The presentation talks about the components of FHIR, its distribution and use. Scenarios for the introduction of FHIR in the country using HL7 V3 are also offered.

1. FHIR
Igor.Bossenko@Kodality.com
20.12.2018

2. Igor Bossenko @ Healthcare
➤ Estonian Blood System “father”, architect & the only developer
-1995/2005
➤ HIS ESTER3 “father”, architect & developer - 1999/2005
➤ HIS eHL “father” & architect - 2005/2013
➤ HL7 V3 standard visioner & implementor in Estonian NHS - 2006
➤ Labscala Quality Laboratory (Finland) - 2011
➤ Lithuanian NHS visioner & FHIR standard implementor - 2014/2016
➤ FHIR community member and contributor - 2014/..
➤ Abu-Dhabi Emirate CNM (e-Prescription) - 2017/2018
➤ HIS HEDA architect - 2018/..

3. FHIR EXPERTS

4. INTEROP PROBLEM
Data belongs to patient
So your system has to export and import
INTEROP IS PAIN

5. • Technical interop
• Semantic interop

6. QUICK HX
• HL7v2
• DICOM
• HL7v3 & CDA
• OpenEHR
• FHIR (future)

7. WHAT IS FHIR
• standard
• community
• eco-system

8. WHAT IS FHIR STANDARD?
REST service specification (aka swagger)
• Search
• CRUD
• History

9. PARADIGMS
• REST*
• messaging
• documents

10. REST API
GET /Patient/_search?name=malle&name=maasikas
HTTP/1.1 200 OK
Content-Type: fhir/json;charset=utf-8
Content-Length: length
{
"resourceType": "Patient",
"name": [{
"use": "official",
"family": [ "Maasikas" ],
"given": [ “Malle"]
}],
...
}

11. FHIR RESOURCE

12. FHIR RESOURCES

13. WORKING GROUPS
• chat.fhir.org
• calls
• connectath on tracks
• wg meetings
• ballots

14. FHIR TERMINOLOGY

15. FHIR TERMINOLOGY
VALUESETS

16. EXTENSIBILITY &
PROFILING

17. FHIR PROFILE REGISTRY -
SIMPLIFIER.NET

18. FHIR COMMUNITY
• chat.fhir.org
• wiki.hl7.org
• Connectathons
• github

19. EVENTS
•☑ FHIR App Roundtable: Washington
•☑ Annual Plenary: Baltimore
•☑ FHIR DevDays: Amsterdam 14 Nov
•☑ FHIR Meetup Kiev 1 Dec
•☐ WGM: San Antonio 12 Jan
•☐ FHIR Meetup SPb 26 Jan
•☐ HIMSS: Orlando 11 Feb
•☐ FHIR Meetup @ Tallinn: XX 2019?

20. ECO-SYSTEM
• servers
• libraries
• tooling
• open-source
• …

21. SMART ON FHIR

22. CDS HOOKS

23. SELECT DISTINCT(p.id), p.resource#>'{name,0}'
FROM patient p
JOIN observation o ON o.resource#>>'{subject,id}' = p.id
WHERE (o.resource @>
-- LOINC: Smoking status
'{"code": {"coding": [{"code": "72166-2"}]}}'::jsonb)
AND ((o.resource @>
-- SNOMED: Current every day smoker
'{"value": {"CodeableConcept": { "coding": [{"code": "449868002"}]}}}')
-- SNOMED: Former smoker
OR (o.resource @> '{"value": {"CodeableConcept": { "coding": [{"code": "8517006"}]}}}'))
-- patient's age > 45
AND (extract(year from age(now(), (p.resource->>'birthDate')::date)) > 45)
-- patient gender is male
AND (p.resource->>'gender' = 'male');
FHIR ANALYTICS & BULK API
https://fbdemo.aidbox.app

24. ONC OPEN API & APPLE
HEALTH KIT

25. FHIR WORLD-WIDE
➤ US Hospital Argonaut project http://
argonautwiki.hl7.org
➤ Smart App Galery https://
apps.smarthealthit.org
➤ Possible direct access in Apple Health
App https://www.apple.com/newsroom/
2018/01/apple-announces-effortless-
solution-bringing-health-records-to-
iPhone/
➤ Google Big Data project https://
ai.googleblog.com/2018/03/making-
healthcare-data-work-better-with.html

26. FHIR IMPLEMENTORS & PILOTS
• Lithuania (NHS)
• Finland (Kanta)
• UK (NHS)
• Russia (MIAZ SPb, N3)
• Australia
• Abu-Dhabi Emirate (e-Prescription)
• ...

27. Lithuanian NHS
Lithuanian
eHealth
Information
ecosystem
NHS
Integration
layer
eHealth portal
Reports &
statistics
Medical
Image Bank
ePrescription 176 Healthcare
providers
National register
Authentification
Health
insurance fund
Social insurance
fund
Disability assessment
organization
Internet patient
registration
• #1 FHIR NHS in the world

28. Lithuanian NHS architecture
• Oracle DB
• Jboss Fuse
(OSGI, Karaf)
• Apache CXF
• OAuth
• Angular 1.x

29. Abu-Dhabi CNM
• United Arab Emirates consists
from 7 emirates
• Abu Dhabi Emirate
contributes ~60 per cent of the
GDP
• Population of Abu-Dhabi
Emirate ~2,120,700 people
• CNM - Control Narcotic
Medication
• #1 FHIR implementation in the
Gulf

30. е-Prescription (resources)

31. Blaze - FHIR server

32. projectcrucible.org
• Passed ~1700 tests
• Problems with external
libraries …

33. Extensions usage
• ~ 90% of the HL7 V3 templates in Estonia have
extensions
• ~ 60% of the resources HL7 FHIR v0.5 in Lithuania have
extensions
• 0% of HL7 FHIR resources v3.0.1 in the UAE have
extensions

34. SMART on FHIR Scopes
and Launch Context
• The rights to the organization only prescribe the prescriptions:
• user/Patient.*; user/MedicationRequest.*; user/Organization.read; user/
Practitioner.read; user/Medication.read; user/MedicationDispense.read;
• Rights for the organization of only dispensing medication:
• user/Patient.*; user/MedicationRequest.read; user/Organization.read; user/
Practitioner.read; user/Medication.read; user/Provenance.*; user/
MedicationDispense.*;
• The information about the scopes is stored in в Jasig CAS token attribute

35. FHIR MISCONCEPTIONS
• silver bullet
• FHIR is simple
• modeling is hard
• interop is hard
• => go to community

36. FHIR KNOWN PROBLEMS
• version hell
• profiling is hard
• extensibility

37. HOW TO USE FHIR?
1. inspiration
2. community
3. integration
4. internal

38. HEDA
(internal use)
•Micro-services
•Java
•Micronaut
•PostgreSQL
•Angular
•FHIR
•Open-source

39. Estonia
2006-2010
Estonia is the first country which has implemented a nationwide
electronic health record system and gives full access to its citizens.
This provides new opportunities to citizens, healthcare providers
and e-health developers
Тhe international council on medical & care compunetics
(http://recordaccess.icmcc.org/tag/portal/)
“Patient Opportunities in the Estonian Electronic Health Record System”
2019
????
Estonia is behind of Lithuania, Uzbekistan, Belarus, etc.

40. Action plan
• FHIR pilot
• FHIR read-only(?) interface to (some) current V3
services
• Make new standard in FHIR
• Take FHIR for terminology
• FHIR meet up @ Tallinn
• We will found external speakers

41. THANK YOU!
Credits to Nikolay Ryzhkov