This document discusses the potential uses of HL7 FHIR in New Zealand's healthcare system. It describes the current use of HL7 v2 and CDA standards for messaging and document sharing. It notes issues with the varying implementations of v2 and the complexity of the XDS document sharing standard. The document proposes that FHIR could provide simpler RESTful interfaces as an alternative to these standards. Specifically, it suggests FHIR could be used for shared care portals, online patient health records, identity services, and replacing existing GP to GP and ePrescribing standards. The document concludes by welcoming any questions or comments about how FHIR could be adopted in New Zealand.

1. HL7 FHIR
Potential Uses in New Zealand
PeterJordan
HL7NewZealand BoardMember
SolutionsArchitect
PatientsFirstLtd
www.patientsfirst.org.nz

2. Page 2 • HL7 New Zealand
International HIE Standards in NZ
• Up and Running…
– HL7 v2 messaging (Labs, RSD, Service Fee Claiming, ADT)
– HL7 v3 CDA (GP2GP, NZePS, interRAI)
– Clinical Data Repositories (TestSafe, eSCRV)
• Speed Bumps
– Varying, and often non-compliant, v2 implementations
– CDA hard to consume and no transport standard
– Record Locator Service slow progress (is ‘native’ XDS the right solution?)
• Green Fields...
– Shared Care Portals
– On-Line Patient Health Records
– Identity and Enrolment Services
Then came a FHIR ...

3. Page 3 • HL7 New Zealand
FHIR at the Service Station
• V2 Messaging…‘if it isn’t broken – don’t fix it’
– ‘Contained’ but deeply entrenched
– Oil and tire changes – standard code and data sets
– Hosting data in CDRs likely to drive change
• CDA…salvaged from the wreckage of the RIM
– Constrained by HISO (closed templates) and NZ CDA Toolkit
– New Wheels – RESTful Web Services
– FHIR Documents could well be CDA Release 3
• XDS...a difficult vehicle to steer
– Complex solution to sharing documents across enterprises
– FHIR attractive as a simpler facade
– http://fhirblog.com/2013/11/05/fhir-and-xds-an-overview/

4. Page 4 • HL7 New Zealand
XDS Logical View
…PIX, PDQ, SOAP…toil and trouble!

5. Page 5 • HL7 New Zealand
Where In The World is XDS?
…what else do these countries have in common?

6. Page 6 • HL7 New Zealand
FHIR and XDS…better, sooner, more convenient

7. Page 7 • HL7 New Zealand
HISO 10044 & FHIR
• Lightweight Forms Standard – Draft Version
 Every forms service has a REST web services interface.
 REST is the natural architectural style of the web. Client applications use
stateless operators to act on uniformly addressable data resources.
Resources have representations in different languages, media types and
formats to suit different clients and applications.
 Each resource is addressed with a uniform resource identifier (URI).
 Clients use the HTTP operators GET, POST, PUT and DELETE to access
resources.
 Content negotiation enables the server to return the best-fit
representation of any resource.
 Draft standard HL7 Fast Healthcare Interoperability Resources (FHIR) is
recognised as one approach to the use of REST web services.

8. Page 8 • HL7 New Zealand
FHIR Roots, New Routes
• Shared Care Portals
– RSD model doesn’t fit concepts of
• distributed, multi-disciplinary, team
• centralised Care Plan
– De-couple from Endpoint Systems
– Facilitate collection from CDRs
– Publish/Subscribe Models for Clinical Health Events
– ATOM update feeds to Team Members
• On-Line Personal Health Records (PHR)
– Remove tethering to individual PMS
– True standards-based HIE interfacing
• Identity & Enrolment Services
– Extension of Web Service interfaces to NHI and HPI
– Potential use for Enrolments (inc. Shared Care and PHRs)
– Health Programme Services

9. Page 9 • HL7 New Zealand
Further Down the Road
• GP2GP
– Electronic transfer request mechanism
– Content Model alignment to shared Clinical Data Models
– Vendor NVPs replaced with FHIR Extensions
• ePrescribing
– Standards-based Clinical Data Repository
– FHIR Profile/ openEHR Template model for ‘shredded’ data
• E-Referrals
– UK National E-Referral project using FHIR Resources
– Reunification bout contender for NZ solution?

10. Page 10 • HL7 New Zealand
Questions and Comments?
…thanks for coming!