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FHIR: The web, for Healthcare
Open Community Open Standard
• Make it easier to exchange healthcare information
• Open Participation - uses web infrastructure (social media)
• Lead by HL7 - deeply connected to world wide health community
• Describes how to exchange healthcare information
• A web API - web standards where possible
• Continuity with existing healthcare standards
• Public Treasure (http://hl7.org/fhir)
Web APIs are better
• Capability based approach (rather than use case based approach)
• Search is ubiquitous
• Stable identifiers (a struggle?)
• Web framework offers deep well support stack
• Big community
• But FHIR is more than a Web API
FHIR – a RESTful API
• RESTful API- based on web/http
• Each record is a “resource” – a URL that can be read, updated etc
• For R, we are not interested in updating, only read
• GET [Server]/[ResourceType]/[id] using HTTP • Id – up to 64 chars (letters, numbers, _, .)
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Definition of a Resource
• http://hl7.org/fhir/Patient.html
• Scope and Usage
• Content
• Tabular view
• UML
• XML + JSON + Turtle – we use JSON in RonFHIR library
• Terminology Bindings
• Discussion of Use
7 AMIA 2019 Annual Symposium | amia.org
Key Data types • Identifier
• system + value: url that identifies a namespace + id unique in the namespace
• type: indicates the type of the identifier (a slippery concept)
• CodeableConcept • Multiple System + code – reference to code system + code it defines – precise meaning
• text – human representation of concept
• Quantity
• value + unit : decimal value + stated unit (string for human consumption)
• code + system: coded unit for computation purposes (UCUM strongly preferred)
• Reference • reference : Url – absolute or relative reference to another resource
• display: String – a description of what is being referenced
8 AMIA 2019 Annual Symposium | amia.org
Exploring Reading Resources
• Use “_summary” to reduce what is returned
• Use “_elements” to control what is returned
9 AMIA 2019 Annual Symposium | amia.org
Search
• A key facility in FHIR is searching for matching resources
• GET [Server]/[ResourceType]?parameters using HTTP
• Parameters are defined for each resource type
• Explore the mimic patients using POSTman… • Note – no names / phone numbers / addresses
• Other sample Searches (all http://mimic.fhir.org/r4) • Encounter
• http://mimic.fhir.org/r3/Condition?code=038.9&_include=Condition:patient
• Observation?code=600-7&subject=Patient/9467
• Observation?code=2708-6&subject=Patient/30831
10 AMIA 2019 Annual Symposium | amia.org
Our Goals
• Disrupt Healthcare IT Standards
• Disrupt Healthcare IT
• Disrupt Healthcare
• Not about commercial outcomes
Disrupting Healthcare IT Standards
• Move to open source / open process
• Move to Agile systems
• Much more focus on implementation success
• Reduce the economic comfort of the SDOs
• Finished….
The 3 Legs of the process
• Platform Standard • HL7, FHIR
• Adapting to a Community of Use • Government Projects, Vendor Consortiums, NGOs (large & small)
• “FHIR Community Process”
• Driving into production • Regulation, Vendor Consortiums, NHS(X)
• Where the action & challenges are
Disrupting Healthcare IT
• Empower applications to offer more functionality at less cost
• Drive implementations towards interoperability as core
• Use cloud / web changes to allow modular software • Best of Breed
• Open source drives change in market
• In progress…
Shallow vs Deep Interoperability
• Integration points on the perimeter:
• Integration Points part of the system:
Where adoption is happening
• Secondary Data Repositories • Patient access to data
• Specific Clinical Data Repositories -> Big Data
• National Health Records / Sharing frameworks
• Application Extension • Argonaut / EHR Plug-ins / Decision Support Integration
• Primary Apps: SaaS (health)
• Business Process Automation • Meds mgmt, Payments, Diagnostics, supply chains
National Adoption around the world
• USA • Argonaut / Patient Access to Data
• Da Vinci: refactor the payment process
• CMS / CDA: many projects around adoption
• Europe • UK, Netherlands, Germany, Scandinavia, Lithuania
• Others • Australia, Russia…
Innovation Strategy
• Get engaged early • Wear the risk of unstable interfaces & ongoing change • Expose your IP to the wider community (open process) • Influence the outcome (standard more naturally fits your goals) • Demonstrate your expertise
• Get engaged late • No (or much lower) risk of ongoing change • No need to engage with the community • No influence and not reputation
• Pace of change is changing…
Disrupting Healthcare
• Clinical Processes are disconnected • Governance boundaries are points of failure • Boundaries: physical (buildings), organisations, regulatory • Costly to change (and inappropriate to change)
• Instead, allow deep integration of work flows across boundaries • Requires cultural change (and community involvement) • Can only be driven by clinical champions • Provide IT / Governance / Policy / Cheer-leading support
• Remove IT as a barrier to seamless care (+ Path for AI to be delivered)
• Just beginning….
Changing A Clinical Process
Rat
e o
f A
dve
rse
Even
ts
Events not addressed by change
Events caused by old process
Net reduction in adverse events
Events caused by new process
Future Plans
• Make existing content normative (finished, stable)
• Round out specification (EBM, Research, Translational Science) • + work on related specifications – imaging, social media, etc
• Consolidate implementation eco-system + Community Process
• Build out country support (multi-language support)
• Create and Support related communities • Healthcare knowledge standards
Join Us
• FHIR is a critical infrastructure enabler • A community solution for the IT requirements
• But FHIR is not a solution to anything itself
• Need new community infrastructure at many levels • Governance is critical: Build confidence and trust – open community treasure
• Needs stable Governance foundations with consistent transparency
• Join the community (FHIR, or others) • http://hl7.org/fhir, http://fhir.org