Post on 03-Nov-2019
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Argonaut Data Query and US Core
Brett Marquard, WaveOne
Instructor
Brett Marquard
• Principal, WaveOne Associates
• Extensive EHR experience
• Primary Editor, Consolidated CDA (C-CDA)
• Primary Editor, Argonaut Data Query IG / US FHIR Core IG
• brett@waveoneassociates.com
Outline
Background on Argonaut
Data Query and Document Query
US Core
Future
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What is the Argonaut Project?
The Argonaut Project is an implementation community comprising leading technology vendors
and provider organizations to accelerate the use of FHIR and OAuth in health care information
exchange.
We are:
• Private sector initiated and funded
• Working collaboratively with other FHIR initiatives such as SMART-on-FHIR, the Health Systems
Platform Consortium, and the FHIR Foundation
• Creating open industry Implementation Guides in high priority use cases of importance to patients,
providers and the industry as a whole
We are NOT:
• A standards development organization
• A separate legal entity
• A proprietary activity
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Technology Vendors Provider Organizations
• Accenture • Beth Israel Deaconess Medical Center
• Apple • Intermountain Health
• athenahealth • Mayo Clinic
• Cerner • Partners Healthcare
• Epic • SMART at Boston Children’s Hospital • Change Healthcare
• MEDITECH
• Surescripts
• The Advisory Board Company/Optum
Staff (current and past)
• Prime contractor: HL7
• FHIR initiatives: Grahame Grieve, , Eric Haas, Josh Mandel, Brett Marquard
• OAuth initiatives: Dixie Baker, Josh Mandel
• Project Management: Jennifer Monahan, Micky Tripathi
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Clinical Identification Workflow Infrastructure Conformance FinancialAllergyIntolerance Patient Encounter Questionnaire ValueSet Coverage
Condition (Problem) Practitioner EpisodeOfCare QuestionnaireRespons ConceptMap Eligibil ityRequest
Procedure RelatedPerson Communication Provenance NamingSystem Eligibil ityResponse
ClinicalImpression Organization Flag AuditEvent StructureDefinition EnrollmentRequest
FamilyMemberHistory HealthcareService Appointment Composition DataElement EnrollmentResponse
RiskAssessment Group AppointmentResponse DocumentManifest Conformance Claim
DetectedIssue Location Schedule DocumentReference OperationDefinition ClaimResponse
CarePlan Substance Slot List SearchParameter PaymentNotice
Goal Person Order Media ImplementationGuide PaymentReconciliation
ReferralRequest Contract OrderResponse Binary TestScript ExplanationOfBenefit
ProcedureRequest Device CommunicationRequest Bundle
NutritionOrder DeviceComponent DeviceUseRequest Basic
VisionPrescription DeviceMetric DeviceUseStatement MessageHeader
Medication ProcessRequest OperationOutcome
MedicationOrder ProcessResponse Parameters
MedicationAdministration SupplyRequest Subscription
MedicationDispense SupplyDelivery
MedicationStatement
Immunization
ImmunizationRecommendation
Observation
DiagnosticReport
DiagnosticOrder
Specimen
BodySite
ImagingStudy
ImagingObjectSelection
Patient name
Sex
Date of birth
Race
Ethnicity
Preferred language
Smoking status
Problems
Medications
Medication allergies
Laboratory tests
Laboratory results
Vital signs
Procedures
Care team members
Immunizations
Unique Device identifiers
Assessment and Plan of Treatment
Goals
Health concerns
2015 Edition
Common Clinical Data Set 93 FHIR DSTU2 Resources (17 Argonaut CCDS Resources in red)
What does the Argonaut process do? Set priorities
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What does the Argonaut process do? Resolve practical problems
What search criteria can you
use?
What type of data will you
get in response?
How will that data be
represented?
Scope of response
Examples:
• Search for patient will get all
FHIR patient resources
• Search for Procedures will get
all current and historical
procedures or within specified
date range
Content of response
Examples:
• Patient search will get name,
identifier, gender, birthdate,
• Procedures search will get
type of procedure, date
performed, and procedure
status
• In some cases created
Argonaut extensions and value
sets
Search operations
Examples:
• Can search for individual
patient by identifier (e.g.,
MRN) OR full name & gender
OR full name & birthdate
• Can search for Procedures by
patient or by patient &
specified date range
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A Signature Event: Argonaut Data Query Implementation Guide
http://www.fhir.org/guides/argonaut/r2/
• Access to individual data
elements of Common Clinical
Data Set
• Access to structured document (CCD) containing all Common
Clinical Data Set elements
• Leverage OAuth2-based security
and authorization
US FHIR Core
The US FHIR Core is a labeled subset of all HL7 US-Realm produced FHIR profiles.
The label is designed to provide the community with a single point of reference to
foundational US FHIR profiles that:
1) should be used by US stakeholders when implementing FHIR; and
2) always be used as the basis for creating further US-Realm profiles.
Bottom line
• Argonaut IG = US Profiles on DSTU2
• US Core = HL7 balloted US Profiles on STU3. Built from Argonaut requirements.
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Argonaut and US Core STU3 Profiles
Argonaut AllergyIntolerance Profile
Argonaut CarePlan Profile
Argonaut CareTeam Profile
Argonaut Condition Profile
Argonaut Device Profile
Argonaut DiagnosticReport Profile
Argonaut DocumentReference Profile
Argonaut Goal Profile
Argonaut Immunization Profile
Argonaut Medication Profile
Argonaut MedicationOrder Profile
Argonaut MedicationStatement Profile
Argonaut Observation Results Profile
Argonaut Patient Profile
Argonaut Procedure Profile
Argonaut Smoking Status Observation Profile
Argonaut Vital Signs Observation Profile
US Core AllergyIntolerance Profile
US Core CarePlan Profile
US Core CareTeam Profile
US Core Condition (a.k.a Problem) Profile
US Core Device Profile
US Core DiagnosticReport Profile
US Core Goal Profile
US Core Immunization Profile
US Core Location Profile
US Core Medication Profile
US Core MedicationRequest Profile
US Core MedicationStatement Profile
US Core Organization Profile
US Core Patient Profile
US Core Practitioner Profile
US Core Procedure Profile
US Core Results Profile
US Core Smoking Status Profile
Vital Signs Profile (FHIR Core Profile)
January 2018 US Core Ballot
US Core DocumentReference Profile
US Core Encounter Profile
US Core PractitionerRole Profile
…final publication summer 2018!
© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
®
®
Profile-less FHIR
You don’t need profiles to interoperate with FHIR
Resources are “discrete” enough that mechanism to populate most elements is clear
Approach
Populate/consume all elements you know, use HL7 or country-standard
extensions for extras
Map to/from “recommended” terminologies as much as possible, populate CodeableConcept.text
Expose capabilities in Conformance resource
© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
® Profile-less FHIR
You don’t need profiles to interoperate with FHIR
Resources are “discrete” enough that mechanism to populate most elements is clear
Approach
Populate/consume all elements you know, use HL7 or country-standard
extensions for extras
Map to/from “recommended” terminologies as much as possible, populate CodeableConcept.text
Expose capabilities in Conformance resource
© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
® Base Condition Resource vs.
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© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
® US Core Condition
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Key Components – Data Query
General Guidance
Profiles
Extensions
Value Sets
Operations
Conformance
General Guidance
Mapping of FHIR to the ONC 2015 Common Clinical Data Set (CCDS)
‘Must Support’ • Base FHIR guidance -‘When a profile does this, it SHALL also make clear exactly what kind
of "support" is required.’
• Data Query - took us 6 bullets to say, ‘send these values if you have them’
Extensible + Max-ValueSet binding for CodeableConcept Datatype
• Allows for either a code from the specified value set or text
Using UCUM in the [Quantity] datatype
• Free text when necessary
http://www.fhir.org/guides/argonaut/r2/definitions.html
http://hl7.org/fhir/us/core/guidance.html
General Guidance
18 http://hl7.org/fhir/us/core/guidance.html
Profile Deep Dive – Allergies
Prose
Mandatory Elements
Profile Specific Guidance
Formal View
Search
GET /AllergyIntolerance?patient=[id]
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http://hl7.org/fhir/us/core/StructureDefinition-us-core-allergyintolerance.html
Profile Deep Dive – Allergies
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Profile – Patient
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Profile – Patient Quick Start
22 http://hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html
Extensions
US Core Race Extension
Profile-resource association extension
US Core ethnicity Extension
Email is a "direct" email
US Core Birth Sex Extension
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Value Sets - Terminology
23 Value Sets! US Core Substance-Reactant for Intolerance and Negation Codes US Core SNOMED CT Substances Other Than Clinical Drugs US Core Substance RxNorm Codes US Core Substance ND-FRT codes US Core Provider Speciality (NUCC) US Core Provider Role (NUCC) US Core ICD-10-PCS Procedure Codes US Core Procedure Codes Problem Value Set Observation Value Codes (SNOMED-CT) Smoking Status Vaccine National Drug Code (NDC) Narrative Status Medication Clinical Drug (RxNorm) Vaccine Administered Value Set (CVX) US Core Condition Category Codes
CareTeam Provider Roles US Core Birth Sex Value Set Language codes with language and optionally a region
modifier OMB Race Categories OMB Ethnicity Categories US-Core Detailed Race US-Core Detailed ethnicity
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Value Sets - Problem Value Set
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.compose: A definition of which codes are intended to be in the value set ("intension" )
Value Sets - Smoking Status
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Operation - Get DocumentReferences ($docref)
This operation differs from a simple query in that DocumentReferences may be created ‘on-the-fly’ in response to this operation. For example, in some cases the documents themselves may not exist but can be generated when needed so a reference to them can be generated using this operation. If no documents exist and an ‘on-demand’ document cannot be created then the operation will return an empty search bundle.
CapabilityStatement (formerly know as Conformance)
Data Query Implementation Guide Server: The CapabilityStatement defines the expected capabilities of a server when conforming to the US Core Data Query Implementation Guide.
Data Query Implementation Guide Client:
This CapabilityStatement defines the expected capabilities of a client when conforming to the Argonaut Data Query Implementation Guide.
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CapabilityStatement (formerly know as Conformance)
29 http://hl7.org/fhir/us/core/capstmnts.html
Future of Argonaut + US FHIR Core
Argonauts
• Encouraged to use US FHIR Core rather than writing their own FHIR STU3 guide, or R4 guide.
• Piloting new R3 profiles for Clinical Notes and Questionnaires
US Core
• New STU3 publication summer 2018 to add DocumentReference, Encounter, and PractitionerRole
• Discussions at HL7 US Realm Steering Committee to add relevant Argonaut R3 profiles to US Core, such as Clinical Notes in winter 2018-2019 ballot.
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Interop thought experiment
Data vs Narrative Tug of war
Data
Internal Use Only © 2018 WaveOne Associates 33
Narrative – ‘the shoe bin’
Today, after returning from our walk Edison told us he wanted to put the boot bin away. I told him he could help if he got undressed, but he dawdled. I reminded him a couple of times if he wanted to put the boot bin away he would need to get undressed. He chose to watch other children and roll on the floor, so eventually I let him know that I was going to invite other children to put it away. He got very upset and actually cried :( We have seen similar experimental behaviors from Edison so we are working with Edison to link his actions to the consequences. Edison remembers things from the past and so we hark back onto those moments to help explain why he should cooperate or do as we ask.
Internal Use Only 34 © 2018 WaveOne Associates
Other School - Nothing
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Don’t lose the story!
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Clinical Notes…
Common Clinical Notes Set • Discharge documentation (18842-5)
• Consultation (11488-4)
• History & Physical (34117-2)
• Progress note (11506-3)
• Procedures note (28570-0)
• Future: Imaging narrative (18726-0) and Lab/path narrative
….Transfer note, Referral note, Surgical Operation note, Nurse note, Care Plan
Starter Set for testing and design - the value set will not be restricted to these 5
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Anticipated Note Formats
Text or XHTML
RTF or PDF or .doc
Mixed document: structured FHIR resources, and narrative
Progress Note
Connectathon Scenarios
1. Retrieve an Encounter Summary Note with DocumentReference id 2. Retrieve all notes by patient 3. Retrieve an Encounter Summary Note searching with a data range 4. Retrieve a Patient's Discharge Summary Notes 5. Write a new note to a Patient's Chart
Clinical Notes Track Scenario
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Participation
Review existing designs and comment use issues on GitHub
Zulip Chat Channels
• Bulk Data
• Argonaut
Upcoming HL7 Connectathon in Baltimore, MD (9/29 - 9/30)
Contact
• Eric Haas
• Josh Mandel
• Brett Marquard
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Additional Useful Links
FHIR Wiki
Public FHIR Servers for Testing
Proposed Connectathon Tracks September
HL7 Working Group Meeting Register Now!
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