FHIR architecture overview for non-programmers by René Spronk

FHIR Architecture
Overview
for non-programmers
René Spronk (Ringholm)
FHIR Developer Days
November 26, 2014
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FHIR Overview
for executives
FHIR Developer Days
November 26, 2014

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What does FHIR stand
for?
 F – Fast (to implement)
 H – Health
 That’s why we’re here
 I – Interoperable
 R – Resources
 Building blocks – more on these to follow
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Design Philosphy of
FHIR
Focus on Implementers
Target support for common scenarios
Leverage cross-industry web technologies
Require human readability as base level of
interoperability
Make content freely available
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Contextual drivers for
FHIR
 Shift in healthcare
patient in control, sharing data across organizations
 Shift from off-line to on-line
shift from PC to tablet, from web to app, from desktop to
cloud
 Shift towards data transparency
FHIR acts as an ‘open API’ to access data in these silo-like
EHR’s.
 Shift towards analytics
FHIR uses data structures that allow one to easily slice
and dice the data for analytics.
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What is a FHIR ‘Resource’ ?
 Small, discrete concepts that can be
maintained independently
 Akin to HL7v2 segments, DICOM IEs.
 Resources are smallest units of transaction
 Built-in extension mechanism
 Elements used by 80% of implementers are part of
the base resource.
 All other elements are handled as extensions
 Resources have a ‘textual description’
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FHIR Resources
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Example – Patient Resource
References
to other
Resources

Data types
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 Based on cross-industry data types (w3c schema and ISO
data types)
 Stick to the “80% rule” – only expose what most will use
 Data types can have extensions

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Extension with
reference to its definition
Human Readable
Summary
Standard Data
Content:
 MRN
 Name
 Gender
 Date of Birth
 Provider

Narrative
14 Note: could be JSON as well

Extensions
15 Note: could be JSON as well

FHIR references
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RESTful FHIR Examples
GET http://myfhirserver.com/patient/123
GET http://myfhirserver.com/encounter/904?_include=patient
PUT http://myfhirserver.com/encounter/707 {XML or JSON Resource expression}
GET http://myfhirserver.com/document/800511

FHIR Messages
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FHIR Documents
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FHIR profiles
 Resources have nearly no restrictions.
Parties exchanging data define the way
they want to use resources
 Profiles define what ‘your jurisdiction’
needs to communicate and store when it
comes to Resources and their extensions.
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StructureDefinition
Resource (profile)
“Before”
“After”
GET http://myfhirserver.com/StructureDefinition?xxxxxxxxxxxxx

OperationDefinition
Resource (Profile)
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Standard
FHIR REST
Update
Custom
Operations
Read
Search
Check Drug
Interaction
Merge
Patient
Search on
Maiden name

Computable Profiles
GET http://myfhirserver.com/Conformance

Summary: What does
FHIR provide?
 Resources (building blocks)
 Extensions
 Methodology
 Bundles, Profiles, Conformance
 Syntax (XML, JSON)
 Human readability
 Support for multiple Paradigms
 REST, Messaging, Documents, Services
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Application of FHIR
 FHIR is suitable for application in a variety
of settings:
 the classic in-institution exchange of data between
systems
 in a regional setting (Regional Health Information
Organizations)
 on a national scale, e.g. in national health hub’s or EHR's
 in social media and mobile applications
 FHIR is expected to be initially used for
social media and mobile application use-cases.
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FHIR
 Is being implemented right now:
 (US) ONC, SMART, Intermountain, (UK) NHS,
(NZ) Orion Health, (NO) Helse Vest (NL)
Mental health apps
 IHE Profiles
 70 implementations, 20 countries (2014)
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FHIR
 Is easier and cheaper than other
comparable standards:
 It is faster to learn, implement and troubleshoot
 It has a vibrant and open source community
and has frequently held connectathons.
 It uses modern technologies, the same as
used by e.g. Facebook, Twitter and Google.
 There are more people familiar with these
technologies (thus less expensive consultants).
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FHIR
 Is likely to significantly impact Health IT:
 scales well from simple to complex
 flexible
 free and fully open
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Questions?

FHIR Example
for clinical users
FHIR Developer Days
November 26, 2014
Modified from a presentation by David Hay, Orion

Theme: a mobile
application
 A mobile application for a clinician
 Collect and present clinical information about
a patient
 Previous encounters, Lab Data, Documents
 Record details of an encounter
 Schedule encounters
 Make orders for Labs, meds etc.
 Get Decision support
 Save a summary in a Document Repository

Assumptions
 Requirements known
 Data Sources known and
available
 Not considering security
 Not considering app
architecture
 System Architecture

Main Clinical resources
 Observation / Condition (Problem) / Alert
 DiagnosticReport
 MedicationPrescription (and others)
 AdverseReaction / ContraIndication /
AllergyIntolerance
 Immunizations / ImmunizationRecommentation
 Assessment / RiskAssessment / CarePlan
 Questionnaire / QuestionnaireAnswers

Important Supporting
Resources
 Patient / Practitioner
 List
 Encounter / EpisodeOfCare
 Order / OrderResponse / ReferralRequest
 DocumentReference
 Provenance
 Appointment / AppointmentResponse / Availability / Slot /
HealthcareService

Local Notes - Clinical
Scenario
 First consultation
5 year old boy
 Complaining of pain in the r) ear for 3 days with
an elevated temperature. On examination,
temperature 38.5 degrees and an inflamed r)
ear drum with no perforation. Diagnosis Otitis
Media, and prescribed Amoxil 250mg TDS for
5 days
 Follow up consultation
 5 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 and
advised not to take penicillin in the future.
Patient
Encounter
Condition
Observation
Med
Adverse
Reaction
Allergy

Looking at the relationships

Lists of things
 Examples
 Medication list
 Problem List (Conditions)
 Allergies
 Past Medical History
 Past Social History
 Social History
 ‘Organizer’ in Document
 Manage ‘points in time’
and changes
 Explicit ‘none known’

Scheduling patients
 Appointment / AppointmentResponse
 Availability
 Slot
 HealthCareService
 Recalls (care plan)
 Alerts

Ordering stuff
 Order / OrderResponse
 Detailed resources in request
 MedicationPrescription
 DiagnosticOrder
 Referral

Medications
 Medication
 MedicationPrescription
 Order / OrderResponse
 MedicationAdministration
 Provenance
 MedicationDispense
 MedicationStatement
 AllergyIntolerance
 ContraIndication

Viewing investigations
 Diagnostic report
 Imaging Study
 Specimen
 Attachment

Decision Support
 ContraIndication
 AllergyIntolerance
 Alert
 OperationDefinition
 ImmunizationRecommendation

Doing things to people
 Procedures
 Specimen
 DiagnosticReport

Referrals
 Order/OrderResponse
 ReferralRequest
 Many resources as
content

Data collection
 Forms
 Questionnnaire / QuestionnaireAnswers
 Free form

Creating a summary
document
 ddd

Returning to the App…
 Interact with Local Server
 RESTful exchange of resources
 Local server will mediate other services
 Query document repository (XDS-ish)
 Use DocumentReference against Registry
 Simple GET for documents
 Query data repositories (eg Lab)
 RESTful query
 Record Clinical data
 Create resource graph
 Submit as transaction
 Decision Support
 Send a Message to the DSS, get a bundle back
 Update the document repository
 Create a FHIR document and submit via FHIR transaction to repository

Winding Up
FHIR is fit for (clinical) purpose

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Questions?

FHIR architecture overview for non-programmers by René Spronk

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