Australia’s FHIR-based National Clinical Terminology Service Overview, learnings and ideas for alternate implementations

AUSTRALIAN E-HEALTH RESEARCH CENTRE

John Grimes

15 November 2018

• Joined CSIRO this year, am currently undertaking research in the area of analytics using FHIR and SNOMED CT

• Previously worked at the Australian Digital Health Agency as the Lead Architect within the Clinical Terminology Area, and Product Owner for the National Clinical Terminology Service

• Was also involved in the design and implementation of the My Health Record, the Australian national electronic health record

Presentation title | Presenter name

About me

2 |

Background

3 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Australia’s FHIR-based National Clinical Terminology Service | John Grimes 4 |

What is the point of clinical terminology?

National standards adoption

5 |

BARRIER

Time consuming and expensive for software vendors to maintain, and just another thing to manage for adopting organisations.

CHALLENGE

How can we drive consistent, meaningful use while reducing the burden on the software industry?

How can we support localisation to meet the needs of different health professionals across Australia?

OUTCOME

National terminologies adopted by all public and private healthcare organisations and their software providers.

Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Australia’s FHIR-based National Clinical Terminology Service | John Grimes 6 |

Current solution

7 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Products and services

8 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Common use cases

9 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Australia’s FHIR-based National Clinical Terminology Service | John Grimes 10 |

Ontoserver

• Mature implementation of the FHIR Terminology

Services API (STU3)

• Numerous production deployments

• Supports import of release formats for SNOMED CT and

LOINC

• High performance, high quality search algorithms

• Supports SNOMED CT ECL expressions

• https://ontoserver.csiro.au

11 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Customer of vendor

Software vendor

Clinical System

NCTS Integration API (FHIR)

NCTS Syndication API (Atom)

Ontoserver Build Process

Software Update Distribution Mechanism

is dependent upon

National Terminology Content

Software updates loaded with

up-to-date terminology

Jurisdiction A

Business unit

EMR System

Document Submission Service

Coded clinical

documents

Document Repository

Validated clinical documents

Ontoserver

National terminology content

Local terminology content

Terminology Design Application

Ontoserver Clinical System

Code validation

requests

Code

lookups

Jurisdiction B

Terminology Design Application

National Syndication

Server

National Terminology

Server

Australia’s FHIR-based National Clinical Terminology Service | John Grimes 12 |

Decentralised architecture

Syndication feed

<feed>

<entry>

<title>

<link>

<category>

<author>

<id>

<rights>

<updated>

<published>

<summary>

<ncts:contentItemIdentifier>

<ncts:contentItemVersion>

</entry>

...

</feed>

13 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Musings

14 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Pure FHIR syndication

• Complex terminologies like SNOMED CT and LOINC get special treatment in FHIR, and cannot be fully represented by a CodeSystem resource alone

• There is a need for an interface that clients can use to get notifications of updates, and links to download those updates into their downstream server

• CodeSystem extension? • alternateFormats 0..* Attachment

• Could this be used for both read and write?

• Subscription support – get updates via webhook or websocket

Australia’s FHIR-based National Clinical Terminology Service | John Grimes 15 |

• Could we build a platform for publishing and collaborating on clinical terminology artefacts?

• It could support issues, pull requests, forking and merging, similar to GitHub, and special support for the dual authoring and review workflow commonly used by terminologists

• Custom CI / CD platform could include tests which verify the validity and internal consistency of the content

• Automatic publishing in FHIR and other standard formats

• Automatic deployment of content using the FHIR Terminology Services API

• Documentation and metadata is ideally embedded within the content, or at least within the same change control scope

Collaborative authoring and publishing

16 | Australia’s FHIR-based National Clinical Terminology Service | John Grimes

Australian e-Health Research Centre John Grimes Principal Research Consultant

t +61 7 3253 3685 e john.grimes@csiro.au w aehrc.com

AUSTRALIAN E-HEALTH RESEARCH CENTRE