HealthcareInteroperabilityCatchingFHIR!ShaanKassamandBossLimlek
TheUniversityofTexasatAus;n,HealthInforma;csandHealthITProfessionalEduca;onProgram,Summer2016
ABSTRACT
ACKNOWLEDGMENTS
CONCLUSIONS
REFERENCES
CONTACT
INTRODUCTION
RESULTS
METHODS
1. Bender, D., & Sar;pi, K. (2013). HL7 FHIR: An Agile and RESTful approach to healthcare informa;onexchange.Proceedingsofthe26thIEEEInterna;onalSymposiumonComputer-BasedMedicalSystems.doi:10.1109/cbms.2013.66278102. Lamprinakos, G., Mousas, A., Boufis, A., Karmiris, P., Mantzouratos, S., Kapsalis, A.,Venieris, I. (2014).UsingFHIRtodevelopahealthcaremobileapplica;on.Proceedingsofthe4th Interna;onalConferenceonWirelessMobileCommunica;onandHealthcare-"TransformingHealthcarethroughInnova;onsinMobileandWirelessTechnologies"doi:10.4108/icst.mobihealth.2014.2572323. Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: Astandards-based,interoperableappsplabormforelectronichealthrecords.JournaloftheAmericanMedicalInforma;csAssocia;onJAmMedInformAssoc.doi:10.1093/jamia/ocv1894."MedAppTech:PediatricGrowthCharts."MedAppTech:PediatricGrowthCharts.N.p.,n.d.Web.23July2016.5.”MedAppTech:Pillbox."MedAppTech:Pillbox.N.p.,n.d.Web.23July2016.6.1.7IntroducingHL7FHIR.(n.d.).RetrievedJune23,2016,fromhgps://www.hl7.org/hir/summary.html7.Presenta;onbyDr.DavidMcCallie(CernerCorpora;on)at2016SXSWInterac;ve,hgps://www.youtube.com/watch?v=UFF9OBxPYZU&feature=youtu.be
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HealthLevelSevenInterna;onal(HL7)organiza;onisanot-for-profitstandardsdevelopingorganiza;ondedicatedtoprovidingastandardframeworkforelectronichealthdata7.“FastHealthcareInteroperabilityResources(FHIR)isthelateststandarddevelopedundertheHL7organiza;onwhichwasintroducedinresponsetothelimita;onsofHL7Version2(V2)andVersion3(V3)”6.FHIRwascreatedasaplabormforsimultaneouslyaccessingdatafromdifferenthealthcaresystems,regardlessofhowthedataarestored,withtheaimof“expandingEHRcapabili;es,streamlininghealthinforma;onexchange,andcrea;ngopportuni;esforinnova;on”6.FHIRhasgainedmuchagen;oninrecentyearsbecauseitbuildsonthepreviousdataformatstandardsfromHL7V2andV3.Itsfocusisonamodern,web-basedAPItechnology,includingaHTTP-basedRESTfulprotocolwhichmakesiteasiertoimplement,flexible,andscalable7.Inotherwords,FHIRleveragesexis;ngtechnology,standardizesthedata,andu;lizesthesamearchitectureastheWorldWideWeb.ThebasicbuildingblockinFHIRisaresource,whichisanyexchangeablecontent7.FHIRu;lizessetsofresourcestosa;sfythemajorityofcommonusecasessuchascareplansanddiagnos;creports.UsingFHIR’sstandardAPI,externaldeveloperscandeveloptheirownapplica;onsandimplementthemintoexis;ngEHRsystems.
Thisprojectwascompletedwiththeconsulta;onandmentorshipofDr.LeanneField.Weu;lizedPubMed,Googlescholar,andTheUniversityOfTexaslibrarydatabasetoiden;fyrelevantar;clesbysearchingonkeywordssuchas:FHIR,SMART,HL7,interoperability,REST,andstandardsAPI.Researchar;cleswerereviewedfromtheJournalofAmericanMedicalInforma2csAssocia2on,JournalofMedicalSystems,HIMSS2015,andHealthcareInforma2onManagementSystems.Inaddi;on,weresearchedHL7’swebsiteforfurtherdetailsonHL7V2,V3,andFHIRduetothelimitednumberofpeer-reviewedar;clesonFHIR.
WewouldliketothankDr.LeanneField,forprovidingmentorshipandguidance.WealsoaknowledgetheassistanceofMr.JerryMalone,InforCorpora;on,whoprovideduswithvaluableinforma;onaboutFHIR.
Whiles;llunderdevelopment,theFHIRstandardhasagractedagreatdealofagen;onfromthehealthcareindustry1.UnlikeHL7V2messagingwhichfollowedanadhocdevelopmentprocessandHL7V3whichfollowedadefinedtop-downmodelprocess,FHIRfollowstheRESTfularchitecture,bogomupdriveprocessandconsumer-focusedmodel1.Thepoten;alofFHIRextendsbeyonditsstandardAPIbecauseofitsabilitytobeimplementedinmobileplabormsandtoprovidelowbarriersofentryfornon-healthcaredevelopers7.Inanagempttobecomethenextgenera;on’sstandardsframework,FHIRappearstocombinethebestfeaturesofHL7’sV2,andV3whileleveragingthelatestwebstandardsandfocusonimplementability7.
FHIRAPPLICATIONS:Twoapplica;onsthatu;lizeFHIRwereevaluated.• MedAppTechandHarvardMedicalSchoolusedaFHIRenvironmentto
developabasicgrowthchartthatcanbeincorporatedinmostEHRsandcreatesanintegratedviewthatpa;entsunderstandandcanupdatereal-;me.3Thisprovidesprovidersup-to-dateinforma;onwhileeduca;ngparentsonimportantclinicalinforma;on.
• MedAppTechandDukeUniversitycreatedaPillBoxappdesignedasaninterac;velearningandcommunica;ontoolforpa;entstoprac;cemedica;onmanagementandcrea;ngpersonalizedtreatmentplanswhilesuppor;ngacademicresearch.3
FUTUREOFFHIR:SMARTANDFHIRSMARTisaspecifica;onthatallowstheembeddingofawebpageintotheEHR.3Thiscreatesauser-experiencethatbuildsontopofthedataaccessprovidedwithFHIR.Thecombina;onofbothcanbeusedtoplug-and-playappsintomul;pleEHRvendors.7ThisprovidesfurtherinteroperabilityinhealthcarewhereproprietyproductslikeEHRsareu;lizedasplabormsandallowcommunica;onbetweenpa;entsandproviders.
AUTHORS’PERSPECTIVE:ItishardtodetermineifFHIRwillbesuccessful,butitsapproachhaspromise.TheauthorsbelievethatFHIRcanbeusefulanddrivenewefficienciesandinnova;onwhileimprovingpa;entcareanddrivingdownbogomlinecosts.
HL7MessagingSTANDARDS
YearIniKated
ArchitecturalParadigm
CompaKbilitywithotherversions
DevelopmentProcess/
Methodology
ARributesassignment
Industry&CommunitySupport
InherentlySuitablefor
MobileDevices
DegreeofAdopKon
2011 RESTful Yes IteraKve&Incremental Yes-XML&JSON Yes-Argonaut
Project YesTesKng&
ImplementaKonstages
1997 Message-Oriented No Top-down Some Weak No Verylow
`1987
Message,Fields,&Records
Some-V2.X BoRom-up/adhoc No Strong No VeryHigh
Table1:ComparingHL7MessagingStandards1
Figure2:ApplicaKonsofFHIR:DukePillBoxappbyMedAppTech&DukeUniversitySchoolofMedicine5
Figure1:ApplicaKonsofFHIR:PediatricGrowthChartsbyMedAppTech&HarvardMedicalSchool/BostonChildren’sHospital4
Whilehealthcarerecordsarebecomingincreasinglydigi;zed,interoperabilityremainstobeanissue.Aspa;entsmovearoundthehealthcareecosystem,theirelectronicrecordsmustbeavailableandaccessible.HL7hasbeenaddressingthesechallengesforover20yearswithV2andV31.FHIRisanewspecifica;onthatagemptstou;lizethebenefitsofbothversionstoaddresscurrentchallengesinhealthcare.DespiteHL7V2’subiquitoususe,it’san;quatedstandardsarenotenoughtoaddresscurrentinteroperabilityissuesbetweendisparateEHRsystems.HL7V3,ontheotherhand,agemptstoaddresssomeoftheproblemsinherentinHL7V3buthasnotbeensuccessfuldueto"it’slackofbackwardcompa;bilityandlowadop;onrate"6.Theop;mismwithinthehealthcarecommunityisthatFHIRmaymi;gateissuesfrombothversions.Furthermore,FHIR’sAPIisstandardandallowsapplica;onstobecreatedbythirdpartydevelopersandimplementedinEHRsystems.
PURPOSEThepurposeofthisresearchwastwo-fold:1)tocompareandcontrastthebenefitsanddrawbackofFHIRwithHL7V2andV3,and2)toiden;fyapplica;onsofFHIRbeingusedinapa;ent-providersexngs.
Child’sgrowthchartusingHL7’FHIRstandardwithanintegratedviewtocommunicatewithfamilymembersusingiconsratherthangraphs.
AninteracKvetooluKlizingHL7’sFHIRstandardtomanagepaKent’suseandpracKcemedicaKonregimenswhilecapturingimportantmedicaKonuseinformaKonforfurtherstudy.
BossLimlek:[email protected]:[email protected]
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