This presentation was used for 4th session of the FHIR Basics series which talked about conformance and terminology in context of FHIR .

1. HL7 FHIR BASICS – SESSION 4
Conformance & Terminology
Kumar Satyam
https://www.linkedin.com/in/kumarsatyam/
https://twitter.com/kr_satyam
5-June-2021
Presentation by Kumar Satyam

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

3. Agenda
➢Recap
➢Conformance
➢Terminology
➢Exercise
➢Pre-work for next session
5-June-2021
Presentation by Kumar Satyam

4. 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.
5-June-2021
Presentation by Kumar Satyam

5. Glimpse of some of the community activities
✓Review and feedback digital healthcare initiatives like NDHB
✓FHIR India Connectathon – July 2020
✓NDHM FHIR Profiles
✓Concept papers
✓Education & Implementer support
✓Connect with global community
✓Projects of common interest
5-June-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
5-June-2021
Presentation by Kumar Satyam

7. Recap
5-June-2021
Presentation by Kumar Satyam

8. Fast Healthcare Interoperability Resources
5-June-2021
Presentation by Kumar Satyam

9. FHIR RESTFul Paradigm
➢“REpresentational State Transfer”
➢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, RDF,ND-JSON .
*RESTFul because loosely follows REST.
5-June-2021
Presentation by Kumar Satyam

10. Instance Level
Allows a client to retrieve the current content of a
resource, to update the content to a new state, to
delete the resource, or to see its modification
history
Type Level
Allows a client to search through the existing
resources that already exist, create a new instance
of a resource, or get the history of all changes to
resource of the type.
System Level
Allows a client to determine what functionality is
provided by the system, perform batches and
transactions across multiple resource types, and
get the history of all changes to all resources.
5-June-2021 Presentation by Kumar Satyam
FHIR Base Services

11. Resources in FHIR
• “Resources” are:
• Small logically discrete units of exchange
• Defined behavior and meaning
• Known identity / location
• Smallest unit of transaction
A resource is an entity that:
• has a known identity (a URL) by which it can be addressed
• identifies itself as one of the types of resource defined in this specification
• contains a set of structured data items as described by the definition of the resource
type
• has an identified version that changes if the contents of the resource change
29-May-2021
Presentation by Kumar Satyam

12. What is a Resource
Examples
•Patient, Practitioner, Organization
•Location, Coverage, Invoice
•AllergyIntolerance, Condition, FamilyHistory, CarePlan
•Bundle, Binary, Composition
29-May-2021
Presentation by Kumar Satyam

13. Resource Definitions
• All resources have following :
• An identity
• Meta data
• A base language
• A reference to "Implicit Rules“
29-May-2021
Presentation by Kumar Satyam

14. Domain Resource
A domain resource is a resource that:
• has a human-readable XHTML representation of the content of the resource (see Human
Narrative in resources)
• can contain additional related resources inside the resource (see Contained Resources)
• can have additional extensions and modifierExtensions as well as the defined data
(See Extensibility)
As an abstract resource, this resource is never created directly; instead, one of its
descendant resources (see List of Resources) is created.
This resource extends the base Resource. All of the
listed Resources except Bundle, Parameters and Binary extend this resource.
29-May-2021
Presentation by Kumar Satyam

15. FHIR Resource Example
http://hl7.org/fhir/summary.html#2.17.3
29-May-2021
Presentation by Kumar Satyam

16. 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

17. 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

18. Conformance
5-June-2021
Presentation by Kumar Satyam

19. Conformance
How a system works, or how it should work
Document / Describe
5-June-2021
Presentation by Kumar Satyam

20. Context
•FHIR is a standard for interoperability
Therefore:
If two systems both comply with FHIR, they’ll fully interoperate
•True or false?
•Why not?
5-June-2021
Presentation by Kumar Satyam

21. Context
5-June-2021
Presentation by Kumar Satyam
• 140+ resources
• Do all systems support all resources ?
Most Resource elements are optional
Data type components optional
Terminologies unconstrained
Then there are operations and behaviors.

22. The Need
Need to be able to describe adaptations based on use and context.
• What resources and elements are used?
• What API features are used?
• What terminologies are used?
• How to map these to local requirements/implementations?
In a structured computable way that can be basis for validation, code, report
and UI generation etc.
5-June-2021
Presentation by Kumar Satyam

23. Use of conformance
• To create implementation guides that document expected behavior
• To test that systems conform to a set of documented behavior
• To generate code for reading and writing resources, or search forms or input
screens
• Comparing implementations to see if they are compatible
5-June-2021
Presentation by Kumar Satyam

24. Categories of conformance resources
• Terminology – these resources deal with describing how terminologies are
used.
• Content – these resources describe the content of other resources. In other
specifi cations, these are sometimes called ‘profiles’ or ‘ templates’.
• Behavior – these resources describe the system operations that can or will be
used.
• Management – these resources deal with publishing an implementation guide
(a set of conformance resource.es) and specifying testable behavior.
5-June-2021
Presentation by Kumar Satyam

25. Profiling FHIR
5-June-2021
Presentation by Kumar Satyam

26. Profiling FHIR
5-June-2021
Presentation by Kumar Satyam

27. FHIR Profile
•A set of constraints on a FHIR resource
•A set of constraints on another FHIR profile
5-June-2021
Presentation by Kumar Satyam

28. Profiling a resource
5-June-2021
Presentation by Kumar Satyam
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”

29. Profiling Terminology
•Terminology Bindings
•Binding Strengths
5-June-2021
Presentation by Kumar Satyam

30. Terminology
5-June-2021
Presentation by Kumar Satyam

31. FHIR Terminology Module
5-June-2021
Presentation by Kumar Satyam
http://hl7.org/fhir/terminology-module.html

32. CodeSystem vs ValueSet
5-June-2021
Presentation by Kumar Satyam
“Code System”
“Dante’s deadly sins”
Pride
Envy
Wrath
Sloth
Avarice
Gluttony
Lust
“ValueSet”
Takes concepts from…
An enumeration
of terms
Definition of
terms
Example: SNOMED-CT Example: “Childhood diseases”

33. FHIR Terminology Module
5-June-2021
Presentation by Kumar Satyam

34. Coded Datatypes
• Code
• Just the ‘code’ itself - code system and value set are fixed
• Coding
• ‘code’ + ‘system’ (both are optional, but are both generally present)
• Plus ‘display’, ‘version’, ‘userSelected’ (also optional)
• CodeableConcept
• One or more Coding instances plus optional text
5-June-2021
Presentation by Kumar Satyam

35. Use in Resource
Let’s take a look at Patient Resource
5-June-2021
Presentation by Kumar Satyam

36. Conformance Resources
• Capability Statement
• OperationDefinition
• StructureDefinition
• Value Set
• Concept Map
• NamingSystem
5-June-2021
Presentation by Kumar Satyam

37. Pre-work for next session
5-June-2021
Presentation by Kumar Satyam
http://hl7.org/fhir/conformance-rules.html