Top Banner
Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D. Medical Informatics Director Intermountain Healthcare
17

Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

May 30, 2020

Download

Documents

dariahiddleston
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Using HL7 FHIR to support interoperability: Lessons from a healthcare provider

Scott P. Narus, Ph.D.Medical Informatics DirectorIntermountain Healthcare

Page 2: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Intermountain Healthcare

• Integrated Health Delivery Organization– HQ in Salt Lake City, UT– Spans all of Utah and Southern Idaho

• 22 Hospitals, 185+ clinics• Strong Hx of Informatics Innovation (Homegrown

solutions)

Page 3: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

In the beginning (or about Nov. 2013)…

iCentra

Page 4: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

In the beginning (or about Nov. 2013)…

iCentra• Create an open, standards-

based API to iCentra• Support standards efforts for

interoperability

• 5-year mission• A Fistful of Dollars

Page 5: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Coincidentally…

• DSTU 1 published by HL7 in Feb 2014• Intermountain & Cerner agree on

FHIR as API standard

• Intermountain & Cerner agree on SMART as app interop standard

• Joint support for SMART on FHIR• Participation (w/ other vendors) at

HIMSS 2014, demonstrating interoperable SMART on FHIR apps

Page 6: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Data Repository

Vendor API

FHIR Services

Vendor EMR

Module1Module2Module3Your App1Your App2

Doe, John Age: 25 yrs Sex: Male MRN: 101010

Your AppLoosely Defined: • Clinician, Patient, Researcher

facing Apps• Decision Support Logic• Knowledge Assets• Research Tools• Dashboards• Data extract services• Etc.

FHIR Services

Data Repository

Page 7: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

FHIR• Combine best features of HL7 V2, V3, CDA• Leverage latest web standards (RESTful web services,

XML, JSON)• Focus tightly on implementation• RESTful API provides consistent, granular data operations

– Search, Read, Create, Update, & Delete at the data element (Resource) level

• Data Modeling– Data types, Resources, & Profiles for defining clinical and

administrative data

Page 8: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

SMART on FHIR Growth Chart App

Page 9: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.
Page 10: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Accomplishments

• FHIR DSTU 2 development & production server• OAuth access support• SMART app integration in iCentra• Production release of 2 FHIR-based apps• Use of FHIR resources for HIE support• Implementation of Pub/Sub services*

Page 11: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Lessons Learned I

• EMR Vendor provides a fairly extensive set of FHIR resources…

• …Vendors are cautious & conservative at this point• …Need support for additional use cases and Write

capability

Page 12: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Lessons Learned II

• Still need some expertise on vendor data• Data are not always where you think they are, and they

don’t always come back as expected

Page 13: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Lessons Learned III

• Lack of specificity in FHIR Resources– US Core FHIR Profiles not enough– Need true semantic interoperability (FHIR Profiles)

• FHIR can support single patient/subject queries– Working on population-based queries and formats– Registries and Research-related efforts?

Page 14: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Lessons Learned IV

• Differences in Vendor implementations of FHIR– Data Models– Search parameters and approaches

• Differences in terminology support– Local term mapping probably needed

Page 15: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Lessons Learned V

• Interoperability of apps still in early stages• Open source apps are NOT free• Prioritization and Governance are key

Page 16: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

A Couple of Final Knowledge Tidbits

• Clinical Information Interoperability Council (CIIC) https://healthservices.atlassian.net/wiki/spaces/CIIC/overview– AAN, AAO, ACOG, ACS, ACC, ACP, APTA, ANA, FDA, CDC, NCI, AHRQ, NIAID, DoD, VA,

PCPI, AMIA, SPM, HIMSS and many other organizations – Create ubiquitous sharing of standardized data across the breadth of medicine,

anywhere we use health-related data and information– What data should be collected?– How do we model the data?– What is the meaning of the data?

• Health Services Platform Consortium (HSPC) https://www.hspconsortium.org/– Provider-led consortium– Mission: Improve health by creating a vibrant, open ecosystem of interoperable

applications, knowledge, content, and services– FHIR & SMART development resources (https://www.developers.hspconsortium.org/)

Page 17: Using HL7 FHIR to support interoperability: Lessons from a .... Using HL7 FHIR to...Using HL7 FHIR to support interoperability: Lessons from a healthcare provider Scott P. Narus, Ph.D.

Thank You!

Scott P. Narus, Ph.D.Medical Informatics DirectorIntermountain [email protected]