![{
"resourceType":"Observation",
"id":"287",
"meta":{
"versionId":"2"
},
"extension":[{
"url":"http://uhn.ca/fhir/readings#context",
"valueCode":"BREAKFAST"
}],
"text":{
"div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>"
},
"status":"final",
"code":{
"coding":[{
"system":"http://loinc.org",
"code":"41604-0",
"display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer"
}]
},
"subject":{
"reference":"Patient/1"
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Uploaded byDenis Gagné
Automatable Healthcare Decisions and Workflows using FHIR®
The document discusses the Fast Healthcare Interoperability Resources (FHIR) as a standard for health data interoperability, emphasizing its benefits like central repositories, structured data, and ease of implementation. It outlines the historical context and limitations of previous standards (HL7v2 and CDA), contrasting them with the robust, modern approach of FHIR. Additionally, it highlights how FHIR facilitates workflow and decision automation in healthcare, improving clinical and operational efficiency.
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Automatable Healthcare Decisions and Workflows using FHIR®
- 1. Trisotech.com Automatable Healthcare Decisions andWorkflows Using FHIR® Ken Stevens Director of Enterprise Solutions ken@smilecdr.com Denis Gagne Chief Executive Officer (CEO), dgagne@Trisotech.com
- 2. Trisotech.com Using FHIR® Ken Stevens Directorof Enterprise Solutions ken@smilecdr.com
- 3.
- 4.
- 5. 1989: HL7v2 Lab Meds Appts Claims Lab Meds Appts Claims Site 1Site 2 OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F
- 6. HL7v2 Limitations Lab Meds Appts Claims Lab Meds Appts Claims Site 1Site 2 Limitations: ✖ Point to point ✖ Limited interoperability ✖ Expensive OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F
- 7. 2009 Meaningful Use:CDA HIE Lab Meds Appts Claims Lab Meds Appts Claims Site 1 Site 2 CDA HIE
- 8. CDA HIE Limitations Lab Meds Appts Claims Lab Meds Appts Claims Site1 Site 2 CDA Limitations: ✔ Central Repository ✖ Document oriented ✖ No structured search ✖ Not interoperable ✖ Cumbersome format HIE
- 9.
- 10. 2015: FHIR Lab Meds Appts Claims Lab Meds Appts Claims Site 1Site 2 FHIR Benefits: ✔ Central Repository ✔ Interoperable ✔ Structured data ✔ Rich query language ✔ Easy to implement
- 11.
- 12. FHIR is afree and open standard for health interoperability, based on modern approaches. It consists of: 1. A robust data model for describing health and administrative data 2. A RESTful API for interacting with that data using either JSON or XML 3. A set of open source tools to implement and test FHIR applications 4. A collection of FHIR Servers around the world that you can interact with 5. A community of implementers working together What is FHIR Five Things
- 13. FHIR places aheavy emphasis on the 80:20 rule ● 80% - Specification covers only what is needed by 80% of systems worldwide ● 20% - FHIR is easy to extend for your use cases The FHIR Manifesto Common Scenarios
- 14. FHIR is freeto use and free to contribute to ● Specification is licensed under Creative Commons CC0 ● Many tools are open source (MIT / Apache license) The FHIR Manifesto Be Open
- 15. ● Being easyto learn is critical to the success of FHIR ● Many organizations have adopted FHIR in weeks The FHIR Manifesto Be Easy to Adopt
- 16. The Data Model Theseare the building blocks of the specification, examples include: ● Patient (the person who receives healthcare) ● Encounter (a doctor’s appointment or hospital stay) ● Observation (e.g. a device reading, or lab value) ● DiagnosticReport (e.g. a whole lab or Xray report) ● MedicationPrescription (Rx for meds) FHIR defines a set of roughly 150 resources
- 18. The Data Model TheFHIR data model is freely available online
- 19. { "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of<b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" JSON Metadata Extensions Narrative Structured Data
- 20. Trisotech.com Automatable Healthcare Decisions andWorkflows Denis Gagne Chief Executive Officer (CEO), dgagne@Trisotech.com
- 21. © 2020 ObjectManagement Group Established to foster the sharing and promulgation of best-practices around modeling and sharing: • shareable pathways, • clinical pathways, • automatable clinical guidelines, and • other healthcare knowledge A robust and thriving community-of- practice of healthcare institutions, professional societies, and vendors www.BPM-Plus.org
- 22. Trisotech.com Setting some BasicTerminology Workflow Automation Decision Automation Open Standards DMN (DECISION MODEL AND NOTATION) Decision tables and logical expressions BPMN (BUSINESS PROCESS MODEL AND NOTATION) Prescriptive sequence of activities CMMN (CASE MANAGEMENT MODEL AND NOTATION) Declarative unstructured event-condition-action Technology enabled orchestration of activities, able to react to business events. Both may have humans in the loop or not. (Referred to as Knowledge Workers.) Technology enabled decisions, returning answers given some inputs.
- 23. Trisotech.com Answering the Healthcarecall to action Empowering Patients 01 Moving to Value-Based Care 02 Ensuring and Advancing Interoperability 03 Promoting Use of New Technology 04 Reducing Clinical and Administrative Burden 05
- 24. Trisotech.com Benefits of BPM+Health Automatable Clinical Decisions and Workflows Rapid access to evidence- based best practices Standardized clinical pathways Better coordination of patient care Visual story of the patient's progress Better decisions at point of care Provides data in context Better clinical and financial outcomes Improved organizational and operational efficiency
- 25. Trisotech.com Visual Story ofwhat needs to be done
- 26. Trisotech.com Created by clinicians for clinicians The model is the guideline narrative documentation The model is the guideline behavior specification The model is the guideline logic The model is the guideline automation code BPM+ Guideline Models www.Trisotech.com
- 27.
- 28. Trisotech.com Human in theloop or not Unattended (Straight Through Process) The sequence of activities is “orchestrated” by the automation engine. It does not involve humans in loop. Examples include: o medical calculators, o Scoring, o Categorization, etc. Allows elimination of mundane tasks and decisions. Attended (Human Centric Process) The sequence of activities is “orchestrated” by the automation engine. Humans can be involved to: o confirm or provide inputs, o confirm or provide outputs, o make decisions, or o carry out tasks. Allows humans to have veto power.
- 29. Trisotech.com Human in theloop or not Unattended (Straight Through Process) Attended (Human Centric Process)
- 30. Trisotech.com Modeling Best Practices Computational IndependentModel (CIM) Platform Independent Model (PIM) Platform Specific Model (PSM) SEPARATION OF CONCERNS Narrative FHIR enabled BPMN, CMMN, DMN Services Add data types and logical expressions Add bindings to specific data source
- 31.
- 32. Trisotech.com Models Unattended and Attended Services CDSHooks Card Pre-fetch FHIR enabled Services Emulates an eHR or eMR Subject Matter Expert Healthcare Professional
- 33.
- 34. Trisotech.com Conclusion • Visual storyof the patient's progress • Standardized clinical pathways • Provides data in context • Improved organizational and operational efficiency • Better coordination of patient care • Rapid access to evidence-based best practices • Better decisions at point of care • Better clinical and financial outcomes Automatable Healthcare Decisions and Workflows Using FHIR® Ken Stevens Director of Enterprise Solutions ken@smilecdr.com Denis Gagne Chief Executive Officer (CEO), dgagne@Trisotech.com