getting smart about fhir part 2 · why do we need profiling? fhir provides a single set of...

Getting smart about FHIR – part 2Michael Lawley

Research Group Leader, AEHRC

AUSTRALIAN E-HEALTH RESEARCH CENTRE

Profiling

Why do we need profiling?

FHIR provides a single set of Resources

Many usage contexts:• Jurisdictional boundaries

• Acute care, primary care, specialist care, …

• Scale: Patient-oriented use, cohort-use, population-level use

Few systems will ever implement the entire specification

Most clients will only use a subset of the specification

FHIR Profiles

Describe adaptations based on use & context• Which resources & elements are used

• Which API features are used

• Which terminologies are used

• How to map these to local requirements

Computable• Publish, share, re-use

• Drive tooling: validation, conformance checking, code generation

FHIR Conformance Resources

Terminology

CodeSystem

ValueSet

ConceptMap

NamingSystem

Content

StructureDefinition

ElementDefinition

StructureMap

DataElement

Operations

OperationDefinition

SearchParameter

Compartment-Definition

Misc.

CapabilityStatement

Implementation-Guide

TestScript

TestReport

StructureDefinition

Defines data structures

Core datatypes

Core resources

Constraints on resources & datatypes

Extensions

Logical Models

StructureDefinition

Defines data structures

Core datatypes

Core resources

Constraints on resources & datatypes

Extensions – additions to resources

Logical Models

StructureDefinition - metadata

Canonical url

Name, Title

Status (draft, active)

Date, Version (author assigned)

Author, publisher, contact, ...

Base profile

StructureDefinition - content

List of ElementDefinitions•Name, cardinality, data type

•Definitions, usage notes, requirements

•Default or fixed values

•Complex constraints, length limits

•Terminology bindings

•Mappings to other specifications

ImplementationGuide

Defines scope of usage

Describes requirements for a FHIR implementation

Specifies links to• Relevant FHIR artifacts (e.g. profiles, other IGs)

• Editorial content (documentation)

Usage• Allow authors to publish an implementation guide

• Allow tools to validate conformance

Tooling

•Forgehttps://simplifier.net/forge/

•Lantana Trifolia Workbenchhttps://trifolia.lantanagroup.com/

•ClinFHIRhttp://clinfhir.com

•Manually author XML/JSON

•Excel (build tool)

https://simplifier.net/forge/

https://trifolia.lantanagroup.com/

http://clinfhir.com/

on FHIR

Substitutable Medical Apps, Reusable Technology

“An App Platform for Healthcare”

A set of specifications to integrate Apps with EHRsand other Health IT systems

Source: https://apps.smarthealthit.org/app/growth-chart (Boston Children’s Hospital)

https://apps.smarthealthit.org/app/growth-chart

Data: FHIR

Scopes and permissions: OAuth2

Simple authentication: OpenID Connect

Lightweight UI: HTML5

Scopes & permissions

patient/*.read

user/*.*

openid profile

launch

launch/patient

Launch

Launch from host system:GET https://{app_launch_url}?

launch=123&

iss={fhir_base_url}

App requests CapabilityStatement to determine OAuth2 endpoint details

App performs OAuth2 authorization for required scopes

CDS-hooks

Trigger decision support from the EHR

CDS Service

Invoked by EHR using a hook

Evaluates own rules using FHIR data

Returns decision support via cards

Example hooks

patient-view•a patient’s chart is opened

medication-prescribe•a medication is selected for prescription

order-review•reviewing pending orders for signing

Context and pre-fetch

Context•e.g., current patientId, encounterId, etc

Prefetch•e.g., the actual MedicationOrder

Cards

Information•Text for the user to read

Suggestion•Options for the user to choose between

App link•Link to an App (eg SMART) for more complex interactions

Example - https://example.com/cds-services

{

"services": [{

"hook": "medication-prescribe",

"title": "Medication Brand Substitution CDS Service",

"description": "An example CDS Service that offers other brands

of the medication being prescribed",

"id": "medication-echo",

"prefetch": {

"patient": "Patient/{{context.patientId}}",

"medications": "MedicationOrder?patient={{context.patientId}}”

}

}]

}

FHIR & the Open Community

FHIR is disrupting healthcare IT & healthcare:

• Encouraging the development of open community

• Significantly reducing the cost of data exchange

• Creating new economies of scale and methods of engagement

• Building a solid base to scale healthcare analytics and application

Join our open community – or another one…

More FHIR

The National Children’s DigitalHealth Collaborative

Mon 2:35-3:20, C2.2/3

MSIA Engagement Forum:FHIR State of the Nation

Tue 2:00-3:30, Pyrmont Theatre

AEHRC

getting smart about fhir part 2 · why do we need profiling? fhir provides a single set of...

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