FHIR%–SPARKING% INNOVATION INHEALTH% … ·...
Transcript of FHIR%–SPARKING% INNOVATION INHEALTH% … ·...
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Todays Agenda
▸ What is FHIR (and why do we need it)▸ Resources, Exchange and Profiling▸ Security and how SMART will enable this▸ How FHIR will benefit clinicians, healthcare executives, implementers and informed patients
▸ How FHIR APIs will future-proof your organisation▸ Orion Health and FHIR
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Why Interoperability?
▸ Health information sharing is becoming increasingly important▸ Individuals involved in delivering care to patients now expect the information they require to be available at the point of care
▸ Increasing requirement for rapid and secure healthcare interoperability– The sharing of patient information between providers
▸ Need to share data for the good of the patient– And involve them in care
▸ Data collected in multiple places– Realistically need to move information around
▸ Interfaces are expensive– Especially if not standards based
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Why FHIR?
In 2011, the Board of HL7 noted:
‣ Interoperability requirements are increasing‣ Need for real time access (API) – Mobile‣ Vast increase in the amount, type and source of data
- e.g. Devices, Genomics‣ Analytics, population health‣ Implementer expectations
Existing standards were lacking, a fresh look was needed…
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Overview of FHIR
▸ Fast Healthcare Interoperability Resources (FHIR)▸ Consistent, simple to use content model (resources)
– Domain knowledge is not required– Controlled extensibility
▸ Well thought out, standardised APIs▸ Familiar tools and technologies for implementers▸ Significantly improves healthcare information exchange
– Designed with implementers in mind– Detailed spec for real time APIs
▸ Strong endorsement and support from vendors, providers and regulatory community (e.g. Project Argonaut)
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FHIR timeline
2012 20162014 2018 2020
FirstDraft
2011 20152013 2017 2019
1stDSTU
2ndSTU
~ 1stNorm.
~ 2ndNorm. . . .
FreshLook
3rdSTU
FMM
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Resource example
Resource Identity & Metadata
Human Readable Summary
Extension with URL to definition
Standard Data:• MRN• Name• Gender• Birth Date• Provider
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References between resources
Coded PropertiestypebodySuiteindicationperformer.rolecomplicationrelatedItem.type
Other Propertiesidentifier (Identifier)outcome (String)
PROCEDURE
PATIENT
DIAGNOSTIC REPORTCONDITION
Subject
ReportRelated Item
Encounter Performer
ENCOUNTER PRACTITIONER
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Recording a consultation
12-year-old-boy
First consultationComplaining of pain in the right ear for 3 days with an elevated temperature. On examination, temperature 38°C and an inflamed right eardrum with no perforation. Diagnosis Otitis Media, and prescribed Amoxicillin 250mg 3 times per day for 7 days.
Follow up consultation2 days later returned with an itchy skin rash. No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to Erythromycin 250mg 4 times per day for 10 days.
Patient
Encounter
Condition
Observation
Medication
Allergy Intolerance
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Encounter
Encounter
Practitioner
Patient
Asserter
Performer
Performer
Performer
Performer
Performer
Performer
Asserter
Asserter
Prescriber
Asserter
Pain right ear 3 days
Otitis media
Itchy skin rash
No breathing difficulties
Elevated temperature
Temperature 38°C
Inflamed right drum
Urticarial Rash
Amoxicillin 250mg
Erythromycin 250mg
Penicillin Allergy
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2. Exchange: Paradigms
REST Documents
Messages Services(Operations)
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REST (API)
▸ “Representational state transfer” – an architecture for how to connect systems in real time
▸ Uses HTTP/S▸ Simple to use▸ Very commonly used outside of healthcare – especially mobile
– JASON report called out the lack of an API▸ For simple interactions
– Create– Read– Update – Delete
▸ A lot of tooling / experience available
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Documents and Messages
Pain right ear 3 days
Otitis media
Elevated temperature
Temperature 38°C
Inflamed right drum
Amoxicillin 250mg
Practitioner
Patient
Encounter
Composition
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Services / Operations
▸ For more complex server side logic▸ Real-time▸ Key part of ecosystem▸ E.g.
– Prescribing with Decision Support– Terminology– Immunisation protocols
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Regardless of paradigm, the content is the same
FHIRRepository
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3. Adapting FHIR to your needs: Profiling
▸ Many different contexts in healthcare, but want a single set of Resources▸ Need to be able to describe ‘usage of FHIR’ based on context▸ Allow for these usage statements to:
– Authored in a structured manner– Published in a repository– Discoverable– Used as the basis for validation, code, report and UI generation.
▸ 3 main aspects:– Constraining a resource - remove element or change multiplicity– Change coded element binding– Adding a new element (an extension)
▸ Profiling adapts FHIR for specific scenarios
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Profiling a resource | for example…
Note: Limited mandatory elements in the core spec
Require that the identifier uses the medicare number – and is required
Limit names to just 1 (instead of 0..*)
Change maritalStatusto another set of codes that extends the one from HL7 international
Add an extension to support ethnicity
Don’t support photo
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FHIR Security
▸ Not part of code spec– Highly specialised– Much existing knowledge / systems– Many different environments
▸ Hooks– Security tags– Specific resources
• AuditEvent• Provenance
▸ Recommendations– http://www.hl7.org/implement/standards/fhir/security.html– OAuth2 & SMART
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OAuth2: a high level
An example implementation
APP
1. AUTHENTICATE AND GETACCESS TOKEN
2. MAKE FHIR QUERYINCLUDING ACCESS TOKEN
RESOURCE SERVER
EHR
AUTHORISATIONSERVER
DATABASES
3. CHECK TOKEN
0. ESTABLISH RELATIONSHIPS
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SMART security
SMARTSMARTSMART
SMARTSMARTSMARTEHR
HOSPITAL
EHR
COMMUNITYCARE
EHR
SHAREDREPOSITORY/
HIE
EHR
PRIMARYCARE PROVIDER
EHR
LABORATORYRADIOLOGY
FHIR API FHIR API
FHIR API
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FHIR and SMART: enabling the ecosystem
FHIR API and Resources
Terminology Registry Identity Repository
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Benefits to Implementers and Vendors
▸ Familiar tooling and technologies– XML/JSON, HTTP, REST, SSL, OAuth
▸ Predefined resources and APIs – Allows implementer to focus on the core application functionality
▸ Extensive documentation, samples and reference server implementations▸ Validation services ▸ Active and supportive community▸ Open Source code libraries
– HAPI (Java) and Furore (.Net)▸ Mobile friendly▸ Increases commercial viability of app development as FHIR compliant apps will work with different FHIR Servers (EMRs, HIEs)
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Benefits to Clinicians
▸ Improved access to more complete, higher quality, patient information incl. genomics
▸ Easier to organize investigations and management▸ Greater choice and variety of applications and devices to support clinical workflow▸ Increased IT development speed – solving business problems faster, in innovative ways
▸ Improving Decision Support- E.g. Immunisation protocol
▸ Clinicians can get involved in system design▸ Saving time
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Benefits to Consumers
▸ Prospect of improved patient engagement apps, enabled through FHIR APIs to clinical systems– Can engage more deeply
▸ Clinician has access to a more complete patient record and improved decision making tools, leading to:– Better decision making– More efficient diagnosis and treatment– Higher quality care
▸ Overall improved patient experience – reducing wasted time
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Benefits to Health Care Organizations
▸ Most vendors are committed to FHIR▸ Should lead to:
– faster deployments– lower cost interoperability– reduced vendor lock in as FHIR is adopted by source systems
▸ Standards based APIs to support internal application development▸ Capture data for analytics and Decision Support
– Management– Population
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Incremental Interoperability
▸ Lesson of CDA▸ Start small and build gradually▸ Learn as you go
– How it fits with YOUR system
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The community
▸ Very active community – Assistance & advice
▸ Training and certification– Large amount of understanding & knowledge
▸ Most vendors embracing FHIR▸ Most countries embracing FHIR
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Commonly used standards & tooling
▸ Builds on existing commonly used technologies– XML, JSON, Markdown– SSL, TLS– REST
▸ Lots of tooling available– Compared to previous healthcare interpretability standards
▸ Proven in practice– And actively maintained
▸ Quicker & cheaper to build▸ More ‘person resource’ available
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Continually enhanced
▸ People are using FHIR to meet new (as well as existing) business needs▸ Workflow▸ Notifications▸ Terminology Integration▸ Privacy / Consent▸ Clinical Reasoning
– Decision Support– Clinical Quality Measures
▸ Associated Standards– CDS Hooks– FluentPath
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When to start using FHIR
▸ Now!▸ Better than bespoke
– Even though not finished…▸ Build on decades (person centuries) of thought & experience▸ Already real world uses out there
– Lithuania– Commonwell
▸ Access to community for advice– Contribute own experience
▸ Which version?– Others have to upgrade too
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In Summary
▸ FHIR is the latest HL7 interoperability standard▸ Promises to revolutionise sharing of healthcare information▸ Enormous interest locally and internationally▸ It future-proofs your IT investment▸ Is not a silver bullet▸ FHIR is disruptive▸ FHIR IS in your future
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How FHIR APIs will future-proof your organisation
▸ We are a 100% healthcare focused software vendor ▸ Reputation for integration and interoperability▸ Although FHIR is a draft standard, we are committed and already introducing FHIR capability in to our suite of products
▸ For Orion Health, FHIR is enabling smarter exchange and acquisition of data, mobility and new types of connected solutions
▸ We are developing FHIR expertise among our people and also guide our customers on their integration and interoperability journey
▸ Participation in Connectathons and other various other events and initiatives around the world
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FHIR Unlocks Innovation In Health Information Sharing
▸ FHIR - Evolving, next generation HL7 standard▸ Focused on decreasing interoperability costs and unlocking technical innovation in healthcare
▸ Profiling can customise FHIR for your organisation▸ SMART will enable Security for FHIR▸ FHIR will benefit clinicians, healthcare executives, implementers and
informed patients▸ FHIR APIs will future-proof your organisation▸ Orion Health is committed to FHIR as leaders in healthcare integration and interoperability
FHIR®Developer Days Event16-18 Nov 2016Amsterdam
Online blogfhirblog.com
Webinar ‘Health interoperability: FHIR® essentials for
CCIOs’
25 Nov 2016 12:30 –13:30
bit.ly/DrDavidHayFHIR
Coming up | Learn more about FHIR from Dr David Hay, FHIR Evangelist and Product Strategist at Orion Health
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