Gora Datta, CEO of CAL2CAL Corporation, HL7 International Ambassador, co-Chair of HL7 Mobile Health group, Board member of IEEE Southern California Council & Chair of IEEE Orange County CyberSecurity SIG. Gora Datta will introduce the story behind what, why & how FHIR has become alphabet of interoperability in the mobile connected digital world we live in and how emerging Mobile Health standards are helping the way to a safe and secure world.

1. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
 HL7 International Ambassador & Speaker
 (founding) Co-Chair HL7 Mobile Health
 (founding) Member Education Advisory Council
 US Delegate to ISO/TC215 Health Informatics
 ISO/TC215 Outreach & Comm. TF Chair
 Board Member IEEE Southern California Council
 Treasurer & Past Chair IEEE OC Section
 Secretary IEEE USGovt Communities of Interest
1
STATE OF MOBILE HEALTH on FHIR
https://www.linkedin.com/in/goradatta/
FHIR @ ScaleLA
June 5, 2019
GORA DATTA
 (founding) Chair IEEE SoCal CyberSecurity SIG
 Vice Chair IEEE SUSTECH2020 Conference
 Senior Member , IEEE, ACM
 US (DHHS) SENIOR HEALTH-IT SME
 SME on EHR, Quality Measures, P4P
 ICT Expert - World Bank , Asian Development Bank
 CHITO to US Physician Practices
 Group Chairman & CEO CAL2CAL Corporation

2. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
MINE, MINE & MINE!!!
 The views and opinions expressed in this talk are those of
the speaker and do not necessarily reflect the official policy
or position of any entity, agency or corporation.
 All trademarks, service marks, trade names, trade dress,
product names and logos appearing on this presentation are
the property of their respective owners. Any rights not
expressly granted herein are reserved.
 NOW, let’s take a closer look……
2

3. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 3

4. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Mobile Health – Integrated Innovation
4
Innovation
Engagement Security
Privacy
Fitness EHRs HealthcareTrust Medications Wearables
Care Providers
Patient Needs
Safety
Efficiency Guidelines
Best Practices

5. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Mobile Health Scenarios
 Caregiver on the move
 Hospitals, Clinics, Long term care, Hospice
 Patient empowerment
 Patient involvement in care process across a wide range of lifestyles, including: support for
long term conditions
 Independent living
 Assisted living drawing on a range of mobile services
 Behavioral health
 Behavioral health support anytime, anywhere
 Messaging (ranging from unsecure to secure)
 Bridging the health divide
 Public/Population Health
 Disaster Management to PH outreach
5

6. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FUEL: MOBILE REVOLUTION!
https://www.statista.com/statistics/263437/global-smartphone-sales-to-end-users-since-2007/
6

7. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FUEL: IoT REVOLUTION!
7

8. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
MOBILE HEALTH TAKES-OFF!
1. Main driver: Ever increasing global smartphone users
2. Young Customers driving the market
3. MH apps leveraging features of smartphones or tablets
 Location service
 IM
 Picture, Video
 Gyroscope
 Accelerometer
 Two-factor identification
 Biometric identification
 Payment service
4. MH apps native rather than web-based applications
5. Rise of MH app stores
6. 2nd generation mHealth applications will focus on chronic diseases
7. MH apps entering traditional (health) distribution channels
8. Evolving MH standards © Copyright CAL2CAL Corporation
8

9. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 9
APP CENTRIC VIEW OF THE WORLD

10. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 10
MOBILE HEALTH APP CHANGING TREND
Source: unknown

11. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
REFLECTION TIME!
 There are between 400,000 to 500,000 health & fitness apps
(Jan 2019)
 There are over 325,000 mobile health apps (Apr 2018)
 There are over 165,000 mobile health apps (2017)
 There are over 150,000 mobile health apps (2015-16)
11

12. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
EMERGING Mobile Health Standards
 HL7 Emerging Standards
 Consumer Mobile Health Application Functional Framework – cMHAFF
 STU – Jan 2018
 Mobile Framework for Healthcare Adoption of Short-Message Technologies
(mFHAST)
 Proposed STU – Jan 2020
 FHIRFrame
 WIP
 ISO/TC215
 Graphical Symbols/Pictorial Representation in (Mobile) Health
 IEEE 11073 family
12

13. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
HL7 cMHAFF
Standard for Trial Use
(STU since Jan 2018)
consumer Mobile Health Application
Functional Framework (cMHAFF)
13

14. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Security
mLabel
Guidance/ Certification /Localization
cMHAFF Overview
14

15. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
 Provide a framework for assessment of the common foundations of mobile
health apps
 Product Information (disclosures/transparency)
 Security
 Privacy/consent/
authorization
 Risk assessment/analysis
 Data access privileges
 Data exchange/sharing
 Usability & Accessibility
 Assessment could include attestation, endorsement, testing, voluntary or
regulatory-driven certification
 Out of scope: specific clinical content or functionality
cMHAFF Scope and Goals
15

16. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
cMHAFF Sections and App Life Cycle
App Development and Support
 Regulatory Considerations  Risk Assessment and Mitigation
 Usability Assessment  Customer Support
16
Consumer Use of App
Product
Information
Launch app,
establish account Authentication
Authorization/
consent for data
collection/ use
Data exchange/
interop
Data provenance/
authenticity
Security for data at
rest & in transit
Pairing or syncing
with user devices
Notifications and
Alerts
App and Data
Removal
Product
Upgrades
Audit

17. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
cMHAFF: U.S. & Global Industry Inspired
17
ONC ISA Task Force
and PGHD Whitepaper
on
OWASP Mobile Top 10
Security Risks
FTC/FDA/OCR Mobile App Developer Guidance Tool

18. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
cMHAFF: European Guidelines Assessed
 French mHealth Good
Practice Guidelines
 German Mobile Health
Assessment Criteria
 Andalusian App
Recommendations
 U.K. PAS277 Quality Criteria
 Finland PHR Cert Criteria
 Other EU initiatives
18

19. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR
FAST HEALTHCARE
INTEROPERABILITY RESOURCES
19
WHAT’s IN A NAME*…..
* “FHIR” name/acronym was approved by HL7 Marketing Committee (Rene, Gora & Martin) on 2011/10/04

20. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
HL7 101
 HL7 International: ANSI.ORG accredited SDO (standards
development organization) – founded in 1987
 Four “categories” of standards [Gora’s oversimplification!]
 Messaging (v2, v3)
 Documents (CDA: clinical document architecture]
 Functional Model (EHR-System FM, PHR-S FM)
 Services (SOA, FHIR)
+
…..and some more [RIM, Data types, vocabularies/terminologies…..]
20

21. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
HL7 “FHIR” to the rescue! [9/2011]
 FHIR R4 – a Normative Standard: www.hl7.org/fhir
 FHIR is a healthcare information exchange standard that makes use of
an HL7-defined set of “resources” to support information sharing by a
variety of means, including documents, messages, services and
RESTful interfaces (aka APIs).
 FHIR defines resources for clinical and administrative content (e.g.
Observation, Patient, etc.) as well as resources for “infrastructure”
purposes.
 FHIR specification describes a set of resources, frameworks
and APIs
21

22. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
What is REST?
Representational State Transfer
22
Definition:
REST is intended to evoke an image of
how a well-designed Web application
behaves: a network of web pages (a
virtual state-machine), where the user
progresses through an application by
selecting links (state transitions), resulting
in the next page (representing the next
state of the application) being transferred
to the user and rendered for their use.
Roy Fielding, PhD Dissertation, UCI, 2000
Source: https://medium.com/@sagar.mane006/understanding-rest-representational-state-transfer-85256b9424aa

23. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Peeling the FHIR onion….
 80-20 rule
 Normative (forward compatible; maybe backward compatible)
 STU (NOT necessarily forward compatible)
 Informative (informational purpose)
 FMM: FHIR Maturity Model [level 1 to 5 (highest)]
 Where are we today: R4 – many resources normative NOT all
 Earlier ones: R3 STU, R2 STU, R1 STU
 WIP: R5
23

24. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR RESOURCES
24

25. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 25
RESOURCES

26. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 26

27. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
FHIR IMPLEMENTORS
 www.fhir.org FHIR FOUNDATION
•FHIR® Community Links Where to find support for
FHIR
•Public Community Forum
•FHIR Chat Channels
•The FHIR standard is maintained by HL7 (get
involved)
•FHIR Foundation Member Services Forums:
Foundation Forum and Market Place
•Monthly Status Reports
Become a Member Now
•FHIR Implementation Links Registry of
Implementation Guides
•Registry of Implementations
•Smart-on-FHIR App Registry
•FHIR Community Projects (coming)
•FHIR Reference Implementations (coming)
FHIR Implementation Support
•FHIR Trademark use applications for Community
and Product Use
•Conformance Testing

28. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Who is using FHIR?
 Amazon
 Apple
 Google
 IBM
 Microsoft
 Salesforce
 2015 Certified 655* EHR systems
 ……the list goes on
*as of June 2019
28

29. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
SUMMARY!
 As we transition to a digital record framework; use of Mobile Technology leads
the way (in access, capture and dissemination of health information)
 As Mobile & IoT Devices become more and more ubiquitous, accessing our
health information is only a few tap/swipe/transmit away!
 LIFE IN 21st CENTURY
 Standards (FHIR) enabled, cloud connected, IoT driven, micro-
services enhanced, cyber-safe Digital Health world
© Copyright CAL2CAL Corporation

30. © 2019 Health Level Seven ® International. All Rights Reserved.
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
THANK YOU
goradatta@ieee.org
30