fhir implementations for personal connected health · cdg a global standard through itu. extend ihe...

A membership-based HIMSS Innovation Company

FHIR Implementations forPersonal Connected Health

HIMSS’19 Global Conference – Developer Innovation LabFebruary 14, 2019

• personal technology that communicates secure clinical-grade data,

• transformed into actionable information,

• based on evidence to change health behaviors, and

• to enable management of chronic conditions.

PCHAlliance supports a patient/consumer-centered approach to improving health and wellness through…

Continua Design Guidelines

• Healthcare Providers– Achieve outcomes at lower costs

• Remote Care Service Companies– Simplify integration of multiple

observations into healthcare information systems

• Device and Sensor Companies– Furnish medical-grade observations

• Pharmaceutical Companies– Better measure of drug efficacy

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http://www.pchalliance.org/about-continua

H.811 H.812 H.813

H.810

http://www.itu.int/rec/T-REC-H.810-201312-I

H.812.5

Secure Medical-Grade Data from Patient to Care Delivery Using Open Standard

Continua Design Guidelines

JIC

CDG a global standard through ITU

Extend IHE profiles for personal connected health and participate in

both IHE USA and Europe Connect-a-thons.

Development of new standardswithin the IEEE PHD for acquiring

medical-grade data.

Integrating work group collaboration within both CTA and PCHAlliance

Joint initiative on SDO Global Health Informatics Standardization

Driving IEC’s SyC AAL, Assisted Living Working Group

Working to make medical-grade data available over

BTLE

First to profile HL7 FHIR for remote patient monitoring

Advancing HL7 standards to support remote patient monitoring

We enable standards-based solution to be truly interoperable

Role in Ecosystem

CODE Project Overview

• Continua Design Guidelines– Secure Medical Data Exchange– Enables Improved Outcomes at Lower Cost– Implementation Outside Stakeholder Focus

• Commercial Ready Software– Simplifies implementation of Continua

Interfaces– Expedites Regulatory Approvals

• Open Source Software Project– Anyone can Inspect, Modify, Enhance– Broaden Community of Experts &

Developers

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http://www.pchalliance.org/continua-open-development-environment

FHIR Implementations

• Health & Fitness Service: Observation Server– A Kubernetes cluster running under Amazon Web Services that

incorporates a secured FHIR server meeting HL7 and Continua H.812.5 draft specifications.

– Operational• Personal Health Gateway: Observation Upload

– Maps vital signs data from a variety of sensors into FHIR resources and uploads separately or combined as a multi-measurement.

– Available mid-2019• Personal Health Gateway: Bluetooth Low Energy Manager

– Collects vitals signs data over BTLE transport and transcodes to IEEE-11073 data structures.

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Conformity Assessment by Continua

Continua Test ToolCTT

Continua

Certified

Continua

Compliant

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“Continua Compliant”

Continua Certified Product Showcase

Continua CompliantListing

PCHAlliance Match-making(matching buyers to sellers)

Continua Test Tool

Free Listing

Member Only Listing

PCHAlliance MarketsMember’s Product

https://www.pchalliance.org/continua-conformity-assessment

• Ensures products conform to the Continua Design Guidelines and underlying standards and demonstrate interoperability between conforming products.

Opportunity to Engage

• Medical Device Manufacturers– Help grow the ecosystem and your market opportunity

• Medical Providers– Enjoy improved ambulatory care at lower cost

• Health Informatics– Measure population health using reliable consistent data

• Regulators– Ensure secure and reliable data transmission to digitally

connected devices

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Additional Information

PCHAlliance Web Site – Become a Member Today!Fundamentals of Data Exchange White PaperIntroduction to the Continua Design GuidelinesContinua Design GuidelinesConformity Assessment Scheme by ContinuaMichael Kirwan, VP Continua mkirwan@pchalliance.orgThomas Erickson, Director Technical Operations terickson@pchalliance.org

Thank You

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By Light Professional IT Services LLC

IHE on FHIRJohn Moehrke

<John.Moehrke@byLight.com>Co-Chair: IHE ITI Planning Committee, HL7 Security WG

FHIR Foundation founding memberFHIR Management Group, FHIR Facilitator

www.bylight.com

IHE Domains

•Cardiology•Dental•Eye Care•IT Infrastructure (ITI)•Pathology and Laboratory Medicine

•Patient Care Coordination

•Patient Care Devices•Pharmacy

•Quality, Research and Public Health

•Radiation Oncology•Radiology

•Mammography•Nuclear Medicine

Source: https://www.ihe.net/IHE_Domains/

* Marked in red are domains using FHIR

Mobile

•Most profiles from IHE that leverage FHIR have the word “Mobile” in their title.

• Indicates FHIR was used•Usually only used when historic use-case is re-

evaluated using FHIR•Does NOT restrict the use to non-Mobile use

https://wiki.ihe.net/index.php/Category:FHIR

ITI Profiles on FHIR

• Mobile Access to Health Documents (MHD) • Audit Trail and Node Authentication (ATNA) - Query• Mobile Alert Communication Management (mACM)• Mobile Care Services Discovery (mCSD)

• Healthcare Provider Directory• Mobile Cross-Enterprise Doc Data Element Extraction (mXDE)• Non-patient File Sharing (NPFS)• Patient Identifier Cross-reference for Mobile (PIXm)• Patient Demographic Query for Mobile (PDQm)• Internet User Authentication (IUA) – Special Mention• Patient Identity Management

Appendix Z on FHIR

• Common text for all IHE Domains to re-use• Introduction to FHIR profiling concepts • Common query parameter clarifications• Relationship between CapabilityStatement and IHE

Integration Statement• Pointer to library of conformance resources• Mapping of FHIR Identifier datatype to HL7 v3 root, and

XDS Cxi• Security Considerations

Patient Care Coordination Profiles on FHIR

• Clinical Mapping (CMAP)• Dynamic Care Planning (DCP)• Dynamic Care Team Management (DCTM)• Point of Care Medical Device Tracking (PMDT)• Query for Existing Data for Mobile (QEDm) • Reconciliation of Clinical Content and Care Providers

(RECON)• Routine Interfacility Patient Transport (RIPT)• Paramedicine Care Summary (PCS)

Pharmacy Profiles on FHIR

• Mobile Medication Administration (MMA)• Uniform Barcode Processing (UBP)

QRPH Profiles on FHIR

• Mobile Retrieve Form for Data Capture (mRFD)• Vital Records Death Reporting (VRDR)• Birth and Fetal Death Reporting – Enhanced (BFDE)• Quality Outcome Reporting for EMS (QORE)

Radiology Profiles on FHIR

•Standardized Operational Log of Events (SOLE)

•Special mention as these use compatible DICOM web• Web Image Capture (WIC)• Web Image Access (WIA) formerly called MHD-I• Invoke Image Display (IID) - Special mention

Move to FHIR R4

• All profiles are expected to be revised to use FHIR R4• IHE Governance prevents normative until underlying standard is

normative

• Priority set of Profiles are updated to R4 and are in Public Comment

• Mobile Access to Health Documents (MHD) • Mobile Care Services Discovery (mCSD)• Patient Demographic Query for Mobile (PDQm)• Query for Existing Data for Mobile (QEDm) • Appendix Z• Mobile Cross-Enterprise Doc Data Element Extraction (mXDE)

• Equivalent to US-Core

IHE on FHIR

• 23 Profiles and growing• IT Infrastructure (ITI) - 8• Patient Care Coordination - 8• Pharmacy - 2• Quality, Research and Public Health - 4• Radiology - 1

• https://wiki.ihe.net/index.php/Category:FHIR• http://www.ihe.net

• Blog – John Moehrke’s Healthcare Exchange Standards• https://healthcaresecprivacy.blogspot.com

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Questions?

John MoehrkeGmail JohnMoehrkeTwitter JohnMoehrkeSkype johnmoehrke

Blog healthcareSecPrivacy.blogspot.com