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Vitalis 2016 FHIR Introduction

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Morning session at Vitalis 2016 - giving a high-level overview of the why what and how of HL7 and FHIR. These slides combine background information on the principles that shaped FHIR and the components of FHIR.

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Vitalis 2016 FHIR Introduction

  1. 1. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Introduction to HL7® FHIR® Ewout Kramer FHIR Core team (and software developer) Furore (Amsterdam, NL) email: e.kramer@furore.com web: http://thefhirplace.com http://fhir.furore.com skype: ewoutkramer
  2. 2. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  3. 3. © 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. 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. Relative – No technology can make integration as fast as we’d like That’s why we’re here Building blocks – more on these to follow The Acronym
  5. 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.
  6. 6. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. HL7 v2.0
  7. 7. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. ? HL7 v3
  8. 8. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Focus on implementers Keep common scenarios simple Leverage existing technologies Make content freely available Invoke the community
  9. 9. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. If your neighbour 's son can’t hack an app with <your technology X> in a weekend….. you won’t get adopted Focus on implementers..
  10. 10. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. THE RISE OF THE API Background 10
  11. 11. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Your “Mobile” device becomes the Big Aggregator and Coordinator of data and functionality What I want from my healthcare app
  12. 12. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The API economy 12 Where companies expose their (internal) digital business assets or services in the form of (web) APIs to third parties with the goal of unlocking additional business value through the creation of new assets
  13. 13. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 3rd-party becomes the norm 13
  14. 14. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 2012 The Rise of the API 2016
  15. 15. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. So what about HL7 & FHIR?  With FHIR, HL7 joins the ranks of the API troopers.  But other than Twitter, Facebook etc. HL7 has no “services” or “functionality” to offer  FHIR is just a set of flexible standardized models and best- practices that others can use to create healthcare API’s  3rd-party (app/software) developers can then seamlessly connect to your FHIR API.
  16. 16. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. App marketplace…
  17. 17. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. NO: Region Helse-Vest
  18. 18. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. EHR Vendors…
  19. 19. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. COMPONENTS OF FHIR In-Depth
  20. 20. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Divide health care data in discrete “building blocks” MedicationPrescription Problem A FHIR ‘Resource’ • Cover “the 80%” • Unit of exchange • Maintained & documented independently • Have a textual description
  21. 21. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resources - example
  22. 22. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example – Patient Resource References to other Resources
  23. 23. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. References between resources A web of resources that can tell any story
  24. 24. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 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 changed to erythromycin and advised not to take penicillin in the future. Condition Observation Med Allergy Encounter 5 year old boy Patient
  25. 25. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource view
  26. 26. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Extending Patient References to other Resources Yes, but where are: • citizenship • mothersmaidenname, • us-core-race Don’t worry, you can add extensions: your own elements – FHIR even defines a few favorite ones!
  27. 27. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. + = Cover the 80% out of the box… Everyone needs extensions… Simple choice – design for absolutely everything or allow extensions Everyone needs extensions, everyone hates them!
  28. 28. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Anatomy 28
  29. 29. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Anatomy 29
  30. 30. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Exchange Patterns 30 REST Documents Messages Services (API)
  31. 31. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. REST:“Repository” model of healthcare Hospital System Create Record Create Encounter FHIR server Patient Observation Patient Patient Order Observation Observation Diagnostic Report Notify new Lab results Update Patient data Lab System Post Lab resultQuery Lab orders
  32. 32. © 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 Messages 32  Used to inform or instruct  Patient Admitted  Lab result available  Similar to v2 messaging
  33. 33. © 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 Documents 33  Use for ‘point in time’ record  Discharge Summary  Referral  Similar to CDA
  34. 34. © 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 Repository Regardless of paradigm, the content is the same Lab System FHIR Message FHIR Document National Exchange
  35. 35. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 35 Questions? (and then small break!)
  36. 36. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. WHY (UNIVERSAL) STANDARDIZATION IS HARD 36
  37. 37. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 1st: Ego’s
  38. 38. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 2nd: Cost “Communicate first, standardize later” “I need to be ready next month” “Standardize first, communicate later” “This needs to be done right, takes time” CHAOS? “He who ships code, wins”
  39. 39. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Interoperability  Interoperability: A model is agreed to that allows all systems to exchange what needs to be exchanged, without requiring any design changes to the way their systems works.   Well known deficiencies of this: semantic scalability, fragmentation etc.  39
  40. 40. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Intraoperability  Rework the core structures of the systems to function in an agreed way. Because all the systems work the same way, then exchange between the systems is easy and straight forward.   Intraoperability has fewer deficiencies, but they are much bigger: it’s much harder to get agreement…  40
  41. 41. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 3rd: Different communities and timelines GP System – Uses Prescriptions Cancer Center – Uses Prescriptions Regional collaborations – share prescriptions Other regions – trying the same thing
  42. 42. © 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 can we do promote interoperability  Produce basic building blocks everyone needs. Quickly!  Cooperate with your region/countries biggest players to get them adopted  Open up a (FHIR, openEHR) registry to promote reusable profiles, patterns & practices.  Let everyone publish their specialized “dialect” of FHIR  Re-integrate when need arises (= there’s interest and money)  Promote, facilitate. Much more successful than enforcement and subsidized projects.
  43. 43. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. “… the mad dreamers who tried to build a perfect language” (terminology, information model) A history lesson…
  44. 44. © 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 PROFILING Adapting FHIR
  45. 45. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The need for profiling Need to be able to describe adaptations based on use and context  Which resources and elements are used?  Which API features are used?  Which terminologies are used?  How to map these to local requirements/implementations?
  46. 46. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Layered profiles  Country adapts a national profile  Regions or specialties may develop specialized versions of national profile  Profile with use-case specific constraints 48
  47. 47. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Constraining a resource Demand that the identifier uses your national patient identifier Limit names to just 1 (instead of 0..*) Limit maritalStatus to another set of codes that extends the one from HL7 international Add an extension to support “RaceCode” Note: hardly any mandatory elements in the core spec!
  48. 48. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Extensions 50 Note: could be JSON as well Key = location of formal definition Value = value according to definition
  49. 49. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. In v3 CDA…”text-based”
  50. 50. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. openEHR ADL …computable!
  51. 51. © 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: StructureDefinition 53 Computable expression: as a Resource, just like Patient!
  52. 52. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Adapting the API 54 FHIR ServerFHIR REST Complex Operations Read Update Search Check Drug Interaction Merge Patient Expand ValueSet Validate
  53. 53. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Conformance Conformance Resources 55 55 “Implementation Guide” Structure Definition SearchParam Definition ValueSet Concept Map NamingSystem Operation Definition Forge Excel Implementation Guide TestScript
  54. 54. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Implementation Guide Pour in your Conformance resources and add human narrative:  Functional Requirement and Use case(s)  Data definitions  Actors and Interactions  Examples  Technical Implementation Guidance  Security  Help  Contact Information 56
  55. 55. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  56. 56. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Publish! 58 Author & Store Guide Implementhttp://simplifier.net http://registry.fhir.org
  57. 57. © 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 Registry 59
  58. 58. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FUTURE PLANS 60
  59. 59. © 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 Timeline 2012 20162014 2018 2020 First Draft 2011 20152013 2017 2019 1st DSTU 2nd DSTU 3rd STU Normative First Connectathon! Update 1 Updates every 18-24 months
  60. 60. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. October 2015 – DSTU2 Conformance ValueSet, Conformance, StructureDefinition, OperationDefinition Scheduling Appointment, Schedule, Slot Workflow / PC CarePlan, Goal, Episode, Alert, Communication, ReferralRequest, DiagnosticOrder IHE XDS (MHD) DocumentReference DocumentManifest IHE PCD DeviceComponent DeviceMetric DICOM ImagingStudy, ImagingObjectSelection AuditEvent (ATNA) W3C Provenance > 1.000 requests for changes processed number of resources more or less doubled to just over 100
  61. 61. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. During the year… 63 20172016 DSTU 2 STU 3 OctMayJan Workgroup Meeting Workgroup Meeting Workgroup Meeting
  62. 62. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. October 2016 – STU3  New resources & support around:  Clinical Decision Support  Care coordination  Workflow management  Genomic data  eClaims  Provider directories  CCDA profiles  Consent management  250 requests for changes processed (so far) 64
  63. 63. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. STU?  Standard for TRIAL Use  “Regardless of the degree of prior implementation, all aspects of the FHIR specification are potentially subject to change.”
  64. 64. © 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 Maturity Model 66 Level 0: “Draft”, Just added to the spec for first review Level 1: Ready for test implementation by pilots Level 2: Pilots exist and have interoperated with in realistic scenarios Level 3: Meets quality guidelines, formal ballot resulting in changes Level 4: Tested, verified and stable. Backw. compatibility becomes a prio. Level 5: Widely implemented across scope and jurisdictions. Frozen.
  65. 65. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Going normative  Iterative process  First FMM level 4/5 in 2018  From 2018 updates every 18-24 months  More and more parts become level 4/5 67
  66. 66. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. THE FHIR COMMUNITY Background 68
  67. 67. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. We exist now! 69
  68. 68. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Where in the world? 70 2015 HAPI FHIR Test Server statistics
  69. 69. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. New products every day 71
  70. 70. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. HSPC Argonaut SMART (on FHIR) US Co-operations 72 FHIR C-CDA 1.1 FHIR Profiles (MU3) Profiles, OIDC/OAuth Services Intermountain Healthcare, Veterans Affiars, IBM, Epic, Cerner, Mayo, Kaiser, …
  71. 71. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Gartner hype cycle
  72. 72. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. At your service 74
  73. 73. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Connectathons 75
  74. 74. © 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 foundation Home of the community (not the SDO):  Implementers chats  Calender of events, webcasts  Repository of Extensions and profiles  Showcases, repo of FHIR projects  Best-practices & patterns  Open-source initiatives Located at http://fhir.org76
  75. 75. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FINALLY… 77
  76. 76. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Life on the FHIR core team
  77. 77. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Goal achieved?  It is fast to learn, implement and troubleshoot  It has a vibrant and open source community and has frequently held hackathons.  Matures because we get LOADS of feedback  Spontaneous adoption (of a standard!) 79
  78. 78. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. But…  We can only make the technology bit easier  Interoperability is hard, and is a human problem of common process and understanding  FHIR cannot fix this. And it is no silver bullet. 80
  79. 79. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 81 Questions? (and then lunch!)
  80. 80. © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 82  Tutorials  All the latest information on FHIR  Connectathon  Meet fellow developers  Put FHIR to the test  Networking  FHIR experts and authors on hand http://fhir.furore.com/devdays

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