Clinicians on FHIR Dr. David Hay Chair Emeritus HL7 NZ Dr. Amir - PowerPoint PPT Presentation

Clinicians on FHIR Dr. David Hay – Chair Emeritus HL7 NZ Dr. Amir Mehrkar – Co-chair INTEROPen 1

INTEROPen Board Representatives

Care Organisations Networks & Others Alder Hey NHS Foundation Trust BCS (British Computer Society) Belfast City Hospital Digital Health CCIO Network Birmingham & Solihull LDR Digital Health CIO Network Birmingham & Solihull Mental Health NHS Foundation Trust EMIS National User Group Cambridge University Hospital Innovative UK - Knowledge Transfer Network Connecting Care Partnership Klas Research Dorset Health & Care Community (Dorset CCG) NHS HACK DAY Great North Care Record Northern Ireland CCIO Network Greater Manchester Health & Social Care Partnership CDO One HealthTech Health and Social Care in Northern Ireland OpenHealthHub CIC Holding Your Hand Limited SOCITM Humber, Coast and Vale STP techUK Humber NHS Foundation Trust Imperial College Healthcare NHS Trust Lancashire and South Cumbria STP Standards Organisations Leeds Teaching Hospital NHS Trust HL7 UK Marie Curie UK IHE UK NHS Gloucestershire CCG OpenEHR NHS South, Central and West CSU PRSB (Professional Records Standards Body) NHS Lothian North West London Care Information Exchange North Tyneside CCG ALBs North Yorkshire County Council (Adult Social Care Services) Health Education Northumberland, Tyne and Wear NHS Foundation Trust England Salford Royal NHS Foundation Trust Healthy London Sheffield Health and Social Care NHS Foundation Trust Partnership Somerset Integrated Digital Electronic Record London Health and Taunton and Somerset NHS FT Care Information Tower Hamlet/Newham/City Hackney/Waltham Forest CCG 162 Member Organisations Exchange University College London Hospitals NHS Foundation Trust as of 20/11/17 NHS Digital University Hospitals Southampton NHS Foundation Trust NHS England York Teaching Hospitals NHS Foundation Trust

Egress Intersystems Ramsey Systems IT Suppliers Elsevier JAC Computer Services Ltd Red Embedded Systems AccuRx EMIS Health JKM Care Solutions Restart Consulting Active Medicine Endeavour Health Kainos Evolve Ripple Advanced Health & Care Enovacom Mayden Servelec Aire Logic Ltd Epic Medelinked Sitekit Allocate Software Epro Medical Connections Soliton IT Allscripts everyLIFE Technologies Medxnote Solutions4Health Answer Digital Experis Microsoft Health & Life Sciences Shaping Cloud Application Insight Forcare Microtest Specialist Computer Centres Atos FreshEHR MphRx Stalis Boots G2 Speech B.V myhealth Sunquest Blackpear GPC Group NHS Wales Informatics Service SystemC BT Graphnet Health NoemaLife UK Targett Business Technology Cambio + Healthcare Systems HCI Group (Tech Mahindra Ltd) Northgate Public Services Tiani Spirit Capgemini Health Fabric Nottinghamshire Health Tiny Medical Apps Capita Health Partners Informatics Service (NHIS) TotalMobile Health Intelliegence Careflow Connect Ltd Nth Dimension TPP HealthForge Carelink (Piksel Ltd) OLM Systems Trisoft Healthcare Ltd Healthcare Gateway Cerner Open Mapping Software Virgin Media Business Healthlinked CGI Group Optum International Vision Health Hospedia CharityLog Oracle Wiggly-Amps Huawei Technologies CheckWare Orion Health Wolters Kluwer Health IBM Clinisys “ HealthLanguage ” Ortivus CommonTime IMD-SOFT OTTech Healthcare Consultancy X-Lab CSC IMMJ Systems (Mediviewer) Outcomes Based Healthcare Cyber Media Solutions IMSMAXIMS Phillips Healthcare Deepmind Health Pinnacle Health Partnership Inhealthcare Deontics Prederi Inidus Ltd Docman psHEALTH INPS Docobo Pumpco Intelerad Digital Cognition Quicksilva Systems Integration Solutions Intelesant

About me Medical Doctor ฀ ฀ Chair Emeritus of HL7 New Zealand ฀ Co-chair FHIR Management Group ฀ Product Strategist Orion Health Blog: fhirblog.com ฀ Tooling: clinFHIR.com ฀

Plan for the day Purpose of the workshop ฀ ฀ The clinical problem ฀ Creating an Information model (exercise) ฀ The basic of FHIR : resources and references Resources model and Resources Graph ฀ Create Resource instance graph using Scenario (exercise) ฀ ฀ Structured and Coded data (exercise) ฀ Making a Document (exercise) ฀ Profiling Moving from models to FHIR artifacts ฀ The Implementation Guide ฀ ฀ Last thoughts

Workshop Objectives Create a profiling process that works for Clinicians ฀ ฀ Develop a repeatable workshop for clinicians ฀ Introduce you to FHIR ฀ Introduce you to the clinFHIR tooling And how to use it … ฀ Describe the profiling infrastructure ฀

The road to FHIR (aka the process) Clinician / Business Analyst Clinical Information Resources References FHIR Model Model Graph Problem artifacts FHIR Expert / Terminology

Inspired by the London underground …

The clinical problem

Transfer of Care eDisharge Patient Demographics Content Headings: Encounter Details Content Clinical community Content: Problems/Diagnoses via PRSB Content Data elements Observations NHS number Content SNOMED-CT Medications dm+d Content Allergy Content Free text Plan Content

Sending Recipient Organisation Organisation Patient’s own record IG controls Security controls Technical Artefact in FHIR

Sharing a document Database Shared Data Store Discharge Summary Focus on the document content only …

Information (Logical) Model

Information / Logical Model ฀ What is an Information model It’s the information being shared in ‘clinician speak’ ฀ A form of Logical Model ฀ ฀ Different ways to represent ฀ FHIR ฀ openEHR ฀ CIMI

FHIR datatypes (in Information model) ฀ What is a Data Type ฀ Most useful ones (for now) string ฀ ฀ date ฀ Quantity ฀ CodeableConcept ฀ Coded data, eg SNOMED

clinFHIR ฀ Developed as training tool Evolving! ฀ What does clinFHIR do ฀ - View Patient data - Logical Modeler - Scenario Builder - ValueSet explorer Extension Definition editor - - Implementation Guide viewer Clinfhir.com

clinFHIR: Server roles Specific FHIR server roles ฀ Data/patient – patient related (clinical) - and ‘reference’ (Practitioner, Patient Profiles Terminology and Data (Conformance) Organization) Conformance – profile, extension - Definition, NamingSystem Terminology – ValueSet & Terminology - operations clinFHIR

Demo Url: clinFHIR.com ฀ Clinfhir.com Servers: public HAPI STU3 Email: interopen@clinfhir.com Set the servers ฀ Password: password Public HAPI-3 ฀ ฀ Describe each module, & what it is for ฀ Details for: ฀ Logical Modeler Using the Logical Modeler

Exercise Url: clinFHIR.com Build an Information Model for the ฀ Servers: public HAPI STU3 Discharge Summary Email: interopen@clinfhir.com ฀ Notes Password: password Choose a unique name for the model - - ?your name (no spaces) Make a ‘multi - resource’ model - - What information should be included? - Organize in a way that makes sense to you - Use resource thinking if you want - Choose closest datatype - Remember to save

Review models ฀ Individual group models ฀ Our model

Basics of FHIR

What is FHIR An HL7 Interoperability Standard ฀ ฀ For sharing clinical information ฀ 2 main parts ฀ Content Model (Resources) ฀ Exchange Specification Extending into Clinical Knowledge ฀ ฀ Decision Support ฀ Quality Measures ฀ Also being used for persistence ฀ Supported by a large community

Overview of FHIR Fast Healthcare Interoperability Resources (FHIR) ฀ ฀ Consistent, simple to use content model (resources) - Controlled extensibility ฀ Supports all paradigms of exchange - Real-time APIs - Documents, Messages & Operations ฀ Designed with implementers in mind ฀ Open Source, freely available Detailed on-line, hyperlinked specification (hl7.org/fhir) ฀ ฀ Freely available tooling, servers, libraries ฀ Strong endorsement and support from vendors, providers and regulatory community (e.g. UK - INTEROpen.org, US - Project Argonaut) Massive supporting community ฀

Sharing information – different paradigms Message FHIR Repository Document REST

Where can you use FHIR V3 V2 Application FHIR Integration FHIR Engine PHR API Library FHIR DataBase

Sample clinical use cases ฀ Direct exchange of structured and coded clinical data Eg Discharge Summary, Progress Note, Patient sourced data ฀ Real-time access to data ฀ ฀ Mobile application ฀ Referrals Including directory infrastructure (Services, Providers … ) and ฀ scheduling ฀ Storage of clinical data ฀ Other common pattern is interface ฀ Clinical Decision Support / Quality metrics ฀ Definition and Interface CDS-Hooks ฀

Timeline: Where does FHIR fit? V2 Start V3 V3 CDA Fresh Look FHIR Release 3 1987 1995 2005 2011 2016 V2 V3 CDA FHIR 1980 1990 2000 2010 2020

The specification http://hl7.org/fhir/

Resources: What are they? ฀ The Content model The Thing that is exchanged ฀ - Via REST ( FHIR Restful API), Messages, Documents ฀ Informed by much past work inside & outside of HL7 - HL7: version 2, version 3 (RIM), CDA - Other SDO: openEHR, CIMI, ISO 13606, IHE, DICOM