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HL7 FHIR - IN PRACTICE Kevin Mayfield 19/6/2014
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Hl7 FHIR - in practice

Feb 24, 2016

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Hl7 FHIR - in practice. Kevin Mayfield 19/6/2014. Background (Referral). Health and Social Care Bill 2012-2013, The Scottish Government NHS eHealth strategy - must contribute to care integration and support people with long term conditions - PowerPoint PPT Presentation
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Page 1: Hl7 FHIR -  in practice

HL7 FHIR - IN PRACTICE

Kevin Mayfield19/6/2014

Page 2: Hl7 FHIR -  in practice

Background (Referral)

• Health and Social Care Bill 2012-2013, The Scottish Government

• NHS eHealth strategy - must contribute to care integration and support people with long term conditions

• Replace shared assessment system with an Interagency Portal.

• Build upon existing clinical portal

Page 3: Hl7 FHIR -  in practice

Assessment - Me

• 1996-2009 EMIS (GP Systems)– 300 baud drug ordering system– MOD 'GPtoGP' late 90’s– Defence Medical Information Capability Programme

(DMICP), live streaming of clinical resources to/from operations in Iraq and Afghanistan

• 2010- NHS & Council roles (SQL)– Community, Mental Health and Acute.– 2012 First HL7 interface

Page 4: Hl7 FHIR -  in practice

Assessment - NHS Team

• Using SCIXML and NHS Scotland Data Standards• Many bespoke interfaces and multiple integration

engines.• Minimal exposure to HL7 standards. • Steep learning curve to HL7v3 and CDA.• RESTful?• Community care focused around documents

(questionnaires/forms)

Page 5: Hl7 FHIR -  in practice

Assessment - Social Services

• 4 councils• HL7v2 capable (x1)• NHS (England) ITK and

CDA interfaces. Keen to use FHIR (x2)

• Bespoke (x1)• Organisation using a Care

Plan model (x3)• RESTful

Page 6: Hl7 FHIR -  in practice

Building The 'Care' Plan

• IHE XDS, BPPC and PIX patterns. • Mostly UML focused (seen as too technical, flow

charts preferred.) • Use cases very useful but a tendency to go for

solution early.• FHIR and RESTful/CRUD used as model for

technical discussions.• IHE and FHIR proved to be resistant to project

changes (mostly consent and alerts) and change of supplier.

Page 7: Hl7 FHIR -  in practice

Goals

• Centralised recording of patients and consent • Document sharing with central index• Portal fed data by a variety of methods,

mostly web services (HL7 FHIR preferred).

Page 8: Hl7 FHIR -  in practice

Activities/Interventions (NHS)• Document Index using FHIR DocumentReference– Documents returned from many (NHS) sources using FHIR

Binary– DocumentReference doubled up as a document

notification system.• Questionnaires and other unstructured data using

FHIR Questionnaires• Encounters, Care Plan, Orders, Appointments,

Alert/Observation and Condition resources (NHS only).

• Patient with consent extension and HL7v2 A28/31/40

Page 9: Hl7 FHIR -  in practice

Progress Notes• Naturally aligning with IHE profiles• Too many new things

– FHIR being a major step towards HL7 CDA and IHE profiles– RESTful interfaces scaled down– Standard coding (SNOMED) premature

• FHIR 80/20 rule nearly always correct• Resistance due to DSTU status

– ReferralRequest– Consent– Appointments

Page 10: Hl7 FHIR -  in practice

Review• Patient identity and consent first

– Information Governance• Too much IT focus but the information model FHIR uses, especially

the CarePlan resource, showed the way.• DocumentReference/Binary allowed the adoption of an XDS

pattern and get the metadata correct– Path to HL7 CDA?

• Questionnaires useful but need to used only when other resource not available (tended to capture the 20 in the 80/20)

• Only suitable for NHS trusts/social services with EPR systems, PAS systems could stick with HL7v2

• SCRUM worked! FHIR allows sprints

Page 11: Hl7 FHIR -  in practice

Questions?