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Getting Smart about FHIRPart 1: Introduction
Grahame Grieve
HL7 - FHIR Product Director
Sydney 30-July 2018
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Origin of FHIR: the state of Healthcare
• Health care has broken processes
• Other industries are being transformed• IT enables process transformation
• This process is not happening in healthcare• IT standards to integrate B2B and C2B do not exist
• IT is not properly implemented
• There are many other blockers (culture, business process, liability, regulation)
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FHIR: Transforming Healthcare IT
• Reduce the cost of interoperability (90%!)
• More outcomes for the same investment• Transformation is already evident, but far from complete
• Will increase investment
• Change is not driven by IT • Data is worthless by itself
• IT is just an enabler
• Clinical Champions change culture and outcomes
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About HL7
• HL7 = Health Level 7• 7 = Obscure reference to obsolete network model: application exchange
• HL7 publishes Health care data exchange standards• V2 : healthcare messaging (“HL7”) – widely adopted
• V3 : healthcare exchange modelling framework – not much adopted
• CDA : Clinical Document Framework (MyHR, others)
• FHIR : API for Healthcare data exchange, based on current technology
• CCOW, CQL, Arden Syntax, others
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What is FHIR?
• Fast Health Interoperable Resources
• A Community• Meets under the umbrella of HL7
• Dedicated to making it easier to exchange healthcare information
• Uses web infrastructure to solve problems about healthcare
• A specification• Freely available on the web (http://hl7.org/fhir)
• Describes how to exchange information about healthcare
• Adds healthcare knowledge to web standard infrastructure
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FHIR: The web, for Healthcare
Open Community Open Standard
• Make it easier to exchange healthcare information
• Open Participation - uses web infrastructure (social media)
• Lead by HL7 - deeply connected to world wide health community
• Describes how to exchange healthcare information
• Public Domain (http://hl7.org/fhir)
• A web API - web standards where possible
• Continuity with existing healthcare standards
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Building the FHIR culture
• Open community – anyone can join
• Produces open standards – community treasure
• Foundation: solid governance backed by ANSI
• Build by iteration and continuous demonstration that trust is rewarded
• Connectathons, Face to face meetings, teleconferences, email lists, community forums, instant messaging, stack overflow
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FHIR Specification
• A web API
• A set of ‘resources’ (Json, XML , RDF formats)
• Common infrastructure and rules for exchange• Type framework
• Versioning rules
• Mapping
• Supporting Infrastructure for implementations
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FHIR Building Blocks
5. Clinical Decision Support, Clinical Knowledge Management, Care Plan Management
4. Clinical Content / Clinical Record / Care Management
3. Health Administration (Patients, Organizations, Provider/Staff Management, Scheduling)
2. Terminology/Conformance (Getting systems to talk)
1. Internal Specification Infrastructure
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What makes FHIR worth it?
• Web API (capability based)
• Use of common content model across the entire spectrum
• Open License
• Internal philosophy: pragmatism
• Open community
• Public Tooling/Testing Infrastructure
• Continuity with existing healthcare standards
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Timeline
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Date Event Comments
July 2011 Conception / Initiation
Feb 2014 1st Release First copy for implementation use
Sept 2015 2nd Release Base for US Adoption / Argonaut
Mar 2017 3rd Release Use around the world, preparation for normative
~Dec 2018 4th Release First normative (stable) version
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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, 2
• Breaking changes at level 4 and 5 need community discussion
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Opening up EHRs
• Provide an API that allows access to EHR data and services
• With Integrated security
• US Argonaut Project
• Potential is there • prototype → specification → delivery → production
• Need a much broader set of data
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Clinical Knowledge
• Terminology Services (National / Specialist)
• Clinical Rule / care plan definition repositories
• Decision Support API
• Decision Support / Clinical best practice logic sharing
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Analytics
• FHIR Bulk Data interface
• Large scale transfer of data
• Store build as FHIR resources natively
• Use generic big data / text-nlp tools
• Outcomes shared/reported in FHIR formats
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Empowering Patients
• Making data accessible to Patients
• Making Data from patients accessible to system
• Allowing patient to control data sharing
• Creating a single common patient record
• Services not Data are empowering
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Coordinated Care
• Common Frustration of Patients:• Scheduling/Communication problems• Conflicting care plans / payment options• Conflicting system definitions of success• Must be resolved by the patient
• FHIR enables Services for • distributed care plan• virtual clinical review
• Virtual Institutions
• Integrated Home Care (medication management)
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Gartner Technology Adoption Curve
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Projects Around the world: US Argonaut
• Main EHR vendors – common API to access clinical summary• http://www.fhir.org/guides/argonaut/r2/
• Builds 2 things:• Patient access to data
• App eco-system around the EHR systems
• Adopted by Apple for healthkit
• EHR companies & Apple have a global reach• Argonaut coming to you
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Around the world: Clinical Data Repositories
• Google Brain project• https://ai.googleblog.com/2018/03/making-healthcare-data-work-better-
with.html
• Cerner Bunsen: https://github.com/cerner/bunsen
• 100s of projects around the world to build FHIR data stores for analysis / AI / Business reporting
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Around the world: National EHRs
• Lithuania
• Australia
• Vietnam
• Canada
• Netherlands
• UK (renal repository)
• Progress on these is variable – large slow moving projects
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Making FHIR work
• International Specification defines overall framework
• Countries / Regions / Projects publish adaptations to local culture/regulations/requirements etc
• Implementation Guide: How FHIR is implemented• What kind of codes are in use (CodeSystem / Valueset)
• What features of a resource + local extensions (StructureDefinition)
• How is the API used (CapabilityStatement, OperationDefinition, Search Parameter)
• How do you handle security? How do you enable trust?
• What communication paradigms are in use? (Who communicates when?)