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OLVG on FHIR ““The connected patient””
Bouke de Boer, PhD
b.a.deboer@olvg.nl
Introduction
agenda
• Introducing OLVG
• eHealth agenda OLVG
• PIJN-app (Pain-app)
• ‘FHIR server’
• Architecture
• User story Pain-app
• Some considerations
Page 2
Introducing OLVG
Page 3
Sint Lucas Andreas
Ziekenhuis
Onze Lieve Vrouwe
Gasthuis July 2015
Live on Epic since
2009 Live on Epic since
2015
Introducing OLVG
Page 4
Education CQI patient grade
Employees Nurses Deliveries Average stay Occupation OR
Science
Financials Employee
Employee illness Top 5 revenue
Medical staff
Number of patients
Developments
Page 5
eHealth and Personal Health Records give patients access to better information
and tools for taking direction
Disruptive IT and Artificial Intelligence will fundamentally change processes and
relationships (patient is point-of-care, joint decision making, pHealth, etc.)
Closer co-operation within the healthcare network system is imperative
Hospitals will shrink, up to 50%, whereas the potential patient base will grow
significantly via use of eHealth technology
Health insurers demand higher degrees of cost effectiveness and quality of
care benchmarking by Health Outcome Measurement
European privacy laws will mean stricter compliance and, in some cases high
fines
Government enforces all of the above, plus use of IT standards and open
systems to facilitate free transfer of health data
Introducing OLVG
Page 6
• Value Based Healthcare: High
quality care at lower cost
• Ambition: most improving Dutch
hospital (“Together, demonstrable
and improving”, 2015)
• 5 Strategic pillars dominate the
agenda 2017-2019
Primary locations
eHealth
Partnerships
Proud on OLVG
Professional and
business
e-health
Page 7
Anchored in our strategy
focus 2017-2019:
1. Patient engagement using MyOLVG, self measurement and
home monitoring
2. Decision support; predictive analytics, less overdiagnosis
3. Continues improvement; PROMS, benchmarking
Work in progress:
• FHIR server, apps like home monitoring and Pain-app
• Improvement service degree outpatients (logistics)
• Support eHealth innovations by innovation team
• Integrated care with GP´s
• Zorgdomein, Zorgmail, EpicCare, Video visits
• Care supplier portal together with other hospitals
• BovenIJ en OLVG
Post-operative pain
• Very common symptom during hospital admission
• 60% of admitted patients experiences pain
• Of whom 40% to 75% experience moderate to serious pain (VAS
> 3)
• OLVG East 2014 & 2015 ≈ 14% serious post operative pain
• OLVG East & West 2016 ≈ 12% serious post operative pain
Page 8
Why pain registration?
• Important for individual patient care
• Core competence of anesthesia
• Pain and stress reduction are the core of the ERAS protocols
• Gives feedback about quality of pain care
Page 9
Innovative application
• Patient-friendly self-reporting tool
• Feedback loop to APS dashboard
• Scientific foundation
Page 10
Demands:
- EHR integration via standard
- Bidirectional (read +write)
- App independent
- EHR independent
- Exchange of data + images
- Budget friendly
- In house development (agile)
- MyChart (limited write functionality)
- Apple Healthkit (Android etc.
incompatibility)
- XDS (no app compatibility)
- …..
Alternatives?
Page 11
- Interoperability via relatively new
HL7 FHIR standard (sound &
growing support base)
- Bi-directional (read and write)
- Application independent (EMR
and PACS data)
- EMR independent (Epic, non-
Epic)
- Cookbook’ for ‘app developers’
‘FHIR server’
Architecture
Page 13
• Standard with high adoption rate: FHIR
• ‘Make or buy’ decission FHIR server
• Smart-on-FHIR (Oauth2)
• ZIB’s (Dutch clinical information building blocks)
• Translation FHIR to HL7 v2
(on communication engine)
• Dutch PHR (PGO) compliant
What to do with non-compliant systems?
EPIC
• Read only of a limited number of FHIR resources
Solution: Translation on communication server
• FHIR Questionair response and FHIR observation to HL7
v2 ORU
• HL7 v2 ADT Encounter
Page 14
Identification en authorisation
Option 1: Enrolment via employee portal:
• Patient request for a connection from an App
• Employee checks identity
• Employee connects app-install and patientnr
• App gets access token with limited scope
Option 2: Via patient portal
• Patient requests from app
• Patient gets redirected to myOLVG
• Patient logs on at myOLVG
• Patient gives app permission to the necessary
FHIR resources
• App get access token with limited scope
Page 15
Identification and authorisation: patient portal
Register app at Open.epic.com ClientID
ClientID gets distributed to all Epic systems
Grant access locally
Requirements Epic: Transparency, Safety, Security, Privacy,
Sharing, Reliability, Efficiency, Data Integrity, Verifiability and
Reciprocity
Pagina 16
Architecture – open.epic.com
Page 17
Architecture – FHIR server
Page 18
Architecture – SMART on FHIR
Page 19
Architecture – ZIB’s, FHIR, MedMij
Page 20
Architecture – translations
Pagina 21
Pagina 22
Preoperative visit
Page 23
Instantly visible in EMR
25
Some considerations
Page 26
• ‘Make or buy’ - FHIR server (open source?)
• ‘Make or buy’ – app’s
• Epic currently provides only “Read only” FHIR recourses
• Translation from HL7v2 to FHIR
• Connecting lifestyle data from patient devices
Acknowledgements
Project lead PIJN-app: Bram Thiel Project lead ‘Stopcontact’: Onno Gabel Developer FHIR ‘Stopcontact’: Jamshid Radmanesh Stichting vrienden OLVG
: Closing
Thanks for your attention
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