Furore devdays 2017- fhir and devices - cooper thc2

1. FHIR® is the registered trademark of HL7 and is used with the permission of HL7. The Flame Design mark is the registered trademark of HL7 and is used with the permission of HL7.
Amsterdam, 15-17 November | @fhir_furore | #fhirdevdays17 | www.fhirdevdays.com
Using FHIR to Connect Devices & Apps: How hard can it be?!
Todd Cooper, Chief Instigator, Devices on FHIR (DoF) Initiative

2. Devices?
 Which exactly are we talking about?

3. What ”devices” are we talking about?
 Hospital / Acute Care Contexts
Source: West Health
 Point-of-Care Devices (PoCD)
 Monitors, ventilators, pumps …
 Scale from Simple to Complex
 “Professional” Users
 STU3 Ready!

4. What ”devices” are we talking about?
Structure
H.811 H.812 H.813
H.810
Structure
H.811 H.812 H.813
H.810
 Home / Mobile Care Contexts
 Personal Health Devices (PHD)
 BP & Temp., PulseOx, weighing
scale, urine analyzer, …
 Relatively Simple (a few parameters)
 “Personal” Users
 STU3++ => R4

5. What ”devices” are we talking about?
 Spans home to hospital contexts
 Wearables + IoT + Cloud + …
 Physio parameters +
environmental + patient
generated + …
 Mostly simple … but Billions of them!
 Personal & Professional Users
BYOMD … Minituration ... Commoditization ...
“The new monitor, which will be the size of a small

6. Device considerations …
 Consumer vs. “Professional”: volume & $$$ … inverse relationship
 Regulated medical devices vs. non-regulated health devices
 Health Devices vs. Health Software …
 NOTE: Definition & regulation `
continues to be a moving target …

7. So … what’s the big deal?
 The value for integrating device-sourced content

8. Value of Integrating Device Information
 Devices represent Islands of Information …
100’s of parameters / PoCD device
 Today: Expensive, complex & “brittle” integration
 FHIR-based device info opens doors for new apps …
 Minimized content flows
 Supports “flowsheet” applications
 Streaming vs. On-demand Access
 Knowledge-driven: Give me everything!
 Analytics, decision support, machine learning,
AI, precision medicine, etc.
 Goal: Democratized Access to Granular Dev Info

9. Example: CDS Demo @ HIMSS’16 (Cognitive & HSPC)
real-world clinical problems today and enabling more elaborate capabilities in the future.
Healthcare will eventually experience the same standardization of services that
revolutionized the banking, airline, retail, manufacturing and e-commerce industries. This
HSPC demonstration illustrates how standards, open architecture and collaborative research
can make advanced cognitive support at the bedside a reality. The general system
architecture is depicted below.
 Use Case: Transient, but clinically
significant (suboptimal) drops in
systemic blood pressure that
correlate with each metoprolol
administration
?
Devices on FHIR!

10. User
Activity
Treatment
Environment
Community
CC
PrecisionHealth
Management
ByOrganic
PopulationCluster
+
ByIndividual
Personalized
Medicine
ORGANIC ANALYSIS with
HYBRID DEEP LEARNING
TECHNOLOGY &
NEURAL NETWORKS
CLOUD-BASEDSOLUTIONfor PAYORS
&RISK-SHARINGPROVIDERS

11. Goal: Consistent Device Semantics
 Regardless of the source protocol or transport

12. Road to Consistent Device Semantic Content
 5 Standards-based Device Interoperability paths:
1. IHE PCD: Device content over HL7 V2.6 “transport”
2. PCHAlliance / Continua: Device content over IEEE 11073 PnP + BT/USB/…
3. OR.net / OpenSDC: Device content over SOAP-based messaging
4. MDPnP: Device content over OMG DDS
5. DoF: Device content over HL7 FHIR
 Device Content: All based on ISO/IEEE 11073 Semantics
 Terminology specialized for health devices
 Information model specialized for device architectures

13. 11073 “MDC” Device Info Model (highly simplified!)
Physical Top-Level Device Info (ID, H/W & S/W versions, battery …)
Medical Device
System (MDS)
Virtual Medical
Device (VMS)
Channel
Metric
Device Subsystem Info (BP, ECG, temp …)
Related Parameter Group Info (ECG Channel #1, #2, #3, …)
Parameter Metadata Info (Datatype independent info, e.g. period)
1..*
1..*
1..*
Numerics /
Enumerations /
Waves
1..1
Parameter Info (Value + datatype-specific elements)
Defined in ISO/IEEE 11073-10201 & 11073-20601

14. 11073 “MDC” PoCD Model FHIR Mapping (current)
Medical Device
System (MDS)
Virtual Medical
Device (VMS)
Channel
Metric
(Abstract)
Numerics /
Enumerations /
Waves
1..*
1..*
1..*
1..1
Device
Patient
Observation
DeviceComponent
(MDS Profile)
DeviceComponent
(VMD Profile)
DeviceComponent
(Channel Profile)
DeviceMetric

15. 11073 “MDC” PHD Model FHIR Mapping (current)
Medical Device
System (MDS)
Metric
(Abstract)
Numerics /
Enumerations /
Waves
1..*
1..1
Patient
Observation
DeviceComponent
(PHD MDS Profile)

16. Devices on FHIR (DoF) Initiative
 Collaborating for a common FHIR approach to device informatics

17. Devices on FHIR (DoF) Initiative
 Initiated summer ’16 as a joint effort …
 Objective: A consistent use of FHIR to
exchange device-sourced information
 Community activities include …
 Weekly WebEx sessions
 FHIR Connectathons
 IHE DoF Plug-a-thons (PAT) [U.S. & Korea]
 Joint development & testing of profiles & IGs

18. Hollie & Danny’s Story
 Postnatal Preeclampsia (P3E) Use Case

19. Hollie & Danny’s Story … A Multi-Care Context Use Case
 Holly monitored for preeclampsia during pregnancy
 Danny delivered by emergency C-section – 4 weeks early
 Holly sent home … told to monitor BP and report back
 BP spiked at > 180 … Holly readmitted days later … with Danny
 Challenges over subsequent months resulted in readmissions & a
search for the right treatment protocol
Care Contexts: Hospital & home … PoCD & PHD devices
Epilog: Today, Holly & Danny are doing fine … finally!

20. P3E @ HIMSS’17 Demo – Hospital Component

21. P3E @ HIMSS’17 Demo – Home Monitoring Component

22. Hands-on Track: Devices
 Connecting devices and applications

23. Devices Hands-On Track
 We have devices! (both PHD and PoCD)
 Hands-on Exercises for both …
 Device data sources (either devices or simulators)
 Device data consumers – applications!
 Build up to the P3E use case
 NOTE: See Device Exercises sheet for more inforation
 Shout out to facilitators: Melanie Yeung, Stefan Karl & John Rhoads

24. Devices on FHIR: What’s next?
 After DevDays’17 …

25. Devices on FHIR (DoF): What’s next?
 Don’t miss: Melanie Yeung, Thursday @ 09:45 in Room Muhamad!
“Continua implementing FHIR”
 DoF: Finalizing PHD & PoCD IGs for December Ballot
 Detailed implementation guidance
 11073 to FHIR detailed mappings (StructureDefinitions)
 11073 terminology + LOINC & UCUM mappings
 DoF Community …
 Weekly DoF FCC meetings + devicesonfhir@lists.hl7.org
 2018 HL7 FHIR Connectathons will have DoF tracks
 2018 IHE Plug-a-thons (PAT) DoF tracks: Cleveland & Korea planned
 Moving from HL7 FHIR wiki to HL7 Confluence / Jira tools