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Argonaut Data Query on FHIR R4

Eric Haas

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Instructor

Eric Haas • Primary Editor, Argonaut Data Query IG / US FHIR

Core IG

• Self proclaimed FHIR expert

• ehaas@healthedatainc.com

Brett Marquard • Partner in Crime

• Primary Editor, Argonaut Data Query IG / US FHIR Core IG

• Primary Editor, Consolidated CDA (C-CDA)

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Outline

Background on Argonaut

Data Query

US Core

Future of Argonaut and US Core

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What is the Argonaut Project?

• The Argonaut Project is an implementation community comprising leading technology vendors and provider organizations to accelerate the use of FHIR and OAuth in health care information exchange.

We are:

• Private sector initiated and funded

• Working collaboratively with other FHIR initiatives such as SMART-on-FHIR, the Health Systems

Platform Consortium, and the FHIR Foundation

• Creating open industry Implementation Guides in high priority use cases of importance to patients,

providers and the industry as a whole

We are NOT:

• A standards development organization

• A separate legal entity

• A proprietary activity

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Technology Vendors Provider Organizations

• Accenture • Beth Israel Deaconess Medical Center

• Allscripts

• Apple

• Intermountain Health

• Mayo Clinic

• Athenahealth • Partners Healthcare

• Cerner • SMART at Boston Children’s Hospital

• Epic

• Change Healthcare

• MEDITECH

• Optum

• Surescripts

Staff (current and past)

• Prime contractor: HL7

• FHIR initiatives: Grahame Grieve, Eric Haas, Josh Mandel, Brett Marquard

• OAuth initiatives: Dixie Baker, Josh Mandel

• Project Management: Jennifer Monahan, Micky Tripathi

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The Argonaut process helps resolve practical problems

Search operations

Examples:

• Can search for individual

patient by identifier (e.g.,

MRN) OR full name & gender

OR full name & birthdate

• Can search for Procedures by

patient or by patient &

specified date range

What search criteria can you

use?

What type of data will you

get in response?

How will that data be

represented?

Scope of response

Examples:

• Search for patient will get all

FHIR patient resources

• Search for Procedures will get

all current and historical

procedures or within specified

date range

Content of response

Examples:

• Patient search will get name,

identifier, gender, birthdate,

• Procedures search will get

type of procedure, date

performed, and procedure

status

• In some cases created

Argonaut extensions and value

sets

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The Signature Event: Argonaut Data Query Implementation Guide

http://www.fhir.org/guides/argonaut/r2/

• Access to individual data

elements of Common Clinical

Data Set

• Access to structured document (CCD) containing all Common

Clinical Data Set elements

• Leverage OAuth2-based security

and authorization

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US FHIR Core

The US FHIR Core is a labeled subset of all HL7 US Realm produced FHIR profiles.

The label is designed to provide the community with a single point of reference to

foundational US FHIR profiles that:

1) should be used by US stakeholders when implementing FHIR; and

2) always be used as the basis for creating further US-Realm profiles.

Bottom line • Argonaut IG = US Profiles on DSTU2

• US Core = HL7 balloted US Profiles. Built from Argonaut requirements. Versions built for FHIR R3 and R4.

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Argonaut DSTU 2 vs US Core R4 Profiles

Argonaut DSTU 2

1. Argonaut AllergyIntolerance Profile

2. Argonaut CarePlan Profile

3. Argonaut CareTeam Profile

4. Argonaut Condition Profile

5. Argonaut Device Profile

6. Argonaut DiagnosticReport Profile

7. Argonaut DocumentReference Profile

8. Argonaut Goal Profile

9. Argonaut Immunization Profile

10. Argonaut Medication Profile

11. Argonaut MedicationOrder Profile

12. Argonaut MedicationStatement Profile

13. Argonaut Observation Results Profile

14. Argonaut Patient Profile

15. Argonaut Procedure Profile

16. Argonaut Smoking Status Observation Profile

17. Argonaut Vital Signs Observation Profile

US Core R4

1. US Core AllergyIntolerance Profile

2. US Core CarePlan Profile

3. US Core CareTeam Profile

4. US Core Condition (a.k.a Problem) Profile

5. US Core Device Profile

6. US Core DiagnosticReport Profile for Laboratory Results Reporting

7. US Core DiagnosticReport Profile for Report and Note exchange

8. US Core DocumentReference Profile

9. US Core Encounter Profile 10. US Core Goal Profile

11. US Core Immunization Profile

12. US Core Laboratory Result Observation Profile

13. US Core Location Profile

14. US Core Medication Profile

15. US Core MedicationRequest Profile

16. US Core MedicationStatement Profile

17. US Core Organization Profile

18. US Core Patient Profile

19. US Core Pediatric BMI for Age Observation Profile 20. US Core Pediatric Weight for Height Observation Profile

21. US Core Practitioner Profile

22. US Core PractitionerRole Profile

23. US Core Procedure Profile

24. US Core Smoking Status Profile

25. Vital Signs Profile (FHIR Core Profile)

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January 2019 US Core Ballot based on FHIR R4

Clinical Notes

• US Core DocumentReference Profile

• US Core DiagnosticReport Profile for Report and Note exchange

New Vital Signs from ONC Notification of Proposed Rule Making (NPRM) • US Core Pediatric BMI for Age Observation Profile

• US Core Pediatric Weight for Height Observation Profile

To be published June 2019 as HL7 FHIR® US Core Implementation Guide STU 3 (based on FHIR R4)

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Profile-less FHIR

• You don’t need profiles to interoperate with FHIR

• Resources are “discrete” enough that mechanism to populate most elements is clear

• Approach

• Populate/consume all elements you know, use HL7 or country-standard extensions for extras

• Map to/from “recommended” terminologies as much as possible, populate CodeableConcept.text

• Expose capabilities in Conformance resource

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Profile-less FHIR

• You don’t need profiles to interoperate with FHIR

• Resources are “discrete” enough that mechanism to populate most elements is clear

• Approach

• Populate/consume all elements you know, use HL7 or country-standard extensions for extras

• Map to/from “recommended” terminologies as much as possible, populate CodeableConcept.text

• Expose capabilities in Conformance resource

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Base Condition Resource vs…

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…

…

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US Core Condition

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Key Components – Data Query

General Guidance

FHIR Artifacts: Profiles*

Extensions

Value Sets

Operations

SearchParameters

Conformance

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General Guidance

• Mapping of FHIR to the ONC 2015 Common Clinical Data Set (CCDS) and latest US Core Data for Interoperability (USCDI)

• ‘Must Support’ • Base FHIR guidance -‘When a profile does this, it SHALL also make clear exactly what kind of

"support" is required.’ • Data Query - took us 6 bullets to say, ‘send these values if you have them’

• Extensible + Max-ValueSet binding for CodeableConcept Datatype • Allows for either a code from the specified value set or text

• Using UCUM in the [Quantity] datatype • Free text when necessary

http://www.fhir.org/guides/argonaut/r2/definitions.html

http://hl7.org/fhir/us/core/guidance.html

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General Guidance: USCDI to US Core Profile Mapping

http://hl7.org/fhir/us/core/guidance.html

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Profile Deep Dive – Allergies

• Prose

• Mandatory Elements

• Profile Specific Guidance

• Formal View

• “Quick Start” = Search

GET /AllergyIntolerance?patient=[id]

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http://hl7.org/fhir/us/core/StructureDefinition-us-core-allergyintolerance.html

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Profile Deep Dive – Allergies

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Profile – Patient

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Profile – Patient “Quick Start” Section

http://hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html

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Extensions

•US Core Birth Sex Extension

•US Core Direct email Extension

•US Core Ethnicity Extension •US Core Race Extension

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Value Sets - Terminology 24 Value Sets!

• US Core Medication Codes (RxNorm) • US Core Smoking Status • OMB Race Categories • US Core Common substances for allergy and

intolerance documentation including refutations • US Core Narrative Status • US Core DocumentReference Type • OMB Ethnicity Categories • US Core Condition Category Codes • Detailed ethnicity • US Core Vaccine National Drug Codes (NDC) • US Core ICD-10-PCS Procedure Codes • US Core Provider Speciality (NUCC) • US Core Vaccine Administered Value Set (CVX) • US Core Status for Smoking Status Observation • USPS Two Letter Alphabetic Codes • US Core Encounter Type

http://hl7.org/fhir/us/core/terminology.html

•US Core Problem •Birth Sex •US Core Diagnosticreport Report And Note Codes •US Core Provider Role (NUCC) •US Core Smoking Status Observation Codes •US Core CareTeam Provider Roles •US Core DiagnosticReport Category •US Core Clinical Note Type •US Core DocumentReference Category •US Core Procedure Codes •Language codes with language and optionally a region modifier •US Core Observation Value Codes (SNOMED-CT) •US Core Diagnostic Report Laboratory Codes •Detailed Race

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Value Sets - Problem Value Set

.compose: A definition of which codes are intended to be in the value set ("intension" )

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Value Sets - Smoking Status

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Operation - Get DocumentReferences ($docref)

This operation differs from a simple query in that DocumentReferences may be created ‘on-the-fly’ in response to this operation. For example, in some cases the documents themselves may not exist but can be generated when needed so a reference to them can be generated using this operation. If no documents exist and an ‘on-demand’ document cannot be created then the operation will return an empty search bundle.

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CapabilityStatement

US Core Server CapabilityStatement defines the expected capabilities of a server when conforming to the US Core Data Query Implementation Guide.

US Core Client CapabilityStatement defines the expected capabilities of a client when conforming to the Argonaut Data Query Implementation Guide.

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CapabilityStatement

http://hl7.org/fhir/us/core/capstmnts.html

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Future of Argonaut + US FHIR Core

Argonauts • Encouraged to use US FHIR Core rather than writing their own FHIR STU3 guide, or R4

guide.

• New development in 2019 for Subscriptions, Provenance, CDS hooks, and Argonaut Data Query testing on R4!

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Argonaut FHIR R4 Implementation Ground Rules

• Reuse HL7 US Core profiles • Issues identified with US Core Profiles will be reported to HL7 to be fixed in fall

STU update

• New profiles, such as Provenance, may be included in the Argonaut IG before being ported to US Corev

• Profiles not planned for port to US Core are out of scope

• Argonaut IG will include additional samples and guidance specific to Data Query Access

Argonaut Implementation Guide

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Open Issues

• Search filters and hidden default values by EHRs

• Medication list in R4

• When data is missing

• Extra patient search syntax

• UDI Testing and planning

• Meta data elements (e.g. security labels)

• R2 to R4 conversion and guidance

• Inspired O2 Concentration

• Misc Technical Issues

• Provenance

• Search for multiple patients (not to be confused with bulk data)

• Bulk Data Use Case

• Must Support • for use in ONC Certification

• for use when deriving other profiles from US Core

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Summer Argonaut Sprint Planning

Sprint Start End

Patient, Allergy, Encounters ~May! 6/19/2019

Procedure, Lab Observations 6/5/2019 7/3/2019

MedicationRequest… others<discuss>

If two servers or clients complete, we move on!

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Participation

• Review existing designs and comment use issues on GitHub

• Zulip Chat Channels

• Bulk Data

• Argonaut

• Upcoming HL7 Connectathon in Atlanta, GA (9/14 - 9/15)

• Contacts

• Eric Haas

• Josh Mandel

• Brett Marquard

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