FHIR-first development of healthcare applications

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Nikolai Ryzhikov, CTO of Health Samurai and lead of the FHIR Storage and Analytics track. Nikolai talks about the FHIR-first development of healthcare applications and the differences between using FHIR for new healthcare solutions versus interoperability

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FHIRSTFHIRST
Nikolai Ryzhikov CTO @ Health Samurai
@niquola (tw, gmail, gh)
SF FHIR; Jan 2019

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ABOUT ME & SAMURAIABOUT ME & SAMURAI
with FHIR from 2012
fhirbase (OS database)
fhir.js
fhirpath (js, clj, postgres)
storage & analytic track
[a]idbox - FHIR backend since 2015

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WHAT IS FHIR?WHAT IS FHIR?
HL7 standard
Community
Eco-system

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FHIR AS A STANDARDFHIR AS A STANDARD
Happy New normative release (ANSI)
ONC Open API (stage III)

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FHIR AS A COMMUNITY!FHIR AS A COMMUNITY!
- join now
- read more
- this weekend
chat.fhir.org
wiki.hl7.org
Connectathons
FHIR Foundation

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FHIR AS A ECO-SYSTEM!FHIR AS A ECO-SYSTEM!
More Tools: Profiling, Analytic, QA
Servers
Libraries

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FHIRFHIR
was designed for interop

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but can be used for development
FHIR FIRSTFHIR FIRST

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1. INFORMATIONAL MODEL1. INFORMATIONAL MODEL

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FHIR RESOURCEFHIR RESOURCE

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RESOURCE = DDD AGGREGATERESOURCE = DDD AGGREGATE

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FHIR RESOURCESFHIR RESOURCES

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2. TERMINOLOGY FRAMEWORK2. TERMINOLOGY FRAMEWORK

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CODED ELEMENTSCODED ELEMENTS

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BINDINGSBINDINGS

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TERMINOLOGY SERVICETERMINOLOGY SERVICE
GET [base]/ValueSet/23/$expand?filter=abdo
GET [base]/CodeSystem/loinc/$lookup?code=1963-8
GET [base]/ValueSet/23/$validate-code?system=http://loinc.org&

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3. REST API3. REST API
Search
CRUD
History
Transactions
GraphQL

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REST APIREST API
GET /Patient/_search?name=john&birthDate=lt1960
POST /Patient/
GET /Patient/pt-id
PUT /Patient/pt-id
PATCH /Patient/pt-id
DELETE /Patient/pt-id
GET /Patient/$history

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Well-designed
BACKEND SPECIFICATION!?BACKEND SPECIFICATION!?

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4. RE-USE4. RE-USE
libraries
frameworks
servers
save time & resources

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SOME PROBLEMS :(SOME PROBLEMS :(

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EXTENSIBILITYEXTENSIBILITY
closed-world-assumption

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EXTENSIONSEXTENSIONS
resourceType: Patient
extension:
- url: http://hl7.org/fhir/StructureDefinition/patient-clinica
extension:
- url: NCT
valueString: '123456789'
- url: period
valuePeriod:
start: '2009-03-14'
- url: reason
valueCodeableConcept:
coding:
- system: http://acme.org/codes/general
code: tt14j

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FIRST CLASS EXTENSIONSFIRST CLASS EXTENSIONS

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WANTEDWANTED
Name clash?
RDF & clojure - namespaced keys
resourceType: Patient
clinicalTrial:
period: '2009-03-14'
NTC: '123456789'
reason:
coding:
- system: http://acme.org/codes/general
code: tt14j

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UNIFY DEFINITION OF CORE AND EXTENSIONSUNIFY DEFINITION OF CORE AND EXTENSIONS
- resourceType: ElementDefinition
source: fhir
path: [name]
type: { id: HumanName }
resource: { id: Patient }
- resourceType: ElementDefinition
source: us-core
path: [race]
type: { id: Coding }
resource: { id: Patient }

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VERSION-LESS FHIRVERSION-LESS FHIR
releases as a package of extensions
feature detection vs versions
backward & forward compatibility

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FHIR search is complicated & limited
SQL APISQL API

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FHIR & SQL FOR RESCUEFHIR & SQL FOR RESCUE
join storage & analytic track
SELECT DISTINCT(p.id), p.resource#>'{name,0}'
FROM patient p
JOIN observation o ON o.resource#>>'{subject,id}' = p.id
WHERE (o.resource @> '{"code": {"coding": [{"code": "72166-2"}
AND ((o.resource @> '{"value": {"CodeableConcept": { "coding
OR (o.resource @> '{"value": {"CodeableConcept": { "cod
AND (extract(year from age(now(), (p.resource->>'birthDate')
AND (p.resource->>'gender' = 'male'); -- patient gender is m

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FHIRSTFHIRST
Number of Digital Health startups
Narus Health
Cleo EHR

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DIGITAL HEALTH LEGODIGITAL HEALTH LEGO

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FHIR-first development of healthcare applications

1. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 1/33 FHIRSTFHIRST Nikolai Ryzhikov CTO @ Health Samurai @niquola (tw, gmail, gh) SF FHIR; Jan 2019

2. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 2/33 ABOUT ME & SAMURAIABOUT ME & SAMURAI with FHIR from 2012 fhirbase (OS database) fhir.js fhirpath (js, clj, postgres) storage & analytic track [a]idbox - FHIR backend since 2015

3. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 3/33 WHAT IS FHIR?WHAT IS FHIR? HL7 standard Community Eco-system

4. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 4/33 FHIR AS A STANDARDFHIR AS A STANDARD Happy New normative release (ANSI) ONC Open API (stage III)

5. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 5/33 FHIR AS A COMMUNITY!FHIR AS A COMMUNITY! - join now - read more - this weekend chat.fhir.org wiki.hl7.org Connectathons FHIR Foundation

6. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 6/33 FHIR AS A ECO-SYSTEM!FHIR AS A ECO-SYSTEM! More Tools: Profiling, Analytic, QA Servers Libraries

7. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 7/33 FHIRFHIR was designed for interop

8. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 8/33 but can be used for development FHIR FIRSTFHIR FIRST

9. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 9/33 1. INFORMATIONAL MODEL1. INFORMATIONAL MODEL

10. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 10/33 FHIR RESOURCEFHIR RESOURCE

11. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 11/33 RESOURCE = DDD AGGREGATERESOURCE = DDD AGGREGATE

12. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 12/33 FHIR RESOURCESFHIR RESOURCES

13. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 13/33 2. TERMINOLOGY FRAMEWORK2. TERMINOLOGY FRAMEWORK

14. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 14/33 CODED ELEMENTSCODED ELEMENTS

15. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 15/33

16. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 16/33 BINDINGSBINDINGS

17. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 17/33 TERMINOLOGY SERVICETERMINOLOGY SERVICE GET [base]/ValueSet/23/$expand?filter=abdo GET [base]/CodeSystem/loinc/$lookup?code=1963-8 GET [base]/ValueSet/23/$validate-code?system=http://loinc.org&

18. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 18/33 3. REST API3. REST API Search CRUD History Transactions GraphQL

19. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 19/33 REST APIREST API GET /Patient/_search?name=john&birthDate=lt1960 POST /Patient/ GET /Patient/pt-id PUT /Patient/pt-id PATCH /Patient/pt-id DELETE /Patient/pt-id GET /Patient/$history

20. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 20/33 Well-designed BACKEND SPECIFICATION!?BACKEND SPECIFICATION!?

21. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 21/33 4. RE-USE4. RE-USE libraries frameworks servers save time & resources

22. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 22/33 SOME PROBLEMS :(SOME PROBLEMS :(

23. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 23/33 EXTENSIBILITYEXTENSIBILITY closed-world-assumption

24. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 24/33 EXTENSIONSEXTENSIONS resourceType: Patient extension: - url: http://hl7.org/fhir/StructureDefinition/patient-clinica extension: - url: NCT valueString: '123456789' - url: period valuePeriod: start: '2009-03-14' - url: reason valueCodeableConcept: coding: - system: http://acme.org/codes/general code: tt14j

25. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 25/33 FIRST CLASS EXTENSIONSFIRST CLASS EXTENSIONS

26. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 26/33 WANTEDWANTED Name clash? RDF & clojure - namespaced keys resourceType: Patient clinicalTrial: period: '2009-03-14' NTC: '123456789' reason: coding: - system: http://acme.org/codes/general code: tt14j

27. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 27/33 UNIFY DEFINITION OF CORE AND EXTENSIONSUNIFY DEFINITION OF CORE AND EXTENSIONS - resourceType: ElementDefinition source: fhir path: [name] type: { id: HumanName } resource: { id: Patient } - resourceType: ElementDefinition source: us-core path: [race] type: { id: Coding } resource: { id: Patient }

28. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 28/33 VERSION-LESS FHIRVERSION-LESS FHIR releases as a package of extensions feature detection vs versions backward & forward compatibility

29. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 29/33 FHIR search is complicated & limited SQL APISQL API

30. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 30/33 FHIR & SQL FOR RESCUEFHIR & SQL FOR RESCUE join storage & analytic track SELECT DISTINCT(p.id), p.resource#>'{name,0}' FROM patient p JOIN observation o ON o.resource#>>'{subject,id}' = p.id WHERE (o.resource @> '{"code": {"coding": [{"code": "72166-2"} AND ((o.resource @> '{"value": {"CodeableConcept": { "coding OR (o.resource @> '{"value": {"CodeableConcept": { "cod AND (extract(year from age(now(), (p.resource->>'birthDate') AND (p.resource->>'gender' = 'male'); -- patient gender is m

31. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 31/33 FHIRSTFHIRST Number of Digital Health startups Narus Health Cleo EHR

32. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 32/33 DIGITAL HEALTH LEGODIGITAL HEALTH LEGO

33. 1/16/2019 fhir meetup https://niquola.github.io/sﬀhir-2019-slides/?print-pdf#/ 33/33 THXTHX

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