Nikolai Ryzhikov, CTO of Health Samurai and lead of the FHIR Storage and Analytics track. Nikolai talks about the FHIR-first development of healthcare applications and the differences between using FHIR for new healthcare solutions versus interoperability

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FHIRSTFHIRST
Nikolai Ryzhikov CTO @ Health Samurai
@niquola (tw, gmail, gh)
SF FHIR; Jan 2019

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ABOUT ME & SAMURAIABOUT ME & SAMURAI
with FHIR from 2012
fhirbase (OS database)
fhir.js
fhirpath (js, clj, postgres)
storage & analytic track
[a]idbox - FHIR backend since 2015

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WHAT IS FHIR?WHAT IS FHIR?
HL7 standard
Community
Eco-system

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FHIR AS A STANDARDFHIR AS A STANDARD
Happy New normative release (ANSI)
ONC Open API (stage III)

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FHIR AS A COMMUNITY!FHIR AS A COMMUNITY!
- join now
- read more
- this weekend
chat.fhir.org
wiki.hl7.org
Connectathons
FHIR Foundation

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FHIR AS A ECO-SYSTEM!FHIR AS A ECO-SYSTEM!
More Tools: Profiling, Analytic, QA
Servers
Libraries

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FHIRFHIR
was designed for interop

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but can be used for development
FHIR FIRSTFHIR FIRST

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1. INFORMATIONAL MODEL1. INFORMATIONAL MODEL

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FHIR RESOURCEFHIR RESOURCE

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RESOURCE = DDD AGGREGATERESOURCE = DDD AGGREGATE

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FHIR RESOURCESFHIR RESOURCES

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2. TERMINOLOGY FRAMEWORK2. TERMINOLOGY FRAMEWORK

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CODED ELEMENTSCODED ELEMENTS

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BINDINGSBINDINGS

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TERMINOLOGY SERVICETERMINOLOGY SERVICE
GET [base]/ValueSet/23/$expand?filter=abdo
GET [base]/CodeSystem/loinc/$lookup?code=1963-8
GET [base]/ValueSet/23/$validate-code?system=http://loinc.org&

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3. REST API3. REST API
Search
CRUD
History
Transactions
GraphQL

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REST APIREST API
GET /Patient/_search?name=john&birthDate=lt1960
POST /Patient/
GET /Patient/pt-id
PUT /Patient/pt-id
PATCH /Patient/pt-id
DELETE /Patient/pt-id
GET /Patient/$history

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Well-designed
BACKEND SPECIFICATION!?BACKEND SPECIFICATION!?

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4. RE-USE4. RE-USE
libraries
frameworks
servers
save time & resources

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SOME PROBLEMS :(SOME PROBLEMS :(

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EXTENSIBILITYEXTENSIBILITY
closed-world-assumption

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EXTENSIONSEXTENSIONS
resourceType: Patient
extension:
- url: http://hl7.org/fhir/StructureDefinition/patient-clinica
extension:
- url: NCT
valueString: '123456789'
- url: period
valuePeriod:
start: '2009-03-14'
- url: reason
valueCodeableConcept:
coding:
- system: http://acme.org/codes/general
code: tt14j

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FIRST CLASS EXTENSIONSFIRST CLASS EXTENSIONS

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WANTEDWANTED
Name clash?
RDF & clojure - namespaced keys
resourceType: Patient
clinicalTrial:
period: '2009-03-14'
NTC: '123456789'
reason:
coding:
- system: http://acme.org/codes/general
code: tt14j

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UNIFY DEFINITION OF CORE AND EXTENSIONSUNIFY DEFINITION OF CORE AND EXTENSIONS
- resourceType: ElementDefinition
source: fhir
path: [name]
type: { id: HumanName }
resource: { id: Patient }
- resourceType: ElementDefinition
source: us-core
path: [race]
type: { id: Coding }
resource: { id: Patient }

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VERSION-LESS FHIRVERSION-LESS FHIR
releases as a package of extensions
feature detection vs versions
backward & forward compatibility

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FHIR search is complicated & limited
SQL APISQL API

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FHIR & SQL FOR RESCUEFHIR & SQL FOR RESCUE
join storage & analytic track
SELECT DISTINCT(p.id), p.resource#>'{name,0}'
FROM patient p
JOIN observation o ON o.resource#>>'{subject,id}' = p.id
WHERE (o.resource @> '{"code": {"coding": [{"code": "72166-2"}
AND ((o.resource @> '{"value": {"CodeableConcept": { "coding
OR (o.resource @> '{"value": {"CodeableConcept": { "cod
AND (extract(year from age(now(), (p.resource->>'birthDate')
AND (p.resource->>'gender' = 'male'); -- patient gender is m

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FHIRSTFHIRST
Number of Digital Health startups
Narus Health
Cleo EHR

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DIGITAL HEALTH LEGODIGITAL HEALTH LEGO

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THXTHX