Devices on FHIR (DoF) Update & Discussion · Devices on FHIR® Collaborative effort to ensure semantically consistent device information exchange whether it is achieved using current

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Devices on FHIR (DoF)– Update & Discussion

HL7 Baltimore WGM2016.9


DoF 2016-09 Baltimore

n Wednesday Q3 – WG DiscussionsØ DoF General Update Ø Roadmap 2016-17Ø Joint FHIR Agenda - Thursday Q1 Prep.Ø Key Topics / Issues

n Thursday Q1 – Joint with FHIR Ø DoF – Even more general update for FHIR Rep’sØ PSS Review & GuidanceØ FHIR 2016 SEPT Ballot Resolution [TBD]Ø Key IssuesØ Roadmap Review

9/22/162





9/22/163


Devices on FHIR Update

n DoF Launched after 2016 May WGMØ @ http://wiki.hl7.org/index.php?title=Devices_on_FHIR

n Weekly web meetings, etc.n Updated DEV FHIR PSS (#1277)n Coordination with CDS Collaborative …

as listeners!n Coordination w/ Continua & IHEn What’s next? (Roadmap)

9/22/164


HL7 DEV FHIR PSS - Updated

n New #1277 PSS (replaces #1103)

n Simple title: FHIR for Device Data Reportingn Targets …

Ø Narrow primary focus: Data Reporting using ...n Device / DeviceComponent / DeviceMetric / Observation

Ø Advance FHIR Maturity Model (FMM) for resourcesØ Consider device-related profilesØ Implementation Guide – for consistent implementationØ White Papers – for topics like alerting or control

n Co-sponsors: O&O, mHealth, HSIn Schedule: Target 2017 May

9/22/165


DoF Testing: Virtual & F2F Connectathons

n Pre-2016.09: Dev. Guys were Lonely! n 2016.09 FHIR Connectathon

Ø CDS Collaborative engaged as consumers!Ø Pre-Connectathon testing @ Cognitive PlatformØ But … we all had... Challenges ...

n HAPI FHIR API ... Massive changes between ver’sn Scheduling conflicts / travel challengesn Normal spec issues – the main testing purpose!

Ø So ... Still a bit lonely BUT more part of the event!?Ø Bottom Line: Great progress!

9/22/166



n Post 2016.09 FHIR ConnectathonØ Establish 2-3 week scrums w/ virtual testing?Ø Move to HSPC-based HAPI FHIR sandbox?Ø Testing based on advancing PSS, Continua & IHE

use case needs, demonstration events, etc.n Next F2F Connectathon events …

Ø 2016.11 Amsterdam DevDays (Continua managed)Ø 2017.01 San Antonio @ HL7 WGMØ 2017.01 IHE NA CAT17Ø 2017.08 IHE Australia & Korea Connectathons

9/22/167


DoF @ IHE & HIMSS’17

n FHIR is HL7 … but DoF is broad!

9/22/168


DoF – Harmonized Semantics

9/22/169

©TrustedSolutionsFoundry,Inc.2016

TrustedSolutionsFoundry

SamsungMedicalCenter~Seoul~22.08.2016~Cooper

MDI Standards & Technology LandscapeToday, devices use 100’s of proprietary or “semi-standard” protocols.

Getting to the Big 5 would be at least 2 orders of magnitude better!

Using common semantic base is #1 objective.

16

Program IHEPCD IEEE PHD/Continua

OpenSDC/OR.net

OpenICE /MDPnP

HL7DevicesonFHIR

TechnicalBase HL7 V2.61 IEEE11073 WS* OMG DDS REST/HTTP

Maturity

Dozensofcommer-ciallyavailableproducts

100’sofCertifiedPnPProducts

Prototyped;11073standardization inprocess

Prototyped;IEEEICEAllianceadvancing

StartingFHIRConnectathonTesting

Semantics IEEE 11073Terminology&Model2

1 AddingHL7FHIR2 Core11073termsmappedtoLOINC


<IHE profiles>

9/22/1610

TestingOptions• IHEProfilesand• HL7’sConslidatedClinicalDocumentArchitecture(C-CDA)

o January23– 27,2017

• DevicesonFHIR®o January24– 26,2017


9/22/1611

DevicesonFHIR®CollaborativeefforttoensuresemanticallyconsistentdeviceinformationexchangewhetheritisachievedusingcurrentPatientCareDevices(PCD)HL7V2-basedmessagingorHL7FHIR-basedresources&profiles.

Activeparticipantsinclude:

Agenda: • Introduction • Structure • H.810 • H.811 • H.812

H.812.1 H.812.2 H.812.3 H.812.4

• H.813 • Guideline

Development • Q/A

Structure

H.811 H.812 H.813

H.810

Agenda: • Introduction • Structure • H.810 • H.811 • H.812

H.812.1 H.812.2 H.812.3 H.812.4

• H.813 • Guideline

Development • Q/A

Structure

H.811 H.812 H.813

H.810


9/22/1612

DevicesonFHIR®Objective:On-demand,real-time,high-resolutiondevicedataaccesstosupportservicesorientedarchitectures(SOA)andknowledge-basedapplicationsforclinicaldecisionsupport(CDS),precisionmedicine,andanalytics(population&analytics).

UnitesactivitiesunderwayinHL7,Continua,andIHE.

Systemsandapplicationsinclude:• Devices&Gateways• EHRsandEnterprise-levelSystems• Knowledge-basedServicesandApplicationPlatforms


9/22/1613

DevicesonFHIR®Projectwillinclude:

• Establishingaconsistentmappingfromabstractdevicesemanticsto

FHIRconstructs(perIHERosettaTerm.Mapping)

• StartingwithDevice-to-Enterprise(DEC)profile...Othersintime

• IntegratedapproachforuseofcurrentV2-baseddatastreamswith

aFHIR-based,RESTfulAPI/SOAarchitecture

• Leverageagilemethodsandtoolsforprofiledevelopment

• CoordinatecapabilitydevelopmentbetweenFHIRConnectathons

andIHEConnectathons

• HIMSS’17ShowcasetracktohighlightthesetechnologiesDevicesonFHIR®ToddCooper,DevicesonFHIR,TechnicalProgramManager,Email:[email protected]

ToLearnMoreVisit:• HL7‘sWiki:wiki.hl7.org/index.php?title=Devices_on_FHIR• RegistertoattendtheDevicesonFHIR®Webinar

o October17at10:30am-11:30amCTo Registrationlinkwillbepostedonwww.iheusa.org soon


IHE PCD @ FHIR

n IHE PCD 2016-October Boca Raton Kick-offn Approach and prioritization for current

profiles:Ø DEC – integrate V2 & FHIRØ PCIM, RDQ – both could benefit from FHIRØ Infusion Pump Profiles? (PIV / IPEC)

n New Profiles?n Pilot an IHE “agile” development process

9/22/1614


9/22/1615




PCD Profile: Alert Comm. Management (ACM)

23

HL7 Messagesper ACM andWCM profiles

Parameters, waveforms, etc.as evidentiary data items

DeviceSpecificgraphics

AlertInformationSource,Phase,State,Priority

PatientLocationInstanceAlerttextCallback

TimestampEvidentiarydata

DisseminationStatusInstance

AcceptedbyACUndeliverableDeliveredRead

AcceptedRejectedCancelled

Callbackstart/stop

AlertCommunicator

AC

AlertManagerAM

AlertReporterAR

Report AlertPCD-04 →← PCD-05

Report AlertStatus

Disseminate AlertPCD-06 →← PCD-07

DisseminateAlert StatusAlert

Source

§ NewITImACM(FHIR-based)Profile

§ ACM’16updatetorefertoFHIRforPCD-06&-07transactions

Note:SupportsIEC60601-1-8&80001-2-5Standards


Example of ACM @ FHIR …

9/22/1616




Emerging Technologies: Devices on FHIR®©

24


HIMSS’17 Interop. Showcase

n Showcase “vignettes” being developed for …Ø Devices on FHIR enabled solutionsØ CDS / Analytics / Precision Med. use cases Ø IHE PCD Profiles: both V2 and FHIR basedØ For example …

9/22/1617


HIMSS’16 => ‘17

9/22/1618




Cognitive Medical HIMSS ‘16 Demo …

11

HealthcareServicesPlatformConsortium(HSPC)ClinicalDecisionSupportDemonstration

HSPC advocates for standards-based services, data models, and open architecture. We

believe that HL7, OMG, IHTSDO and others have established a foundation of health

informatics standards that can be used to establish a services platform capable of solving

real-world clinical problems today and enabling more elaborate capabilities in the future.

Healthcare will eventually experience the same standardization of services that

revolutionized the banking, airline, retail, manufacturing and e-commerce industries. This

HSPC demonstration illustrates how standards, open architecture and collaborative research

can make advanced cognitive support at the bedside a reality. The general system

architecture is depicted below.

Figure1:PrototypicHSPCCDSArchitecture

The general context for the demonstration involves a hypertensive patient who is seriously

injured in a car accident. He is admitted to a local intensive care unit and is being treated,

among other things, with metoprolol for his essential hypertension. An HSPC-

compliant Clinical Decision Support System (CDSS) monitors the patient's care and advises

the clinical staff as they treat his injuries. The demonstration illustrates four separate use

cases:

Use Case #1: Several days into the hospitalization, the patient begins experiencing transient, but clinically significant (suboptimal) drops in systemic blood pressure that correlate with each metoprolol administration. Typically, these transient events might be managed by a dose and/or interval adjustment and the CDSS advises accordingly.

Use Case #2: Later that day, the CDSS gains access to the patient’s genome profile. It determines that the patient is genetically predisposed to unpredictable responses to

ü UseCase:Transient,butclinicallysignificant(suboptimal)dropsinsystemicbloodpressurethatcorrelatewitheachmetoprololadministration

ü Openstandards-basedAPI’s(e.g.,HL7FHIR&CDS)

ü Systemsdevelopedindependentofusecase

ü Whoisriskmanaging@implementation&use?!

Seecognitivemedicalsystems.com/

?

DevicesonFHIR


Joint DEV-FHIR Agenda

n Review DoF & Progress since Mayn Review PSS & Roadmap through 2017 Mayn FHIR: Schedule & Input to HCD & DoFn Key Topics …

Ø IG ProductionØ Mapping: Formalized in STU3Ø Terminology Bindings (esp. 11073 & LOINC)Ø 11073 BITS-to-FHIR ApproachØ Security Considerations

9/22/1619


Key Topics / Issues

n Mapping 11073 to FHIR Resources / ProfilesØ To Profile or Not to Profile (80/20 Rule)Ø Containment Tree for PoCD & PHD

n Why these resources? Scaling from pumps to scales …Ø 11073 BITS to FHIR

n DeviceComponent: lastSystemChange 1..1?n Regulatory Status Indicator n Terminology Bindings (incl. 11073 & LOINC)n PCIM – ‘Procedure’ Use (Ioana’s proposal)n … (other topics)

9/22/1620





9/22/1621



n Review DoF & Progress since Mayn Review PSS & Roadmap through 2017 Mayn FHIR: Schedule & Input to HCD & DoFn FHIR 2016 SEPT Ballot Resolutionn Key Topics …


9/22/1622


Devices on FHIR Update

n DoF Launched after 2016 May WGMØ @ http://wiki.hl7.org/index.php?title=Devices_on_FHIR

n Weekly web meetings, etc.n Updated DEV FHIR PSS (#1277)n Coordination with CDS Collaborative …

as listeners!n Coordination w/ Continua & IHEn What’s next? (Roadmap)

9/22/1623


HL7 DEV FHIR PSS - Updated

n New #1277 PSS (replaces #1103)

n Simple title: FHIR for Device Data Reportingn Targets …

Ø Narrow primary focus: Data Reporting using ...n Device / DeviceComponent / DeviceMetric / Observation

Ø Advance FHIR Maturity Model (FMM) for resourcesØ Consider device-related profilesØ Implementation Guide – for consistent implementationØ White Papers – for topics like alerting or control

n Co-sponsors: O&O, mHealth, HSIn Schedule: Target 2017 May

9/22/1624



n Pre-2016.09: Dev. Guys were Lonely! n 2016.09 FHIR Connectathon

Ø CDS Collaborative engaged as consumers!Ø Pre-Connectathon testing @ Cognitive PlatformØ But … we all had... Challenges ...

n HAPI FHIR API ... Massive changes between ver’sn Scheduling conflicts / travel challengesn Normal spec issues – the main testing purpose!

Ø So ... Still a bit lonely BUT more part of the event!?Ø Bottom Line: Great progress!

9/22/1625



n Post 2016.09 FHIR ConnectathonØ Establish 2-3 week scrums w/ virtual testing?Ø Move to HSPC-based HAPI FHIR sandbox?Ø Testing based on advancing PSS (FMM), Continua

& IHE use case needs, demonstration events, etc.n Next F2F Connectathon events …

Ø 2016.11 Amsterdam DevDays (see next slide)Ø 2017.01 San Antonio @ HL7 WGMØ 2017.01 IHE NA CAT17Ø 2017.08 IHE Australia & Korea Connectathons

9/22/1626


9/22/1627


9/22/1628

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9/22/1629


FHIR Development & Schedule

n See 2016-09 FHIR TSC presentation to co-chairs.

(08_FHIR TSC.pdf)

9/22/1630


FHIR 2016 SEPT Ballot Resolution

n See ballot spreadsheet …[FHIR_R1_D3_2016SEP_amalgamated-cleaned.xls]

n Review also outstanding CP’s Ø Plan for their discussion & dispositionØ Including: 11006 10170 9966 10575 10556 10276

9/22/1631





9/22/1632


ASN.1 BIT String => FHIR

9/22/1633

• ASN.1 BITs handling• This data cannot be mapped in FHIR/CDA templates

• Proposed Solution:• Define a Vocabulary that can be constructed from protocol• For Enumeration 16 and 32 bit BITs observations

• Code is specified by Typecode.MderBitPosition.• The equivalent ‘Ref-id’ is the ASN.1 name

• Value is binary 1 (yes) 0 (no)• For non-measurement BITs

• Code is AttribiteId/SubAttributeId.MderBitPosition• Value is binary 1 (yes) 0 (no)

Source: Brian Reinhold (Lampry Networks / Continua)


ASN.1 BIT String => FHIR

9/22/1634

Source: Brian Reinhold (Lampry Networks / Continua)

• Example:• Pulse Ox pulse characteristic

TYPE: MDC_PULS_OXIM_PULS_CHAR 2:19512 = 150584• pulse-qual-nominal(0) Quality of the detected pulse is nominal, in that there are no recognized

abnormalities in the detected pulse• pulse-qual-marginal(1) Perfusion or quality of the detected pulse is marginal.• pulse-qual-minimal(2) Perfusion or quality of the detected pulse is minimal.• pulse-qual-unacceptable(3) Perfusion or quality of the detected pulse is unacceptable

Code ASN.1 name

150584.0 pulse-qual-nominal

150584.1 pulse-qual-marginal

150584.2 pulse-qual-minimal

150584.3 pulse-qual-unacceptable"code":{"coding":[

{"system":"whatever the vocabulary name is to be","code":“150584.0","display":“MDC_PULSE_OXIM_PULS_CHAR.pulse-qual-nominal (pulse quality okay)"

},]

},“valueCodeableConcept (binary value set: y/n)

NOTE: WG Discussion pointed out that this example includes other issues not related to the BITs => FHIR question.

Documents

Devices on FHIR (DoF) Update & Discussion · Devices on FHIR® Collaborative effort to ensure semantically consistent device information exchange whether it is achieved using current