Introduction to FHIR / Future Plans

Grahame Grieve

25-Nov 2019

Helsinki

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

• A web API - web standards where possible

• Continuity with existing healthcare standards

• Public Treasure (http://hl7.org/fhir)

Web APIs are better

• Capability based approach (rather than use case based approach)

• Search is ubiquitous

• Stable identifiers (a struggle?)

• Web framework offers deep well support stack

• Big community

• But FHIR is more than a Web API

FHIR – a RESTful API

• RESTful API- based on web/http

• Each record is a “resource” – a URL that can be read, updated etc

• For R, we are not interested in updating, only read

• GET [Server]/[ResourceType]/[id] using HTTP • Id – up to 64 chars (letters, numbers, _, .)

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Use POSTman

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POSTman

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Definition of a Resource

• http://hl7.org/fhir/Patient.html

• Scope and Usage

• Content

• Tabular view

• UML

• XML + JSON + Turtle – we use JSON in RonFHIR library

• Terminology Bindings

• Discussion of Use

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Key Data types • Identifier

• system + value: url that identifies a namespace + id unique in the namespace

• type: indicates the type of the identifier (a slippery concept)

• CodeableConcept • Multiple System + code – reference to code system + code it defines – precise meaning

• text – human representation of concept

• Quantity

• value + unit : decimal value + stated unit (string for human consumption)

• code + system: coded unit for computation purposes (UCUM strongly preferred)

• Reference • reference : Url – absolute or relative reference to another resource

• display: String – a description of what is being referenced

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Exploring Reading Resources

• Use “_summary” to reduce what is returned

• Use “_elements” to control what is returned

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Search

• A key facility in FHIR is searching for matching resources

• GET [Server]/[ResourceType]?parameters using HTTP

• Parameters are defined for each resource type

• Explore the mimic patients using POSTman… • Note – no names / phone numbers / addresses

• Other sample Searches (all http://mimic.fhir.org/r4) • Encounter

• http://mimic.fhir.org/r3/Condition?code=038.9&_include=Condition:patient

• Observation?code=600-7&subject=Patient/9467

• Observation?code=2708-6&subject=Patient/30831

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Overall Progress

Our Goals

• Disrupt Healthcare IT Standards

• Disrupt Healthcare IT

• Disrupt Healthcare

• Not about commercial outcomes

Disrupting Healthcare IT Standards

• Move to open source / open process

• Move to Agile systems

• Much more focus on implementation success

• Reduce the economic comfort of the SDOs

• Finished….

The 3 Legs of the process

• Platform Standard • HL7, FHIR

• Adapting to a Community of Use • Government Projects, Vendor Consortiums, NGOs (large & small)

• “FHIR Community Process”

• Driving into production • Regulation, Vendor Consortiums, NHS(X)

• Where the action & challenges are

Disrupting Healthcare IT

• Empower applications to offer more functionality at less cost

• Drive implementations towards interoperability as core

• Use cloud / web changes to allow modular software • Best of Breed

• Open source drives change in market

• In progress…

Shallow vs Deep Interoperability

• Integration points on the perimeter:

• Integration Points part of the system:

Where adoption is happening

• Secondary Data Repositories • Patient access to data

• Specific Clinical Data Repositories -> Big Data

• National Health Records / Sharing frameworks

• Application Extension • Argonaut / EHR Plug-ins / Decision Support Integration

• Primary Apps: SaaS (health)

• Business Process Automation • Meds mgmt, Payments, Diagnostics, supply chains

National Adoption around the world

• USA • Argonaut / Patient Access to Data

• Da Vinci: refactor the payment process

• CMS / CDA: many projects around adoption

• Europe • UK, Netherlands, Germany, Scandinavia, Lithuania

• Others • Australia, Russia…

Innovation Strategy

• Get engaged early • Wear the risk of unstable interfaces & ongoing change • Expose your IP to the wider community (open process) • Influence the outcome (standard more naturally fits your goals) • Demonstrate your expertise

• Get engaged late • No (or much lower) risk of ongoing change • No need to engage with the community • No influence and not reputation

• Pace of change is changing…

Disrupting Healthcare

• Clinical Processes are disconnected • Governance boundaries are points of failure • Boundaries: physical (buildings), organisations, regulatory • Costly to change (and inappropriate to change)

• Instead, allow deep integration of work flows across boundaries • Requires cultural change (and community involvement) • Can only be driven by clinical champions • Provide IT / Governance / Policy / Cheer-leading support

• Remove IT as a barrier to seamless care (+ Path for AI to be delivered)

• Just beginning….

Changing A Clinical Process

Rat

e o

f A

dve

rse

Even

ts

Events not addressed by change

Events caused by old process

Net reduction in adverse events

Events caused by new process

Future Plans

• Make existing content normative (finished, stable)

• Round out specification (EBM, Research, Translational Science) • + work on related specifications – imaging, social media, etc

• Consolidate implementation eco-system + Community Process

• Build out country support (multi-language support)

• Create and Support related communities • Healthcare knowledge standards

Join Us

• FHIR is a critical infrastructure enabler • A community solution for the IT requirements

• But FHIR is not a solution to anything itself

• Need new community infrastructure at many levels • Governance is critical: Build confidence and trust – open community treasure

• Needs stable Governance foundations with consistent transparency

• Join the community (FHIR, or others) • http://hl7.org/fhir, http://fhir.org