ETSU is on FHIR

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This document summarizes a student project involving Fast Healthcare Interoperability Resources (FHIR). The students' goals were to become familiar with FHIR, incorporate patient search constraints into an existing project, and participate in a FHIR code-a-thon. At the code-a-thon, the students' team created a desktop application using the .NET FHIR API and received the highest score of any academic team for their solution. The document discusses FHIR, the code-a-thon event and competition, the students' project approach and lessons learned, and resources for learning more about FHIR.

Fast Healthcare Interoperability Resources
Jalaj Nautiyal
Mark Buckner

HIT Independent Study Goals
Objectives
• Become more familiar
with FHIR
• Modify HIT course
project
– Include patient search
constraints
• Participate in
HealthCamp Code-a-thon
Plan A
• SMART on FHIR app
Plan B
• Pending & lapsed patient
immunization app
• (Create ETSU FHIR endpoint)
Plan C
• Patient immunization app
– Fetch immunization information
based on patient

What is FHIR?
Fast Healthcare Interoperability Resources
– New standard from HL7
• Result of Argonaut Project
• Currently in trial-use phase
– Facilitates efficient information transfer between
EHR systems
– Modular & flexible
• Easier to implement than previous HL7 standards
• EHR-agnostic

Resources
Clinical
– Medication
– RiskAssessment
– Immunization
Identification
– Patient
– Practitioner
– Organization
Workflow
– Encounter
– Appointment
Financial
– Claim
– PaymentNotice

Code-a-thon Preparations
• FHIR research
• Presentation at MSHA
• Formation of team
– Team WoodStove
– First collaboration
between MSHA IS team
& ETSU Computing Dept.

Team WoodStove
"O, captain! My captain!"
– Dr. Jay Jarman
MSHA representatives
– Wes Combs
– Ian Williams
– Dustin Trent
ETSU graduates
– Jalaj Nautiyal
– Mark Buckner

Locations
– Washington, D.C.
• Day 1: Hubert H. Humphrey Building (Dept. of HHS)
• Day 2: 1776 (startup incubator)
Competition
– 80+ participants
– 12 teams

Objective
– Create app to put a beneficiary’s claims data to use for
the betterment of their health
Use-cases
– Helping beneficiaries manage their health
– Allowing beneficiaries to share their data with their
providers or caregivers
– Allowing beneficiaries to donate their data for research
purposes (e.g., for patient-centered comparative
effectiveness research)

Highest score out of all
academic teams!!!
…only academic team...

Our solution
– Desktop C# app
– Wrapped .NET FHIR API
– Split team between UI &
middleware
– Alternatives
• Microsoft Azure
• Xamarin
• iPhone deception!

Other teams' solutions
– @Point of Care (1st place)
• Leveraged IBM Watson
• Complex health information visualizations
– NavHealth (tied 2nd place)
• Patient decision support system
– Uses recurring neural network algorithm
– UBeWell (tied 2nd place)
• App to improve hypertension via Medicare data

Lessons Learned
• Ad hoc team experience
• Exposure to new technologies
– Postman
• FHIR data-handling structure
– FHIR endpoints
• Communicated with several key FHIR
evangelists

FHIR's Future?
• Vendor buy-in
– Lack of incentives
• Competition
• Universal Medical ID number problem?

FHIR Resources
Documentation & information
– Official HL7 FHIR Documentation
– FHIR Wiki
– Official FHIR .NET API
– Health Intersections
• FHIR project leader’s site
Public endpoints
– FHIR Sandboxes

Thanks!
Please, direct all questions
to Jalaj Nautiyal. :)

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ETSU is on FHIR

1. Fast Healthcare Interoperability Resources Jalaj Nautiyal Mark Buckner

2. HIT Independent Study Goals Objectives • Become more familiar with FHIR • Modify HIT course project – Include patient search constraints • Participate in HealthCamp Code-a-thon Plan A • SMART on FHIR app Plan B • Pending & lapsed patient immunization app • (Create ETSU FHIR endpoint) Plan C • Patient immunization app – Fetch immunization information based on patient

3. What is FHIR? Fast Healthcare Interoperability Resources – New standard from HL7 • Result of Argonaut Project • Currently in trial-use phase – Facilitates efficient information transfer between EHR systems – Modular & flexible • Easier to implement than previous HL7 standards • EHR-agnostic

4. Resources Clinical – Medication – RiskAssessment – Immunization Identification – Patient – Practitioner – Organization Workflow – Encounter – Appointment Financial – Claim – PaymentNotice

5. The Patient Resource

6. Code-a-thon Preparations • FHIR research • Presentation at MSHA • Formation of team – Team WoodStove – First collaboration between MSHA IS team & ETSU Computing Dept.

7. Team WoodStove "O, captain! My captain!" – Dr. Jay Jarman MSHA representatives – Wes Combs – Ian Williams – Dustin Trent ETSU graduates – Jalaj Nautiyal – Mark Buckner

8. Code-a-thon Event

9. Locations – Washington, D.C. • Day 1: Hubert H. Humphrey Building (Dept. of HHS) • Day 2: 1776 (startup incubator) Competition – 80+ participants – 12 teams

10. Objective – Create app to put a beneficiary’s claims data to use for the betterment of their health Use-cases – Helping beneficiaries manage their health – Allowing beneficiaries to share their data with their providers or caregivers – Allowing beneficiaries to donate their data for research purposes (e.g., for patient-centered comparative effectiveness research)

11. Highest score out of all academic teams!!! …only academic team...

12. Our solution – Desktop C# app – Wrapped .NET FHIR API – Split team between UI & middleware – Alternatives • Microsoft Azure • Xamarin • iPhone deception!

13. Other teams' solutions – @Point of Care (1st place) • Leveraged IBM Watson • Complex health information visualizations – NavHealth (tied 2nd place) • Patient decision support system – Uses recurring neural network algorithm – UBeWell (tied 2nd place) • App to improve hypertension via Medicare data

14. Lessons Learned • Ad hoc team experience • Exposure to new technologies – Postman • FHIR data-handling structure – FHIR endpoints • Communicated with several key FHIR evangelists

15. FHIR's Future? • Vendor buy-in – Lack of incentives • Competition • Universal Medical ID number problem?

16. FHIR Resources Documentation & information – Official HL7 FHIR Documentation – FHIR Wiki – Official FHIR .NET API – Health Intersections • FHIR project leader’s site Public endpoints – FHIR Sandboxes

17. Demonstrations

18. Thanks! Please, direct all questions to Jalaj Nautiyal. :)

Editor's Notes

Goals ended up being a moving target due to the newness of FHIR (and SMART on FHIR). PLAN A What is SMART? SMART Health IT is an open, standards based technology platform that enables innovators to create apps that seamlessly and securely run across the healthcare system. Using an electronic health record (EHR) system or data warehouse that supports the SMART standard, patients, doctors, and healthcare practitioners can draw on this library of apps to improve clinical care, research, and public health. Problems encountered: Lack of support from local EHR vendors (Cerner Soarian & Epic) No support until December this year. PLAN B Issues related to missing endpoint resources implementation related immunization, immunization recommendations, patient, practitioner. It can be difficult developing on emerging technology that we have no control over… PLAN C Yahzee!
HL7 (Health Level Seven) JASON Repot -> Argonaut Project -> FHIR (result of Argonaut project) FHIR combines the best features of HL7's v2 , HL7 v3 and CDA product lines while leveraging the latest web standards and applying a tight focus on implementability. FHIR solutions are built from a set of modular components called "Resources". These resources can easily be assembled into working systems that solve real world clinical and administrative problems at a fraction of the price of existing alternatives. FHIR is suitable for use in a wide variety of contexts – mobile phone apps, cloud communications, EHR-based data sharing, server communication in large institutional healthcare providers, and much more. One of its goals is to facilitate interoperation between legacy health care systems, to make it easy to provide health care information to health care providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems. Focuses on hitting 80% of the common use cases rather than the 20% of exceptions.
6 resource categories; 90+ total resources. Top-level Categories Clinical, Identification, Workflow, Financial, Infrastructure, Conformance Clinical Allergy, Specimen, Procedure, RiskAssessment, Observation Workflow Encounter, Appointment, Order Financial Claim, PaymentNotice
1776 is a global incubator and seed fund helping startups transform industries that impact millions of lives every day—education, energy & sustainability, health, transportation and cities.
<INCOMPLETE>
MSHA guys assigned homework related to FHIR. Postman is a API testing plugin for Chrome.
History of data silos in heathcare IT industry. Meaningful Use (Stage 3 – Interoperability requirement) EHR agnostic systems

ETSU is on FHIR

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Editor's Notes