Presentation on the use of HL7 FHIR in New Zealand delivered at the HiNZ Standards Workshop 19 November 2019.

1. NZDIGITALHEALTHWEEK2019:
STANDARDWORKSHOP
NewZealandonFHIR:
ClaudelandsEventCentre,Hamilton:November19,2019
PeterJordan,ChairHL7NewZealand

2. | Introduction
• Personal Introduction
• HL7 FHIR In a Nutshell
• Brief Answers to the Big Questions
• The Background
• Stakeholder 1: The Patient
• Stakeholder 2: The Clinician
• Stakeholder 3: The Implementer
• Stakeholder 4: The Executive
• Stakeholder 5: The Tech Titans
• Great Expectations
• Headwinds and Tailwinds
• Kiwis on FHIR
• SNOMED on FHIR
• The Time Is Right!
“Interoperability is made possible by the implementation of standards”
…Global Digital Health Partnership

3. | Personal Introduction
• Peter Jordan MSc LLB
• Chair of HL7 New Zealand
• Solution Architect at Patients First Ltd
• Member NZ Health Sector Architects Group Executive
• Co-Chair HL7 International Council and SNOMED on FHIR Terminology
Services Group
• HL7 implementer since 1993 (version 2 messaging, CDA Documents, FHIR)
• Author of NZ CDA Toolkit used in GP2GP Patient Record Transfer and NZ
ePrescription Services
• 35 years IT Industry experience

4. | In a Nutshell
• Fast Healthcare Interoperability Resources
• Latest Interoperability Standard from HL7
• Built using Web Standards (HTTP, REST, JSON,
XML, oAuth, etc.)
• Open and free to use with no restrictions
• Implementer-focused
• Supported by a large worldwide community of implementers, vendors, clinicians,
government agencies
• Platform Specification for building APIs – can be extended & constrained
• FHIR is no longer Draft Standard. It has been widely adopted for patient care and
research around the world and R4 contains normative content
• FHIR has a maturity model (FMM) that provides end-users with real data for
implementation decisions

5. | The Big Questions
Q: What is the overall objective of FHIR?
A: To improve healthcare!
Q: How might FHIR achieve this objective?
A: Disrupt Healthcare IT Standards (happened), Healthcare IT (underway) and
Healthcare itself (new focus)
Q: How Will FHIR Create Disruption?
A: Its standards-based exchange mechanism and content will facilitate API-based
data liquidity – set data free.
Q: Estimate the potential size of a FHIR-based Eco-System
A: One Trillion US Dollars!
Q: Can FHIR Succeed Where Others Have Failed?
A: See final slide!

6. | The Background
• Worldwide demand for healthcare Services rapidly
outstripping supply
• ‘Not a technology problem’ – but may only be solved
with the aid of digital technology!
• Paradigm shift from provider-centric, interventionist
systems to consumer-driven health and wellness
• New models of care and treatment – e.g. personalised
medicine based on genomics

7. | Technology Problem?

8. | The Patient
• Better involvement with health care
• It’s my health please engage me!
• Health & Wellness App of MY choice
• API based data aggregation
• Fully informed Care Teams
• Consent-based control
Moving from the Chief Surgeon Model of Care!

9. | e-Patient Dave
Yes, it DOES look like FHIR will enable Gimme
My Data...

10. | The Clinician
• Able to get more involved in system design
• Faster, more timely access to high quality data
• Increased ability for healthcare orgs to innovate
• Removal of unwieldy and unreadable paper records
(…Saturday at Waikato Hospital)
• Better decision-making…
FHIR Overview for Clinicians

11. | The Implementer
• Familiar development environment
• Software Libraries and Server Templates
• Common API v one per endpoint
• Mobile and cloud friendly
• Facilitates test-driven development
• Common data format for aggregation-based use
cases (analytics)

12. | The Executive
• Makes interoperability easier and cheaper to
achieve
• Flexible - scales well from simple to complex
• Free, unrestricted usage
• Exponential increase in market for healthcare
apps
• Large pool of implementers familiar with
underlying Internet Standards

13. | The ‘Tech Titans’

14. | Great Expectations
The HTML of Healthcare or Far Harder In Reality?

15. | Headwinds & Tailwinds
• On-Premise EHRs
• Health Sector Fragmentation
• ‘Not Invented Here’ Syndrome
• Top-Down Architectures
• Information Blocking
• Consumer Access Demand
• National Health Index
• Primary Care – Strong Integration
• National Systems
• Kiwi Spirit (Against The Wind)!

16. | Kiwis on FHIR
• Modelling Tools - ClinFHIR
• Terminology Servers – Terminz & SnoChillies
• Directory Services – Healthpoint API Gateway
• Shared Care Records – HealthOne
• Medication Management – WellApp
• National Services Architecture: nHIP
• Blogs: Hay on FHIR
https://hl7.org.nz/kiwis-on-fhir

17. |SNOMED on FHIR
• A joint project between Health Level Seven (HL7®) International and
SNOMED International (IHTSDO)
• Aim – to define best practices for the use of SNOMED CT with HL7 FHIR .
• Need to ensure that SNOMED CT is used in a consistent manner in FHIR
resources to ensure interoperability and quality of data.
• Two Streams – Terminology Binding & Terminology Services
• Information Deliverables:
– Bindings from FHIR resources to SNOMED CT concept model
– Bindings from FHIR resources to SNOMED CT value sets
– Implementation Guidance on using SNOMED CT in FHIR

18. | The Time Is Right!
Q: Can FHIR succeed where others have failed?
A: In the view of ePatient Dave – YES!
• The data flow actually works
• Creating apps using FHIR is simple enough to be worth the effort
• It can be easily extended to suit more complicated needs with
• Nobody owns it for the purposes of making money.
• Governments (e.g. USA) are in the process of mandating that FHIR
be used
• The FHIR community “really care about sick people”

19. Feb 2-7 2020 - hl7.sydney

20. | Further Information
• Any Questions?
• HL7® FHIR®… http://hl7.org/fhir/