This document provides a summary of a presentation on an introduction to HL7 FHIR basics. The presentation covers the following key points: - It introduces HL7 FHIR standards and their use for healthcare interoperability. - Resources are the basic building blocks of FHIR and support various interoperability paradigms like RESTful APIs, messaging, and documents. - FHIR adoption is growing as major organizations mandate its use and more EHR vendors support FHIR APIs. - The presentation then discusses FHIR resources, implementations, and the principles that guide FHIR including a focus on implementers and using common web technologies.

1. HL7 FHIR BASICS – SESSION 1
Introduction to Interoperability,
HL7 Standards & Principles of FHIR
14-May-2021
Presentation by Kumar Satyam

2. About the course
14-May-2021
Presentation by Kumar Satyam

3. Course Design - Thought
• Community driven.
• Focus on getting started.
• Understand the important concepts.
• Participate , learn and build along with the community.
• Continuous learning
Important : This training is conducted as a FHIR India community initiative. This
training does not substitute any official training provided by HL7.
14-May-2021
Presentation by Kumar Satyam

4. Course layout
• 5 Sessions
• Introduction to Interoperability, HL7 Standards & Principles of FHIR
• What are FHIR Restful APIs
• Understanding FHIR Resources
• FHIR Conformance & Terminology
• FHIR Implementation Considerations
• 60 – 90 minutes duration.
• Online/ Virtual
14-May-2021
Presentation by Kumar Satyam

5. What is FHIR India Community
• Open community of HL7 FHIR & Interoperability enthusiasts.
• #fhirIndia – social media tag.
• https://fhirindia.zulipchat.com/ - Discussion forum
• https://www.linkedin.com/groups/13932672/ - LinkedIn Group
10K by Dec 2021.
14-May-2021
Presentation by Kumar Satyam

6. House Keeping
• Please be on mute while the session is in progress
• Please use your full name in zoom participant's profile.
• Ask questions on zoom chat .
• Follow up & discussions on zulip.
• Everyone please ensure that you are on zulip.
https://fhirindia.zulipchat.com/#narrow/stream/272723-Training-.26.20Conferences/topic/FHIR.20Basics.20Training
14-May-2021
Presentation by Kumar Satyam

7. About Me
Kumar Satyam
• Chair Technical Committee @ HL7 India
• Member Education Advisory Committee @ HL7 International
• Interoperability Committee @Himss India
• Senior Architect – Interoperability @ Philips India
To improve Healthcare delivery in India through use of technology and
standards.
• Mail:- tc@hl7india.org
• LinkedIn :- https://www.linkedin.com/in/kumarsatyam/
• Twitter:- https://twitter.com/kr_satyam
14-May-2021
Presentation by Kumar Satyam

8. Acknowledgements & Credits
This Presentation borrows from the content of presentations by
➢Grahame Grieve
➢Lloyd McKenzie
➢Ewout Kramer
➢David Hay
➢ and other members of HL7 FHIR Community.
14-May-2021
Presentation by Kumar Satyam

9. Introducing HL7 FHIR
14-May-2021
Presentation by Kumar Satyam

10. Some FHIR related news.
• Fast Healthcare Interoperability Resources (FHIR) APIs will become widespread
by 2024
• US Information blocking regulations mandate use of HL7 FHIR.
• New Zealand’s MOH to open up national health data with FHIR
• NDHB prescribes use of FHIR Resources. NDHM uses HL7 FHIR documents
• Cloud vendors support HL7 FHIR.
• Major EHR vendors have FHIR APIs and developer portals.
• Apple HealthKit & CareKit use FHIR
14-May-2021
Presentation by Kumar Satyam

11. FHIR Adoption trend
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Presentation by Kumar Satyam

12. What is FHIR
• New Standard from HL7.
• Latest released version is R4.
• Resources are the basic building blocks
• Interoperability paradigms supported
by FHIR
• Restful API,
• Messaging,
• Documents
• Services
Specification:- https://www.hl7.org/fhir
F-Fast
H-Healthcare
I-Interoperability
R-Resources
14-May-2021
Presentation by Kumar Satyam

13. Resources in FHIR
• “Resources” are:
• Small logically discrete units of exchange
• Defined behavior and meaning
• Known identity / location
• Smallest unit of transaction
• “of interest” to healthcare
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Presentation by Kumar Satyam

14. FHIR Resource Example
http://hl7.org/fhir/summary.html#2.17.3
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Presentation by Kumar Satyam

15. Resource Guide
This page describes the
resources and their
functional intent in more
detail to assist
implementers to
understand their purpose
and scope, and their
supporting classifications.
http://hl7.org/fhir/resourceguide.ht
ml
14-May-2021
Presentation by Kumar Satyam

16. FHIR Restful API examples
• http://hapi.fhir.org/baseR4/Patient?name=test&birthdate=1983-04-01
• Get patient with name test and birthdate of 1983-04-01
• http://hapi.fhir.org/baseR4/Patient/1683887
• Get specific patient whose id is 1683887
• http://hapi.fhir.org/baseR4/Patient/
• Get All patients
*Get all Observations for a patient for a given encounter. - Homework
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Presentation by Kumar Satyam

17. APIs in Healthcare
APIs the future of Healthcare Apps ?
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Presentation by Kumar Satyam

18. Interoperability
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Presentation by Kumar Satyam

19. Covid 19
• Locked in home.
• Family in different places.
• Hunting for a bed, medicine, etc. for family, friends, colleagues, relatives.
• Essential supplies.
• Workload increase. WFH + Homework.
14-May-2021
Presentation by Kumar Satyam

20. Data needs
• Individuals
• Latest situation
• What to do in emergency?
• Am I fine?
• Data privacy & security.
• Govt.
• Optimize use of resources
• Provide accurate information.
• Predict & prepare for next.
• Maintain law & order
• Health Workers
• Patient medical history
• Personal protection
14-May-2021
Presentation by Kumar Satyam

21. Patient Data
• Early Symptoms
• Vital signs
• Monitoring of Condition
• Primary & secondary contact information
• Medical history
• Demographics
• Test results
14-May-2021
Presentation by Kumar Satyam

22. Non-Patient data
• Hospital readiness
• No. of beds
• Staff available
• Equipment availability, free & in use
• Testing centers availability
• Vaccination Slots
• Ambulance & transport
• Essential Medical supplies
• Govt. bulletin & advisory
Data from multiple domains required
*list is only indicative
14-May-2021
Presentation by Kumar Satyam

23. Current situation
Data collection & sharing at present be characterized as
Adhoc , inefficient, manual , unreliable.
14-May-2021
Presentation by Kumar Satyam

24. Desired state
• Regional & National health information grid.
• All healthcare facilities connected to nearest & relevant grids.
• Real time data available at any given point in time
• Interoperable Telemedicine & Telehealth.
• Data flowing not just from hospitals & healthcare facilities but from other
domains to build a complete profile
• Everything connected to everything relevant in a semantic interoperable way.
14-May-2021
Presentation by Kumar Satyam

25. Healthcare Continuum
Philips Healthcare Continuum Model
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Presentation by Kumar Satyam

26. What is Interoperability
Interoperability is ability of two or more systems or components to exchange
information and to use the information that has been exchanged (IEEE 1990)
- Most frequently used definition of Interoperability
14-May-2021
Presentation by Kumar Satyam

27. Types of Interoperability
• Technical Interoperability - Technology layer
• Semantic Interoperability - Data Layer
• Process & Clinical Interoperability - Human Layer
• The Institutional layer - culture, education, regulations ,incentives etc.
14-May-2021
Presentation by Kumar Satyam

28. What is a Standard
Document, established by consensus and approved by a recognized body, that
provides, for common and repeated use, rules, guidelines or characteristics for
activities or their results, aimed at the achievement of the optimum degree of
order in a given context.
• Recognized bodies : ISO, ANSI, HL7
• Examples : DICOM, SNOMED, FHIR, CDA, HL7 V2.3.1.
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Presentation by Kumar Satyam

29. Benefits of Standards
• Multiplier effect
• Avoid Vendor lock-in
• Reduce Cost
• Minimize risk
• Interoperability
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Presentation by Kumar Satyam

30. Standards and Interoperability
Combinatorial Explosion
2 nodes – 1 link
6 nodes – 15 links
100 nodes – 4950 links
Formula
Links = n(n-1)/2
n= number of nodes
The benefits of using standards increase exponentially with the number of different
systems that need to be linked.
14-May-2021
Presentation by Kumar Satyam

31. Benefits of Interoperability - Indicative
Stakeholders Benefits
Patient Care continuity, elimination of redundant testing, improved outcomes, longitudinal records, Wearables,
better privacy & security
Clinicians Faster and more accurate diagnosis, decision support tools, access to information as needed
Hospitals Administrative efficiency, eliminate paper & delays, disease registries , Clinical trials and research, avoid
vendor lock in
Insurance/payer Faster settlement, improved efficiency , fraud detection, Risk profiling
State Population health surveillance, Public health policy, strategic planning.
Vendors Standard interfaces, innovation in product, cost efficiency, level playing field exchange and repurpose health
data for innovative services
14-May-2021
Presentation by Kumar Satyam

32. HL7 Org & Standards
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Presentation by Kumar Satyam

33. Principles of FHIR
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Presentation by Kumar Satyam

34. Fundamental Principles of FHIR
• FHIR Scope and Priorities
• FHIR prioritizes implementation
• FHIR provides a flexible framework for interoperability
• FHIR keeps complexity where it belongs
• FHIR supports but does not mandate tight specifications
• Open Development and Implementation Communities
• FHIR leverages open source development principles
• FHIR is free to use
• FHIR Technology and Dependencies
• FHIR supports multiple exchange paradigms/architectures
• FHIR leverages common web technologies
• FHIR is forward and backward compatible
• Tooling requirements are mainstream and minimal
https://confluence.hl7.org/display/FHIR/Fundamental+Principles+of+FHIR
14-May-2021
Presentation by Kumar Satyam

35. The FHIR Manifesto
• Focus on Implementers.
• Target support for common scenarios.
• Leverage cross- industry web technologies.
• Require human readability as base level of interoperability.
• Make content freely available.
• Support multiple paradigms & architectures
Source : Principles of Health Interoperability_ SNOMED CT, HL7 and FHIR 3rd edition
14-May-2021
Presentation by Kumar Satyam

36. Implementer Focus
• Specification is written for one target audience: implementers (that’s not just programmers)
• Rationale, modeling approaches, etc. kept elsewhere
• Multiple reference implementations from day 1
• Publicly available test servers
• Starter APIs published with spec
• C#, Java, Pascal, Swift, more coming
• Connectathons to verify specification approaches
• Instances you can read and understand ☺
• Lots of examples (and they’re valid too)
using HL7.Fhir.Instance.Model;
using HL7.Fhir.Instance.Parsers;
using HL7.Fhir.Instance.Support;
XmlReader xr = XmlReader.Create(
new StreamRead
IFhirReader r = new XmlFhirReader
// JsonTextReader jr = new JsonTe
// new StreamRead
// IFhirReader r = new JsonFhirRe
ErrorList errors = new ErrorList(
LabReport rep = (LabReport)Resour
Assert.IsTrue(errors.Count() == 0
14-May-2021
Presentation by Kumar Satyam

37. Support “Common” Scenarios
• Inclusion of content in core specification is based on “80%” rule
• Only include data elements we are confident that most (~80%) of normal
implementations using that resource will make use of
• Other content in extensions
• Easy to say, governance challenge to achieve
• Resources are simple and easy to understand & use
14-May-2021
Presentation by Kumar Satyam

38. Won’t extensions break interoperability?
• The 80% + narrative helps provide “base” interoperability
• For “robust” interoperability
• Profile – constrains structure
• Conformance – constrains behavior
• Needed to claim “I’m FHIR conformant”
14-May-2021
Presentation by Kumar Satyam

39. Web technologies
• Instances shared using XML & JSON
• Web calls work the same way they do for Google & Twitter
• Rely on HTTPS, OAuth, etc. for security functions
• Benefits
• Cross-Industry standards
• Well supported by tools
• Understood by developers
14-May-2021
Presentation by Kumar Satyam

40. Human Readable
• Clinical Documents has both narrative and data
• The data / narrative dynamic exists throughout the process
• In FHIR, every resource can (should)
have a human-readable expression
• Can be direct rendering or human entered
14-May-2021
Presentation by Kumar Satyam

41. Freely available
• Unencumbered – free for use, no membership required
• http://hl7.org/fhir + other versions
• Licensed under CC0: True public domain
• Any use is allowed
• HL7 enforces the trademark protection
Business model:
• If you want to vote, you need to pay
http://hl7.org/fhir/license.html
14-May-2021
Presentation by Kumar Satyam

42. Paradigms & Architecture
• FHIR supports 4 interoperability paradigms
• REST – Lightweight, leverages web stack
• Documents – Long-term persistence
• Messages – Request/response paradigm
• Services – other SOA-based interfaces
• Regardless of approach, content stays the same
• Can leverage same models, same profiles everywhere
• FHIR makes no assumptions about the architectural design of systems.
14-May-2021
Presentation by Kumar Satyam

43. RESTful Paradigm
➢“REpresentational State Transfer” protocol
➢Represent your data as “resources”
➢Make “Resource” URI addressable
➢Use HTTP methods to perform CRUD operations
➢FHIR extends the HTTP methods for additional base operations
➢Resources may be exchanged using different formatted representations
▪ XML, JSON, etc.
14-May-2021
Presentation by Kumar Satyam

44. Maturity levels
• Intended to indicate level of stability
• Draft 0
• FMM1 – Resource is “done”, no build warnings
• FMM2 – Tested at approved Connectathon
• FMM3 – Passes QA, has passed ballot
• FMM4* – Tested across scope, published, prototype implementation
• FMM5* – 5 distinct production implementations, multiple countries, 2
• Normative - the artifact is now considered stable
• Non-compatible changes at level 4 and 5 will face increased hurdles
14-May-2021
Presentation by Kumar Satyam