing infrastructure – Testsafe & eSCRV (Auckland & Christchurch) with dispensing data – Is an ePrescribing pilot • Why FHIR – CDA model is complex – especially with local extensions – No obvious alternative transport (other than CDA documents via XDS) • Current progress – Concept of the shared repository of medication data well established – Working on model for medications • Archetypes – CDA templates for medications • Constrained to our models • Mapped to FHIR resources (experimental) Page 16 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    17. 17. Big Picture Resources • Medicine • MedicationPrescription • MedicationDispense • MedicationAdministration • Order • Provenance • List Page 17 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    18. 18. Interactions / Use Cases: Examples • Get current list of medications (MLOM) – GET /Patient/<patient ID>/List?code=meds (if you have the patient ID) – GET /List?code=meds&subject.identifier = <identifier> (if you don’t) • Update the MLOM – PUT /List/<listID> (with an updated List) • Get history of changes to the MLOM – GET /List/<listID/_history • Get all dispensings – GET /MedicationDispense?patient=<patient ID> • Get all administrations • • GET /MedicationAdministration?patient=<patient ID> Prescribe • POST /Order (Containing MedicationPrescription in Order) Page 18 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    19. 19. Local Activity • Vendors – Orion Health • Putting significant resources into FHIR developments • Attendance at connectathons • XDS interfaces • Mobile Medication Administration project – Sysmex • Attendance at connectathons • XDS interfaces • Lab Order interfaces • HINZ 2014 Developer challenge – Encourage innovative development, especially new entrants – Encompass connectathon concept – In planning stage now... Page 19 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    20. 20. Conclusion • The ‘shared repository’ model is established in NZ • FHIR – – – – Adds missing parts (especially the transport & query) Much easier to implement Enables the ecosystem Enables the patient • Progressing with a number of pilot implementations – XDS – Some internal projects • HINZ Developer Challenge • Shameless self-promotion – www.fhirblog.com Page 20 • Copyright © 2013 Orion Health™ group of companies • All rights reserved
    21. 21. www.orionhealth.com

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