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FHIR – SPARKING INNOVATIONIN HEALTH INFORMATION SHARING JAMES TAYLOR

• 2016 © Orion Health™ group of companies

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


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


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…


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)


FHIR timeline

2012 20162014 2018 2020

FirstDraft

2011 20152013 2017 2019

1stDSTU

2ndSTU

~ 1stNorm.

~ 2ndNorm. . . .

FreshLook

3rdSTU

FMM

FHIR:THE BASICS

1.Content2.Exchange3.Profiling


1. Content: Resources


Resource example

Resource Identity & Metadata

Human Readable Summary

Extension with URL to definition

Standard Data:• MRN• Name• Gender• Birth Date• Provider


References between resources

Coded PropertiestypebodySuiteindicationperformer.rolecomplicationrelatedItem.type

Other Propertiesidentifier (Identifier)outcome (String)

PROCEDURE

PATIENT

DIAGNOSTIC REPORTCONDITION

Subject

ReportRelated Item

Encounter Performer

ENCOUNTER PRACTITIONER


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


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


2. Exchange: Paradigms

REST Documents

Messages Services(Operations)


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


Documents and Messages

Pain right ear 3 days

Otitis media

Elevated temperature

Temperature 38°C

Inflamed right drum

Amoxicillin 250mg

Practitioner

Patient

Encounter

Composition


Services / Operations

▸ For more complex server side logic▸ Real-time▸ Key part of ecosystem▸ E.g.

– Prescribing with Decision Support– Terminology– Immunisation protocols


Regardless of paradigm, the content is the same

FHIRRepository


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


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

SMART:SECURITY & ECOSYSTEM


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


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


SMART security

SMARTSMARTSMART

SMARTSMARTSMARTEHR

HOSPITAL

EHR

COMMUNITYCARE

EHR

SHAREDREPOSITORY/

HIE

EHR

PRIMARYCARE PROVIDER

EHR

LABORATORYRADIOLOGY

FHIR API FHIR API

FHIR API


FHIR and SMART: enabling the ecosystem

FHIR API and Resources

Terminology Registry Identity Repository

BENEFITS


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)


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


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


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

PROTECTING YOURINVESTMENT


Incremental Interoperability

▸ Lesson of CDA▸ Start small and build gradually▸ Learn as you go

– How it fits with YOUR system


The community

▸ Very active community – Assistance & advice

▸ Training and certification– Large amount of understanding & knowledge

▸ Most vendors embracing FHIR▸ Most countries embracing FHIR


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


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


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


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


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

DEMONSTRATION


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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