HSCIC – The journey on adopting FHIRFGM Risk Indication System

presented by Richard Kavanagh, Head of Data Standards

HSCIC a brief history

• HSCIC is an organisation that subsumed “Connecting for Health” in England

• It is responsible for the delivery of national architecture for the NHS in England

• It has a scope for both Health and Social Care

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The current HL7 landscape

• National architecture is massively invested in HL7v3 and web services

• Very widely deployed – Over 100 “live” messages– Thousands of service end points– Billions of messages flowing

• However, it is almost universally disliked by the supplier base in England

• The cost of development is reportedly high due to niche skills required for HL7v3

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Can we have FHIR please?

• New projects an opportunity for re-evaluating the HL7 standards used

• “Can we use FHIR please?”– Nobody ever asked for HL7v3– Do they know what they are asking for?

• Industry are currently seeing FHIR as an obvious way to go (mostly)– though few (if any) of them have any

implementation experience yet

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Introducing FHIR into the National Architecture

• FGM Risk System is a new national requirement to be deployed across England

• A new messaging capability required to query a national repository

• Technical complexity is low and offers an ideal test case for trialling FHIR

• Infrastructure, timelines and existing supplier base mandated a “messaging” solution

• Internal reluctance to move away from HL7v3

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Development Team Feedback

• Development of FHIR interfaces via technical “proof of concepts” and “demonstrator” systems.

• Trialling new “agile” development processes internally within HSCIC

• Development team reportedly liked– Open accessibility of the FHIR standard– Simple modular constructs (i.e. the resources)– Managing resource identifiers perceived to be a

challenge for the future

• Though did not like the absence of “tightened” schemas

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Creating the “Implementation Guide”• Internally we have decided that we will create “profiles” for all FHIR

interfaces. Initially for IG creation then for driving validation.

• Furore’s Forge tool is used to create all profiles.

• Internal “publication” software used to create the actual implementation guide, published online here http://data.developer.nhs.uk/fhir/fgm/ evolved from Furore’s DSTU1 open source work in this area.

• Initial open source exemplar software to create/consume FHIR messages being produced.

– C# version using Ewout’s API being used here https://github.com/im2admin/FGM_CSHARP

– Java version will be added - we intend to use the HAPI API

• Early days, but internal effort less than creating HL7v3 RMIMs undertaken by staff with much less training.

• Principally a learning exercise, the next one will be easier ….

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The first national NHS FHIR solution

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The FGM Solution

• A simple query/response pattern

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The Query Message

• Two parameters, a Risk Type and a Patient’s NHS Number

• Contains a Bundle of the following

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The Response Message

• Contains a Bundle of the following:

• No extensions required in the solution

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The Next Steps for FGM

• Use Furore’s new release of Forge to refactor our profiles

• Refactor our “publishing” software for changes from DSTU2 and Forge

• Get the development team to refactor their software solution

• Support the suppliers with their implementations

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The next steps for FHIR at HSCICThe use of FHIR is now growing rapidly. Multiple projects now underway

• More messaging projects:– Maternity pathways (underway)– Pathology messaging (in evaluation)– Ambulance to Emergency Department interface (in evaluation)

• RESTful API projects (all underway) :– APIs for Primary Care systems (i.e. GPs)

Demographics, Scheduling, Medications ….

– APIs Integrated Digital Care records (i.e. Secondary / Tertiary care) Federated development of IGs …

– National Appointment Booking/Referral system

• FHIR Validation/Assurance (2015 Q4):– National approach & tooling

• FHIR for Documents (2016 Q1/Q2):– CDA <> FHIR Conversion based on national profiles

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Any Questions ?

@RKavanaghhttps://

uk.linkedin.com/in/richardkavanagh

richard.kavanagh@hscic.gov.uk

Questions