FHIR architecture overview for non-programmers by René Spronk

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

FHIR Architecture Overview

for non-programmers

René Spronk (Ringholm)

FHIR Developer Days

November 26, 2014


FHIR Overviewfor executives


FHIR Developer Days

November 26, 2014


3

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.4

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.5


What does FHIR stand for?

F – Fast (to implement)

H – Health

That’s why we’re here

I – Interoperable

R – Resources

Building blocks – more on these to follow

6


Design Philosphy of FHIR

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

7


Contextual drivers for FHIR

Shift in healthcare

patient in control, sharing data across organizations

Shift from off-line to on-line

shift from PC to tablet, from web to app, from desktop to

cloud

Shift towards data transparency

FHIR acts as an ‘open API’ to access data in these silo-

like EHR’s.

Shift towards analytics

FHIR uses data structures that allow one to easily slice

and dice the data for analytics.

8


What is a FHIR ‘Resource’ ?

Small, discrete concepts that can be

maintained independently

Akin to HL7v2 segments, DICOM IEs.

Resources are smallest units of transaction

Built-in extension mechanism

Elements used by 80% of implementers are part of

the base resource.

All other elements are handled as extensions

Resources have a ‘textual description’9


FHIR Resources

10


Example – Patient Resource

References

to other

Resources


Data types

12

Based on cross-industry data types (w3c schema and ISO

data types)

Stick to the “80% rule” – only expose what most will use

Data types can have extensions


13

Human Readable

Summary

Standard Data

Content: MRN

Name

Gender

Date of Birth

Provider

Extension with

reference to its definition


Narrative

14 Note: could be JSON as well


Extensions

15 Note: could be JSON as well


FHIR references

16


RESTful FHIR Examples

GET http://myfhirserver.com/patient/123

GET http://myfhirserver.com/encounter/904?_include=patient

PUT http://myfhirserver.com/encounter/707 {XML or JSON Resource expression}

GET http://myfhirserver.com/document/800511


FHIR Messages

18


FHIR Documents

19


FHIR profiles

Resources have nearly no restrictions.

Parties exchanging data define the way

they want to use resources

Profiles define what ‘your jurisdiction’

needs to communicate and store when it

comes to Resources and their extensions.

20


StructureDefinitionResource (profile)

“Before”

“After”

GET http://myfhirserver.com/StructureDefinition?xxxxxxxxxxxxx


OperationDefinitionResource (Profile)

22

Standard

FHIR REST

Custom

Operations

Read

Update

Search

Check Drug

InteractionMerge

Patient

Search on

Maiden name


Computable Profiles

GET http://myfhirserver.com/Conformance


Summary: What does FHIR provide?

Resources (building blocks)

Extensions

Methodology

Bundles, Profiles, Conformance

Syntax (XML, JSON)

Human readability

Support for multiple Paradigms

REST, Messaging, Documents, Services

24


Application of FHIR

FHIR is suitable for application in a variety

of settings: the classic in-institution exchange of data between

systems

in a regional setting (Regional Health Information

Organizations)

on a national scale, e.g. in national health hub’s or EHR's

in social media and mobile applications

FHIR is expected to be initially used for

social media and mobile application use-

cases.25


FHIR

Is being implemented right now:

(US) ONC, SMART, Intermountain, (UK) NHS,

(NZ) Orion Health, (NO) Helse Vest (NL)

Mental health apps

IHE Profiles

70 implementations, 20 countries (2014)

26


FHIR

Is easier and cheaper than other

comparable standards:

It is faster to learn, implement and troubleshoot

It has a vibrant and open source community

and has frequently held connectathons.

It uses modern technologies, the same as

used by e.g. Facebook, Twitter and Google.

There are more people familiar with these

technologies (thus less expensive consultants).27


FHIR

Is likely to significantly impact Health IT:

scales well from simple to complex

flexible

free and fully open

28


29

Questions?


FHIR Examplefor clinical users


FHIR Developer Days

November 26, 2014

Modified from a presentation by David Hay, Orion


Theme: a mobile application

A mobile application for a clinician

Collect and present clinical information about

a patient

Previous encounters, Lab Data, Documents

Record details of an encounter

Schedule encounters

Make orders for Labs, meds etc.

Get Decision support

Save a summary in a Document Repository


Assumptions

Requirements known

Data Sources known and available

Not considering security

Not considering app architecture

System Architecture


Main Clinical resources

Observation / Condition (Problem) / Alert

DiagnosticReport

MedicationPrescription (and others)

AdverseReaction / ContraIndication /

AllergyIntolerance

Immunizations / ImmunizationRecommentation

Assessment / RiskAssessment / CarePlan

Questionnaire / QuestionnaireAnswers


Important Supporting Resources

Patient / Practitioner

List

Encounter / EpisodeOfCare

Order / OrderResponse / ReferralRequest

DocumentReference

Provenance

Appointment / AppointmentResponse / Availability / Slot /

HealthcareService


Local Notes - Clinical Scenario

First consultation Complaining of pain in the r) ear for 3 days with

an elevated temperature. On examination, temperature 38.5 degrees and an inflamed r) ear drum with no perforation. Diagnosis Otitis Media, and prescribed Amoxil 250mg TDS for 5 days

Follow up consultation 5 days later returned with an itchy skin rash.

No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to erythromycin and advised not to take penicillin in the future.

Condition

Observation

Med

Adverse

Reaction

Allergy

Encounter

5 year old boyPatient


Looking at the relationships


Lists of things

Examples

Medication list

Problem List (Conditions)

Allergies

Past Medical History

Past Social History

Social History

‘Organizer’ in Document

Manage ‘points in time’

and changes

Explicit ‘none known’


Scheduling patients

Appointment / AppointmentResponse

Availability

Slot

HealthCareService

Recalls (care plan)

Alerts


Ordering stuff

Order / OrderResponse

Detailed resources in request

MedicationPrescription

DiagnosticOrder

Referral


Medications

Medication

MedicationPrescription Order / OrderResponse

MedicationAdministration Provenance

MedicationDispense

MedicationStatement

AllergyIntolerance

ContraIndication


Viewing investigations

Diagnostic report

Imaging Study

Specimen

Attachment


Decision Support

ContraIndication

AllergyIntolerance

Alert

OperationDefinition

ImmunizationRecommendation


Doing things to people

Procedures

Specimen

DiagnosticReport


Referrals

Order/OrderResponse

ReferralRequest

Many resources as

content


Data collection

Forms

Questionnnaire / QuestionnaireAnswers

Free form


Creating a summary document ddd


Returning to the App…

Interact with Local Server

RESTful exchange of resources

Local server will mediate other services

Query document repository (XDS-ish)

Use DocumentReference against Registry

Simple GET for documents

Query data repositories (eg Lab)

RESTful query

Record Clinical data

Create resource graph

Submit as transaction

Decision Support

Send a Message to the DSS, get a bundle back

Update the document repository

Create a FHIR document and submit via FHIR transaction to repository


Winding Up

FHIR is fit for (clinical) purpose


49

Questions?

FHIR architecture overview for non-programmers by René Spronk

Healthcare

hl7 international

hl7 health level

creative commons

tm office

variability of hl7 v2

complexity of hl7 v3

base level of interoperability

fhir resource