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HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and CTO Corepoint Health [email protected]
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HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Oct 21, 2018

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Page 1: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

HL7 FHIR Overview

Dave Shaver, HL7FCo-Chair of FHIR Governance Board andInfrastructure and Messaging Committee.

Founder and CTO Corepoint Health

[email protected]

Dave Shaver, HL7FCo-Chair of FHIR Governance Board andInfrastructure and Messaging Committee.

Founder and CTO Corepoint Health

[email protected]

Page 2: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Thanks Lloyd et al

Portions based on “FHIR for Executives” licensed under CreativeCommons and available for download:

– http://gforge.hl7.org/gf/project/fhir

As– /trunk/presentations/2016-04 Webinars

Portions based on “FHIR for Executives” licensed under CreativeCommons and available for download:

– http://gforge.hl7.org/gf/project/fhir

As– /trunk/presentations/2016-04 Webinars

Page 3: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Goals

1. Survey

2. Market Context

3. Standards Context1. Technologies

2. Relationships

3. Details

4. Q&A

1. Survey

2. Market Context

3. Standards Context1. Technologies

2. Relationships

3. Details

4. Q&A

Page 4: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 5: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 6: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 7: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 8: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 9: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 10: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 11: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 12: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 13: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 14: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 15: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 16: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 17: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

HL7 in one sentence

• “HL7 makes it easier to integrate!”

• “HL7 is a framework for negotiation”

• “When you have seen one HL7 interface you’ve seen… one”

– Wes Rishel

• "Communication and interoperability are not a science. Theyare an art form perfected over time.“

– Keith Boone(@motorcycle_guy) "On Models" (http://motorcycleguy.blogspot.com/2013/08/on-models.html)

• “HL7 makes it easier to integrate!”

• “HL7 is a framework for negotiation”

• “When you have seen one HL7 interface you’ve seen… one”

– Wes Rishel

• "Communication and interoperability are not a science. Theyare an art form perfected over time.“

– Keith Boone(@motorcycle_guy) "On Models" (http://motorcycleguy.blogspot.com/2013/08/on-models.html)

Page 18: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Pick Two

• Fast, Good, Cheap

• Scope, Time, Budget

• Risk, Resources, Quality

• Privacy, Accuracy, Security

• Cheap, Light, Strong

• Fast, Small, Flexible

• Cheap, Flexible, Interoperable

• Fast, Good, Cheap

• Scope, Time, Budget

• Risk, Resources, Quality

• Privacy, Accuracy, Security

• Cheap, Light, Strong

• Fast, Small, Flexible

• Cheap, Flexible, Interoperable

Page 19: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Dave’s Triple Constraint

• Usable– Specific department

– Across many facilities (customers)

• Flexible– Supporting many workflows

– Configurable

• Interoperable– Across departments, workflows, and care settings

– For “Free”

• Usable– Specific department

– Across many facilities (customers)

• Flexible– Supporting many workflows

– Configurable

• Interoperable– Across departments, workflows, and care settings

– For “Free”

Page 20: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Boiled down, HL7 is all about…

• Moving data between two applications

• Apps written by different vendors

• Vendors created the apps in a vacuum

Consequently:

• Data models differ

• Application uses differ

• Moving data between two applications

• Apps written by different vendors

• Vendors created the apps in a vacuum

Consequently:

• Data models differ

• Application uses differ

Page 21: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

The not so rare…

SquamelCommitteeous

The not so rare…

SquamelCommitteeous

Page 22: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

http

://h

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Page 23: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Different data models

Peanuts

Hives

Peanuts

Pencillin

Loss of app, rash, hives

Peanuts

Hives

Rash

Peanuts

Hives, Rash

Page 24: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Intro to FHIR

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

Dave ShaverPresident & CTO

Page 25: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

http://xkcd.com/927

Page 26: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Fast (to design and implement)

Health

Interoperable

Resources

Fast (to design and implement)

Health

Interoperable

Resources

Page 27: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

• Old: Transactions sent at a point-in-time

• New: API to Source of Truth

• Old: Data only pushed by Source of Truth

• New: Consumer pulls data when needed

• What would healthcare exchange look like if we started anew?– RESTful based API

– Exemplar: Highrise (https://github.com/37signals/highrise-api)

• Old: Transactions sent at a point-in-time

• New: API to Source of Truth

• Old: Data only pushed by Source of Truth

• New: Consumer pulls data when needed

• What would healthcare exchange look like if we started anew?– RESTful based API

– Exemplar: Highrise (https://github.com/37signals/highrise-api)

Page 28: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

http://en.wikipedia.org/wiki/Hype_cycle

Page 29: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Dave’s 30 second take

1. V3 RIM(ish) + RESTful +(JSON|XML)

2. Semantic rigor + implementation-focus

3. Design for the 80% yet allow forthe 100%

1. V3 RIM(ish) + RESTful +(JSON|XML)

2. Semantic rigor + implementation-focus

3. Design for the 80% yet allow forthe 100%

Page 30: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Dave’s Additional 90 Seconds

1. Interfaces based on a statement of capabilities

2. Data stays in the application that is source of truth

3. “API-like” query to data – pull not push

Page 31: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Paradigms

• FHIR supports four interoperability paradigms– REST – Lightweight, leverages web stack

– Documents – Long-term persistence

– Messages – Request/response paradigm

– Services – other SOA-based interfaces

• Regardless of approach, content stays the same– Can leverage same models, same profiles everywhere

• FHIR supports four interoperability paradigms– REST – Lightweight, leverages web stack

– Documents – Long-term persistence

– Messages – Request/response paradigm

– Services – other SOA-based interfaces

• Regardless of approach, content stays the same– Can leverage same models, same profiles everywhere

Page 32: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Advantages

• Based on RESTful web services– IHE profiles are based on SOAP

– Many modern applications (Twitter, Amazon, etc.) based on RESTful

• FHIR is encoded using XML or JSON

• FHIR data can be pushed or pulled

• Off-the-shelf Security– HTTPS, OAuth

• Based on RESTful web services– IHE profiles are based on SOAP

– Many modern applications (Twitter, Amazon, etc.) based on RESTful

• FHIR is encoded using XML or JSON

• FHIR data can be pushed or pulled

• Off-the-shelf Security– HTTPS, OAuth

Page 33: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Intro to FHIR

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

Dave ShaverPresident & CTO

Page 34: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

2.X2.X2.X2.X

2.5.12007

2.31997

2.42000

2.72009

2.21994

2.3.11999

2.52003

2.62008

Pre 2.11987-88

2.11990

2.82011

Vocabulary1997

USAM1999 2006 2008 2010

2.92016?

2012

HL7 Timeline

2014

2.8.12014

2.8.22015

Normative Editions

3.X3.X3.X3.X

2005Concept1996

Methodology1998 2007

Vocabulary1997

USAM1999 2006 2008 2010

2009

2012

2011 2013

FHIRFHIRFHIRFHIR

2014 DSTU2012 Conceived 2015 DSTU2

2014

2015

Page 35: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

FHIR Timeline (planned)

FirstDraft

1st

DSTU2nd

DSTU~ 1st

Norm.~ 2nd

Norm. . . .

2012 20162014 2018 20202011 20152013 2017 2019

DSTU 2.1

Page 36: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

What does STU mean?

“…all aspects of the FHIR specificationare potentially subject to change

Page 37: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Maturity levels

• Intended to indicate level of stability– FMM1 – Resource is “done”, no build warnings

– FMM2 – Tested at approved Connectathon

– FMM3 – Passes QA, has passed ballot

– FMM4* – Tested across scope, published, prototype implementation

– FMM5* – 5 distinct production implementations, multiple countries

• Non-compatible changes at level 4 and 5will face increased hurdles

• Intended to indicate level of stability– FMM1 – Resource is “done”, no build warnings

– FMM2 – Tested at approved Connectathon

– FMM3 – Passes QA, has passed ballot

– FMM4* – Tested across scope, published, prototype implementation

– FMM5* – 5 distinct production implementations, multiple countries

• Non-compatible changes at level 4 and 5will face increased hurdles

Page 38: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Normative FHIR

• Will include– Core specification– Structural resources– Subset of other resources

• Some resources won’t go normative right away

• Future releases– Add more resources– Add profiles on existing resources– May add elements to resources

• Very rare

• Will include– Core specification– Structural resources– Subset of other resources

• Some resources won’t go normative right away

• Future releases– Add more resources– Add profiles on existing resources– May add elements to resources

• Very rare

Page 39: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Migration

• No expectation that people will migrate existing interfaces –any time soon if ever

• Initial adopters will be green-field, new technology

• FHIR may see use behind the scenes in v2 systems before it seesuse over the wire

• Forthcoming policy initiatives may necessitate revisiting existinginterfaces

• No expectation that people will migrate existing interfaces –any time soon if ever

• Initial adopters will be green-field, new technology

• FHIR may see use behind the scenes in v2 systems before it seesuse over the wire

• Forthcoming policy initiatives may necessitate revisiting existinginterfaces

Page 40: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

“In the wild” HL7 Interfaces

2.1

2.2

2.3

2.3.1

2.4

2.52.6

2.7

2.83

CDA

FHIR 2.1

2.2

2.3

2.3.1

2.4

2.52.6

2.7

2.83

CDA

FHIR

Page 41: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

CDA

Message Data and Message DeliveryRepository

Point InTime CCR

CCD

Del

iver

y A

ppro

ach

Snippet Documents

Real TimeHL7 v2

Summary

Del

iver

y A

ppro

ach

Data Depth and Finality

FHIRMsgs

Pulled FHIR

Page 42: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Changing Health IT Landscape

Page 43: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Why vendors care

1.Regulations2.Customers1.Regulations2.Customers

Page 44: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 45: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 46: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Metcalfe’s Law

Network Value = (number of users)2Network Value = (number of users)2

Page 47: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Value = 22 = 4

Value = 52 = 25

http

://e

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.org

/wik

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calfe

's_la

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Value = 122 = 144

http

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ikip

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Page 48: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Dave’s Corollary to Metcalfe’s Law

• The value of a healthcare standard toa new user is driven by number ofprior adopters.

• Few prior adopters = little value

• The value of a healthcare standard toa new user is driven by number ofprior adopters.

• Few prior adopters = little value

Page 49: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Intro to FHIR

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

Dave ShaverPresident & CTO

Page 50: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Export

HL7 2.X Connectivity

Import

HIS

Export

LISImport Export

Import

Page 51: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

AceLISI

E

AceDietaryI

SpringfieldEMR

I E

Hospital – Point-to-Point

AcmeHIS

E

I

AceRISI

AceDietaryI

AceHHIE

E

E

Page 52: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Hospital – Engine

AceLISI

E

AceDietaryI

SpringfieldEMR

I

E

CorepointIntegration

Engine

AcmeHIS

E

I

AceRISI

AceHHI

AceRxI

E

CorepointIntegration

Engine

Page 53: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Community: Dream

AceLISI

E

SpringfieldEMR

I

E

HIE

I

St Luke’s Hospital

Elsewhere Health System

St Francis’ Hospital

AcmeHIS

E

I

AceRISI

AceDietaryI

AceHHI

AceRxI

SpringfieldEMR

E

CorepointIntegration

Engine

Page 54: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Community: Reality

HIEI

St Luke’s Hospital

Elsewhere Health System

West Clinic

Metro Radiology

St John’s HospitalI

I

I

I

St Francis’ Hospital

AcmeHIS

E

I

AceLISI

E

AceRISI

AceDietI

AceHHI

AceRxI

SpringfieldEMR

I

E

ECorepointIntegration

Engine

Page 55: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Mobile App – FHIR Connectivity backboneLeveraging a standard in a proprietary manner

BloodCollection

HIS LIS

FHIR

Page 56: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Real World: HL7 2.X + FHIR IntegrationMultiple sources of truth

BloodCollection

HIS LIS

FHIRFHIR

Page 57: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Mobile App – FHIR IntegrationMultiple sources of truth

ReferringPhysicianPortal

FHIR

PathologyFHIR

HIS LIS

FHIRFHIR

Page 58: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

BedsideCart

FHIR-to-HL7 V2 ORU

AceLISI

E

AceDietaryI

SpringfieldEMR

I

E

FHIR

FHIR

AcmeHIS

E

I

AceRISI

AceHHI

AceRxI

E

Corepoint IntegrationEngine

Page 59: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

FHIR-to-FHIR

AceLIS

I

E

AceDietaryI

Coastal EMR I

E

FHIR

FHIRFHIR

AcmeHIS

E

I

AceRISI

AceHHI

AceRxI

E

Corepoint IntegrationEngine

Page 60: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Context: Standard

Page 61: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

FHIR Manifesto

• 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

• Support multiple paradigms & architectures

• Demonstrate best practice governance

• 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

• Support multiple paradigms & architectures

• Demonstrate best practice governance

Page 62: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Support for Common Scenarios

Content inspecificationBased on 80% rule

Include only data elements that 80% of normalimplementations will likely use

Remaining 20% of content can be included inextensions

ResourcesData elements used inthe common scenarios

Goal: Simple to use and understand

Page 63: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Example: HL7 2.X AD Data type as of 2.3.1

Page 64: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Example: HL7 2.XXAD Data type as

of 2.8.2

Example: HL7 2.XXAD Data type as

of 2.8.2

Page 65: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Example – ISO AD type

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (GTS – no room onthe slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physical, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic

• 0..* parts, each with:– value, code, code system, code system name, code system version,

language, type:• address line, additional locator, unit identifier, unit designator, delivery address

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipality, delimiter, post box, precinct, state or province,postal code, delivery point identifier

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (GTS – no room onthe slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physical, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic

• 0..* parts, each with:– value, code, code system, code system name, code system version,

language, type:• address line, additional locator, unit identifier, unit designator, delivery address

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipality, delimiter, post box, precinct, state or province,postal code, delivery point identifier

Page 66: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Example – FHIR Address

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (low, high) (GTS –no room on the slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physicalvisit, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic, old

• 0..* parts, each with:text– value, code, code system, code system name, code system version,

language, type:• address line, additional locator, unit identifier, unit designator, delivery address

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipalitycity, delimiter, post box, precinct,state or province, postalCode, delivery point identifier

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (low, high) (GTS –no room on the slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physicalvisit, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic, old

• 0..* parts, each with:text– value, code, code system, code system name, code system version,

language, type:• address line, additional locator, unit identifier, unit designator, delivery address

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipalitycity, delimiter, post box, precinct,state or province, postalCode, delivery point identifier

Page 67: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Example: HL7 FHIR DSTU 2 Address Datatype

Page 68: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

FHIR & Cost of Integration

• Cost Factors:– Easier to Develop

– Easier to Troubleshoot

– Easier to Leverage in production

– More people to do the work

• Competing approaches must match the cost ordisappear – already being felt

• Cost Factors:– Easier to Develop

– Easier to Troubleshoot

– Easier to Leverage in production

– More people to do the work

• Competing approaches must match the cost ordisappear – already being felt

Page 69: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Long term: 100-150 Resources

Examples

• Administrative– Patient, Practitioner,

Organization, Location,Coverage, Invoice

• Clinical Concepts– Allergy, Condition, Family

History, Care Plan

• Infrastructure– Document, Message, Profile,

Conformance

Non-examples

• Gender– Too small

• Electronic Health Record– Too big

• Blood Pressure– Too specific

• Intervention– Too broad

• Administrative– Patient, Practitioner,

Organization, Location,Coverage, Invoice

• Clinical Concepts– Allergy, Condition, Family

History, Care Plan

• Infrastructure– Document, Message, Profile,

Conformance

• Gender– Too small

• Electronic Health Record– Too big

• Blood Pressure– Too specific

• Intervention– Too broad

69

Page 70: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

STU 2 Resource List

Page 71: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

STU 2 Resource List

Page 72: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Human ReadableSummary

Extension with referenceto its definition

Identity & Metadata

Standard DataContent: MRN Name Gender Date of Birth Provider

Page 73: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Resource Definitions

Page 74: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Resource Definitions

Page 75: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 76: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and
Page 77: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Bonus Topics

Page 78: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Other Critical Topics

• SMART on FHIR

• MU3

• Argonaut Project

• JSON vs XML

• Resource Extensions

• SMART on FHIR

• MU3

• Argonaut Project

• JSON vs XML

• Resource Extensions

Page 79: HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F Co-Chair of FHIR Governance Board and Infrastructure and Messaging Committee. Founder and

Q&A: HL7 FHIR Overview

Dave Shaver, HL7FCo-Chair of FHIR Governance Board andInfrastructure and Messaging Committee.

Founder and CTO Corepoint Health

[email protected]

Dave Shaver, HL7FCo-Chair of FHIR Governance Board andInfrastructure and Messaging Committee.

Founder and CTO Corepoint Health

[email protected]