This presentation was made on 17.12.2013 in Vilnius (Lithuania) at the Centre of Registers. The purpose of the presentation create interest to the new HL7 FHIR standard to decision-makers, and then take it to use in the NHR project instead of HL7 V3

1. Introduction into HL7 FHIR
Igor Bossenko
@Lithuanian Centre of Registers
17.12.2013

2. Nortal experience in healthcare
! HL7 V2
! 14+ years
! Estonia Image Bank architecture and development
! HL7 V3
! 9+ years
! Estonian NHR HL7 V3&CDA architecture and standard
development
! Estonian eLaboratory standard architecture and development
! HL7 FHIR („fire“)
! EMIR integrated web component (in progress)

3. Why FHIR?
! FHIR stands for Fast Healthcare Interoperable
Resource
! FHIR combines the best features of HL7 V2, HL7
V3, and CDA, while leveraging the latest web
service technologies.
! The design of FHIR is based on RESTful web
services.
! FHIR is based on modular components called
“resources,” and these resources can be combined
together to solve clinical and administrative
problems in a practical way.
! Free

4. Grahame Grieve, Original Architect of
HL7 FHIR
! Q: Can you explain your decision to create HL7
FHIR using modern protocols? How would you
compare this decision to the history of HL7 Version
2 and 3?
! R: FHIR was born out of frustration with the overall
direction of HL7 (i.e. v2, v3, and CDA). V2 has been
great, but has come to the end of the road. V3 has
tremendous strengths but in the end it failed — too
much too soon, I think. CDA fixes only some of v3′s
problems, but is a document, not a data interchange
specification.

5. Standards difference (semantic)
! HL/ V2 (plain text with pipes)
MSH|^~&|MegaReg|XYZHospC|SuperOE|XYZImgCtr|20060529090131-0500||ADT^A01^ADT_A01|01052901|P|2.5
EVN||200605290901||||200605290900
PID|||56782445^^^UAReg^PI||KLEINSAMPLE^BARRY^Q^JR||19620910|M||2028-9^^HL70005^RA99113^^XYZ|260 GOODWIN CREST
DRIVE^^BIRMINGHAM^AL^35 209^^M~NICKELL’S PICKLES^10000 W 100TH
! HL7 V3 (XML with namespaces)
<subject typeCode="SUBJ">
<combinedMedicationRequest xmlns:ext="urn:hl7-EE-DL-Ext:v1" classCode="SBADM" moodCode="RQO"
xsi:type="ext:PORX_IN060360UV_Extension.PORX_MT060160UV.CombinedMedicationRequest" ext:HL7-ClassName="SBADM" ext:HL7-Domain="PORX_RM000000UV" ext:realmCode="EE">
<id root="1.3.6.1.4.1.28284.6.2.4.48" extension="1000025189"/>
<statusCode code="new"/>
<confidentialityCode codeSystem="1.3.6.1.4.1.28284.6.2.2.43.1" codeSystemName="Volituse liik" code=""/>
<subject typeCode="SBJ">
<patient classCode="PAT">
<id root="1.3.6.1.4.1.28284.6.2.2.1" extension="37712092729"/>
<id root="TTOMaaratudIsikuIdOIDnr" extension=""/>
! HL7 FHIR (XML w/o namespaces or JSON)
<Patient xmlns="http://hl7.org/fhir">
<!-- Peter James Chalmers, but called &quot;Jim&quot; -->
<name>
<use value="official"/>
<family value="Chalmers"/>
<given value="Peter"/>
<given value="James"/>
</name>
<name>
<use value="usual"/>
<given value="Jim"/>
</name>
{
"resourceType": "Patient",
"name": [
{
"use": "official",
"family": [ "Chalmers " ],
"given": [ "Peter", "James" ]
},
{
"use": "usual",
"given": [ "Jim" ]
}
]
}

6. Standards difference (protocols)
! HL7 V2
! MLLP: TCP, FTP
! HL7 V3
! SOAP web services
! HL7 FHIR
! REST

7. XDS, CDA?
! XDS || RCMR -> DocumentReference
! used to describe a document that is made available to a
healthcare system.
! establishes its own context
! can be displayed to the user
! has defined update management.
! CDA -> Resource Composition
! A set of healthcare-related information that is assembled
together into a single logical document that provides a
single coherent statement of meaning, establishes its own
context and that has clinical attestation with regard to who
is making the statement.
! EN 13606 uses the term "Composition" to refer to a single
commit to an EHR system

8. Benefits of FHIR
! Easy to understand and implements
! Supports web integration
! Supports atomic transactions
! Possibility to send allergy w/o discharge summary
! Usable on mobile platforms and into devices
! Free
! Low implementation cost
! FHIR could help make money and save money.
! Have ready-to-use Java libraries
! Have many examples
! Have ebook and very good web site

9. Links
! http://hl7.org/implement/standards/fhir/
! http://www.hl7standards.com/blog/2013/06/11/5-
qs-grahame-grieve/
! http://www.hl7standards.com/blog/2013/05/14/
interoperability-paradigms-of-fhir/
! http://www.healthcareimc.com/node/515
! http://www.slideshare.net/HINZ/hay-introduction-to-
hl7-fhir
! http://blog.interfaceware.com/hl7/what-is-fhir-and-
why-should-you-care/

10. Past
! Estonia is first country in the world who
used HL7 V3 in NHR implementation

11. Future with FHIR
! Lithuania will be first country in
the world who will use HL7
FHIR in NHR implementation
! Lithuania will be country with
most innovative and modern
NHR in the world