Patient matching in FHIR

Patient Matching on FHIR

Grahame GrieveHIMSS Workshop

Feb 29th, 2016

®FHIR

A new standard that: Leverages the web infrastructure Uses web standards where ever possible Learns from existing healthcare standards Addresses existing and new use cases for

healthcare data exchange Is completely open / free for use An iterative development process

RESTful API

HTTP manipulation of ‘Resources’ Read / Create / Update / Delete XML or JSON contents Stateless API Resources with stable identities in URLs

“Resources”

Basic atom of functionality in FHIR Different Types of Resources (100+) Resource Types have different data

elements defined in them All Resources have

Identity (URL) Common Metadata Narrative Extensibility

Patient Resource

Read a Resource

Given a URL, fetch the resource HTTP GET – get me the contents of this

resource Specify the return type Get an error or the resource Example:

http://fhir2.healthintersections.com.au/open/Patient/glossy

Use a RESTful client tester (demo)

Update a resource

Given a URL, update the contents to a new resource

HTTP PUT – store this resource herehttp://fhir2.healthintersections.com.au/open/Patient/glossy

Error or Success Demo…

Create a resource

Ask the server to assign an identity to a resource

HTTP POST the resource to http://fhir2.healthintersections.com.au/open/Patient

Server responds with location

Delete a resource

Ask the server to remove the resource HTTP Delete to the URL (e.g.

http://fhir2.healthintersections.com.au/open/Patient/glossy Read / Search (next) fails after this Many healthcare records cannot be deleted Server keeps a full version history / audit trail

Finding Resources

Find all the resources that meet a particular criteria

HTTP GET – on address http://fhir2.healthintersections.com.au/open/Patient

Search Parameters – different for each resource

Search parameters optional and extensible Declared in the conformance statement

Dealing with Variability

The consensus process at HL7 cannot address business variability

Agreement is always incomplete Structures:

Narrative in Resources Extensions Conformance Statements

Narrative in Resource

Every resource includes an XHTML section that describes it A few resources are exempt It’s not mandatory – but highly recommended

Clinical Safety Fall back (per CDA) Allows general software to handle/display

any resource Allows information to travel

Extensibility

Every resource, element can have ‘extensions’ URL – reference the definition Value

Anyone can add and publish extensions Sliding scale of governance

Everyone can read and write all extensions For handling local requirements

®Example Extension

Eye Colour to patient resource: Need to pick a URL Need to choose a type Have to declare and publish the extension

(at the URL)<Patient xmlns="http://hl7.org/fhir"> <extension url="http://acme.org/fhir/patient/eyecolor"> <valueCode value="brown"/> </extension> …

Conformance

Terminology Use Custom Codes, Value Sets, Mappings

Resource Use Profiles and Logical Models, Data Dictionaries

Behaviour Interaction support, Search Parameters,

Operations Published by Servers, Clients, Projects

“Implementation Guide”

Implementation Guides

“DAF” – Data Access Framework “SDC” – Structured Data Capture “US LAB” – Lab ordering & reporting Privacy / Consent Quality / Measure Argonaut

Deployment

FHIR API is an external surface Behind the surface is private Common design options

De novo server based entirely on resources Retrofit FHIR as a façade on existing system Secondary repository FHIR is entirely middleware

Many different technologies used

Deployment / Security

Deployment

No fixed design for an enterprise Each is slightly different, though common

themes Typically

Multiple maintainers of patient registration Legacy data & external integrations Patient matching is an ongoing challenge

FHIR & Patient Matching

On the fly client mediating matching

Background reconciliation process

MPI Search GET http://fhir2.healthintersections.com.au/open/Patient?

_query=mpi&family=james&given=peter&gender=male

Ask the MPI to return possible matches

MPI Search Result<Bundle xmlns="http://hl7.org/fhir"> <id value="70d41bcc-31fb-47ab-af18-67589b9650"/> <meta> <lastUpdated value="2016-02-28T14:04:40Z"/> </meta> <type value="searchset"/> <total value="370"/> <link> .... </link>...</Bundle>

MPI Search Result<entry> <fullUrl value="…"/> <resource> <Patient xmlns="http://hl7.org/fhir"> <id value="11111"/> .... </Patient> </resource> <search> <extension url="http://hl7.org/fhir/StructureDefinition/patient-mpi-match"> <valueCode value="possible"/> </extension> <mode value="match"/> <score value="0.5"/> </search></entry>

Where next?

“Distributed Patient Management” An implementation guide that

describes best practices defines internal and external services provides for conformance expectations standardizes patient matching approaches

Close - Questions

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