Weitere Ă€hnliche Inhalte Ăhnlich wie FHIR Documents by Lloyd McKenzie (20) KĂŒrzlich hochgeladen (20) FHIR Documents by Lloyd McKenzie1. FHIR Documents
Lloyd McKenzie
FHIR Developer Days
November 25, 2014
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
2. This presentation
ïź Can be downloaded here:
ï http://www.slideshare.net/DevDays2014
ïź Is licensed for use under the Creative
Commons, specifically:
ï Creative Commons Attribution 3.0 Unported
License
ï (Do with it as you wish â just give credit)
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
3. Who am I?
ïź Name: Lloyd McKenzie
ïź Company: Gevity
ïź Background:
ï One of FHIRâs 3 principle editors
ï Co-chair FHIR Management Group
ï Co-chair HL7 Modeling & Methodology
ï Chair HL7 Canada Architecture & Infrastructure
ï Heavily involved in HL7 and healthcare exchange
for last 15 years (v2, v3, CDA, etc.)
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
4. Who are you?
ïź Who is familiar with:
ï V2
ï V3
ï CDA
ïź Background
ï Technical (e.g. developer, architect)
ï Clinical
ï Non-technical (e.g. manager, CEO)
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
5. Tutorial Objectives
ïź In next 1.5 hours
ï How documents fit in the FHIR ecosystem
ï How FHIR documents are structured
ï Architecture considerations around documents
ï CDA and FHIR
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
6. WHERE DO DOCUMENTS
FIT?
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
7. Paradigms
ïź FHIR supports 4 interoperability paradigms
7
REST
Documents
Messages Services
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
8. Documents
ïź Similar to CDA
ïź Collection of resources bound together
ï Root is a âCompositionâ resource
ï Just like CDA header
ïź Sent as a bundle
ïź One context
ïź Can be signed, authenticated, etc.
8
Documents
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
9. When to use
Documents?
ïź Focus is on persistence
ïź No workflow involved
ï other than post/retrieve document
Documents
ïź Need tight rules over authenticated content
ïź Want to communicate multiple resources
with control over how data is presented
ïź Data spans multiple resources
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
10. When to avoid
Documents?
ïź Need for workflow
ï Request/response, decision support
ïź Data is dynamic
ï I.e. want view of data now, not at time of
authorship
ï Multiple contributors over time
ïź Resources need to be
accessed/manipulated independently
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Documents
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
11. Clinical Documents
ïź 6 Characteristics
ï Persistence
ï Stewardship
ï Potential for authentication
ï Context
ï Wholeness
ï Human readability
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
12. Non-clinical documents
ïź FHIR documents are a generic structure
ï Can be about anyone/anything
ïź E.g. Trial designs, device reports, public health
studies, etc.
ï Can be processed in ways that donât meet the 6
requirements for a clinical document
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
13. DOCUMENT STRUCTURE
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
14. Dr. Bernard
FHIR Document
Practitioner author
Patient Mary
Patient subject
Kidney Stones
Condition content
Vital Signs
list content
Discharge Meds
list content
Nurse Smith
Practitioner
Pulse
Observation
BP
Observation
Dyclofenac
MedicationPrescription
Tamsulosin
MedicationPrescription
entry
entry
Discharge
Summary
Composition
Chief
Complaint
section
Physical
section
Medications
section
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
15. Dr. Bernard
Practitioner
Patient Mary
Patient
Kidney Stones
Condition
Vital Signs
list
Discharge Meds
list
FHIR Document
author
subject
content
content
content
Nurse Smith
Practitioner
Pulse
Observation
BP
Observation
Dyclofenac
MedicationPrescription
Tamsulosin
MedicationPrescription
entry
entry
Discharge
Summary
Composition
Chief
Complaint
section
Physical
section
Medications
section
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
16. Documents are bundles
Composition Resource
Section
Metadata Attester
Section
List Resource
Observation Resource
Condition Resource
Patient Resource
<bundle>
<entry>
<Composition />
</entry>
<entry>
<List />
</entry>
<entry>
<Observation />
</entry>
<entry>
<Condition />
</entry>
<entry>
<Patient />
</entry>
</bundle>
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
17. The Document resource
A single Resource, very often a List
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
18. Tag as âDocumentâ
<Bundle xmlns="http://hl7.org/fhir">
<id value="9f395ee0-19d2-4760-baf6-097fda52d914"/>
<meta>
<lastUpdated value="2014-03-10T12:42:08.6834841Z"/>
This Bundle
is a
Document
</meta>
<type value="document"/>
<entry></entry>
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
19. Bundle References
ïź References in bundles can be:
ï Absolute: e.g. http://hl7.org/fhir/Patient/1
ï Relative: e.g. Patient/1
ïź Relative is expressed with respect to the âbaseâ
URL declared for the bundle
ïź Non-RESTful ids
ï In some cases, a resource might not exist on a
RESTful server
ïź Solution: entry base = âurn:oidâ or âurn:uuidâ
ïź Resource identifier is an OID or a UUID
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
20. COMMUNICATING FHIR
DOCUMENTS
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
21. Mailbox
ïź You can âdropâ your document on
ï http://server.org/fhir/Mailbox
ï (or http://server.org/fhir/$mailbox)
ïź No storage or disassembly is implied, your
just posting a document in its entirety.
ïź Servers can implement any specific
functionality as required between trading
partners when receiving such a document.
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
22. Document/Bundle
ïź You can store your document using
ï http://server.org/fhir/Document
ï (now http://server.org/fhir/Bundle)
ïź Storage, NO disassembly is implied,
document (and signature) stays intact
ïź Search is supported (you search on itâs
Message header â Composition)
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
23. Transaction
ïź You can post the document to the serverâs
root URL for processing as a transaction
ï http://server.org/fhir
ïź All resources in the instance are
created/updated individually as a single unit
of work
ïź Document id, tags and metadata are lost
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
24. Binary
ïź You can base64-encode the document and
post it as a Binary instance
ï Same as posting a PDF, CDA or any other type of
file
ï http://server.org/fhir/Binary
ïź Can only search by the resource id
ïź Guaranteed to return a binary-identical (and
signature-valid) instance
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
25. DocumentReference
ïź Doesnât actually store the document, just a
reference to it
ïź Useful in âshared indexâ models such as
MHD (XDS on FHIR)
ïź The DocumentReference can then point to
the document itself â at either the
Document/Bundle end-point or the Binary
endpoint.
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
26. Custom operations
ïź The OperationDefinition resource allows
you to define custom operations
ï Take arbitrary data types, resource references and
bundles (e.g. Documents) as parameters
ï Allows you to define behavior around
communicating documents.
ïź E.g. Request a referral to be âprocessedâ by
submitting a referral document
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
27. Is that all?
ïź Nope - Documents can be shared any way you
like
ï Email (secure if youâre sharing patient data!)
ï FTP (ditto)
ï SOAP
ï Memory stick/DVD by courier
ï Smoke signals . . .
ïź FHIR defines the HTTP end-points as
conveniences, not to mandate a transport
solution.
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
28. FHIR DOCUMENT
ARCHITECTURE
CONSIDERATIONS
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
29. Document Profiles
ïź Documents are most useful when you can
define standard structures and content for
them
ï E.g. CCDA, Oncology referral for hospital X
ïź Profile resource allows
ï Defining the structure of the Composition
ïź Slicing section for each section content
ï Defining the structure of all referenced resources
ï Identifying which resources must be/can be
29 included in the document bundle
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
30. Section Slicing
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
31. Document persistance
ïź There is no defined order to entries in a
document other than the first
ï Round-tripping between persistence and XML/
JSON (or RDF) may produce different orders
ï Even with canonicalization, signatures may not
hold if document elements are stored in their
constituent parts
ï Therefore:
ïź If you care about signature, store documents as a
binary
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
32. Document Signatures
ïź Any bundle (including Documents) can have
an XML digital signature
ï Signatures arenât required to use FHIR documents
â other means of verifying integrity, etc. are ok too
ïź One or more resources in a document can
also be signed by including a Provenance
resource.
32
© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
33. Tags and security
ïź Tags (and âsecurityâ metadata) can appear
on both resource entries and at the bundle
level
ï If using security tags, must establish precedence
ïź Safest is âmost restrictive appliesâ, but business
rules may differ
ï Tags inside document entries canât be changed
without breaking the document signature
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
34. FHIR DOCUMENTS & THE
STANDARDS SPACE
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
35. Mobile Health Data
ïź IHE specification that leverages FHIR to
implement XDS
IHE Concept FHIR Resource
DocumentEntry DocumentReference
SubmissionSet DocumentManifest
Folder List
ïź Can index FHIR documents or any other
ï For that matter, XDS can index FHIR documents
too . . .
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
36. CDA on FHIR
ïź Project to define what âclinical documentsâ
should look like in FHIR
ïź Will include
ï Profile of the Composition resource
ï Mapping of CDA header to Composition
ï High-level mapping of root entries to possible
corresponding
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37. CCDA on FHIR
ïź Project to map between CCDA and a FHIR-equivalent,
including profiles
ïź Long term vision is a new version of CCDA
with exact FHIR equivalents balloted in
parallel
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38. CDA <-> FHIR
ïź Some guidance can be found here:
ï http://hl7.org/fhir/comparison-cda.html
ïź Or stay for Grahameâs tutorial
38
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39. Questions?
ïź http://hl7.org/fhir lmckenzie@gevity.com
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© 2014 HL7 Ÿ International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Hinweis der Redaktion We will skim the details â there will be webinars that will cover some of these topics in more detail FHIR doesnât require resources to be stored as sent, but this is generally an expectation for documents
Authentication is of whole content, and of a specific rendered view of content
Context exists independently in each resource, however documents indicate a set of information intended to be consumed together (human context vs. technical context)
Human readability is a SHOULD for resources, but a SHALL for documents, including specific rendering rules. This is how you might create a document from scratch This is how you might create a document from scratch A Document, no matter how nested, is flattened to a list of entries, the Documentâs header being the first.
The document header (and any other the other resources) refer to each other using normal references to reflect the documentâs nesting.
Of course, there may be a digital signature (on the whole Bundle) to attest to the content of the document. * But ofcourse, some server could have functions to disassemble documents on reception. Since the contents of documents are resources, each of the contained resources (including the Document header) can be stored using the normal REST interface. But they are no longer the document anymore! * But ofcourse, some server could have functions to disassemble documents on reception. Since the contents of documents are resources, each of the contained resources (including the Document header) can be stored using the normal REST interface. But they are no longer the document anymore!