BRMS and FHIR Integration

A User Story

Ravi Juneja, MBASr. Manager Enterprise Systems, IT GroupFresenius Medical CareMay, 2018

3

Fresenius Chairside – World’s largest Healthcare Deployment

up to 100k Treatments/day8 Time zones

Advances in medicine and technology

All the research in the world is meaningless unless it turns into meaningful results for patents, which is why our research and development eforts are designed to quickly turn new fndings into market-ready products. This quick tme to market enables us to ofer safer and more efectve individualized treatment to each and every patent. We focus on technologies to reduce product size and simplify their use, while integratng various treatment elements to create holistc therapy systems.

Sustained growth in patent numbers

It is estmated that by 2020, there will be 3.8 million kidney patents worldwide, fueled by an increase in the number of people who sufer from diseases such as high blood pressure and diabetes. As the number of kidney patents rises, health care systems across the globe will be challenged to fnd the resources to care for them. Meetng the resultng demand for safe, efectve and efcient therapies and associated technologies and products is central to our research and development actvites.

Increase in concomitant diseases

Our society is aging overall and the risk of developing end-stage renal disease increases with age. As patents age they also experience a greater likelihood of developing concomitant diseases such as cardiac and vascular conditons. Treatng these patents’ comorbidites is increasingly a focal point of our research and development eforts.point of our research and development eforts.

Rising cost pressure in health care

An aging populaton, growth in chronic illnesses, and the desire to ofer new and improved technologies in patent care all present major long-term fnancial challenges to health care systems across the globe. For this reason, we believe successful product innovatons must not be not only high quality, but also afordable. Based on our experience operatng dialysis clinics, we consider these two priorites to be entrely compatble.

Factors driving change at Fresenius

HIE

Fresenius External Apps…

Data Layer

DATA WAREHOUSEDATA WAREHOUSEAPPLICATION DATABASES

Integraton - ETL

DATA ACQUISITIONCONFORMANCE & INTEGRATIONS - PUBLISH...

PERIMETER SECURITY

Nephrologists Other Providers Ancillary Services Hospitals Nursing Homes SNIFs Health Plans CMS Regulatory Agencies Social & Community

Services

EXTERNAL SOURCESEMPI

OTHER FRESENIUS LINES OF BUSINESSSpectra LabsFresenius RxVascular CareUrgent CarePhysicians Groups

FRESENIUS KIDNEY CARE

Shared Services

Security, ERP, HR,… Hosted Locally

Oh wait… ours is a typical healthcare enterprisemultiplied by 100

Clinical Services

EMR, PHRHosted Locally

Financial Services

Admissions, BillingHosted Locally

Portal Services

ContentHosted Locally

Ours is a typical healthcare enterprise

The Rise of the API in Healthcare

• Fast Healthcare Interoperability* Resources• Exchanging electronic healthcare informaton

• Built on modern web technologies - using REST API.• XML or JSON (Javascript Object Notatonn

• Clients to integrate, request and transfer data between diferent systems.

• FHIR Resources – recipe used to exchange informaton and simple to use and easy to extend

• FHIR Specifcatons - Defnes a way in which resources can be exchanged between diferent systems.

• Resource format is defned by the REST call exchanging the data.

• Goal is to make healthcare informaton portable and interoperability beter.

* noun: interoperability - the ability of computer systems or sofware to exchange and make use of

informaton.htps://www.hl7.org/fir/

WHAT is FHIR (nickname FIRE)

FHIR Resources• Resource Categories

ClinicalAllergiesConditonsProcedureAssessment…

AdministratonPatentsPracttonerOrganizatonHealthcare Service…

DiagnostcsObservatonDiagnostc ReportBodySiteQuestonnaireResponse….

MedicatonsMedicatonMedicatonOrderMedicatonAdminImmunizaton….

FinancialCoverageEligibilityEnrollmentClaim….

WorkfowTaskEncounterAppointmentScheduleSlot….

SecurityProvenanceAuditEventConsent….

FHIR Resources – API syntax• Patent resource

htps://fir-qa.fmcna.com/STU3/firapi/Patent/P5000307186?_format=json

URL Resource ID Parameter

Response - Body

• Resource identty and metadata

• Human readable

• Extensions

• Standard data contents

"resourceType": "Patent",

"id": "P5000307186",

"meta": {

"versionId": "1",

"lastUpdated": "2018-04-10T21:19:25.341-04:00"

},

"text": {

"status": "generated",

"div": "<div xmlns=\"htp://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\">ACESRel2.32SVN <b>TESTPATIENTSVN </b></div><table class=\"hapiPropertyTable\"><tbody><tr><td>Identfer</td><td>5000307186</td></tr><tr><td>Address</td><td><span>32 Hartwell Avenue </span><br/><span>LEXINGTON </span><span>MA </span><span>USA </span></td></tr><tr><td>Date of birth</td><td><span>03 August 1976</span></td></tr></tbody></table></div>"

},"identfer": [

{

"type": {

"coding": [

{

"system": "htp://hl7.org/fir/v2/0203",

"code": "MR"

}

]

},

"system": "urn:oid:2.16.840.1.113883.3.7418.2.1",

"value": "5000307186"

}

],

"name": [

{

"use": "ofcial",

"family": "TestPatentSVN",

"given": [

"ACESRel2.32SVN"

]

}

],

Resource Identty and Meta data

Human Readable Text

Standard Data and Content

Response - Body

Fresenius FABRIC is

Collaboratve app development

Secure User and backend integraton

Transformatve power of technology

High performance and availability in all data centers

Fresenius FABRIC enables to

Harness and encourage user engagement

Transform a system of record into a system of

engagement

Unleash back-end data

Reduce development tme and efort

Fresenius FABRIC Fresenius Advanced Backbone of Reusable Integrated Components

SMART Healthcare Applicaton Platorm for Patents, Clinicians, Physicians

SMART concepts Substtutable Medical Applicatons & Reusable Technologies

Fresenius Clinical Systems approach to APIs

FABRICApplicationsApplications

EnterpriseApplicatons

Web-based Applicatons{External & Local}

Business IntelligenceReportng & Analytcs

Portal Services

ApplicationsApplications

EnterpriseApplicatons

Web-based Applicatons{External & Local}

Business IntelligenceReportng & Analytcs

Portal Services

DATA

Fresenius Kidney

Partners

Spectra

& Shiel

Fresenius Vascular

Care

National Cardio-vascular Partners

. . .

FMCNALines of Business

. . .

Fresenius

Rx

Fresenius

Health

Care

Medspring

SoundPhysicians

SoundPhysicians

FMCNALines of Business

Workfow

Rules Engine

Data Transformaton

Services(Restul, FHIR, API…n

Orchestraton

Development Platorm

eCF eCC Rx FVC

Fabric concept

Fabric FHIR manifestation – Internal applications and consumers

SPA SPA, SWIFT, Android

Care Coordinaton

Patent PortalOrderingChartng

Clinician PortalAdmissions

Populaton Care ManagementPoint of Care EHR

User provision

Business Applicatons

Spring BootContainer

SPA

SPA Service

Jboss EAPContainer

MPASpring BootContainer

SPA Service

Business ApplicatonDomain Services

FHIR

FABRIC

Enterprise Healthcare Data

Precision Nephrology

Data Transformaton

Restul, FHIR, API…

Orchestraton

Development Platorm

OpenID Connect and Oauth2.0

Workfow Engine

STU3 FHIR Server

DATAClinical Financial

Pharmacy others

INTRANET

OpenID Connect SSO

FABRIC = (ESB + Platorm as a Service)

SECURITY – MONITORING – AUDITING _ DEPLOYMENT

Workfow Engine(Business and Service)

Messaging Data Transformaton

Services(Restul, FHIR, API…)

Orchestraton Development Platorm

SMART OS – RedHat 6.x

SMART PaaS - Platform as a Service (container manager) – FABRIC8

SMART Containers – OSGI, SPRING BOOT (JVM stacks – Oracle WebLogic, JBoss EAP, Tomcat, Node.js)

SMART ESB – Web Services Apache CXF, Apache Camel Routes, Persistence (Mongo DB), back ends MS SQL, Oracle DB..

SMART SOA – FHIR Healthcare API, User Authorization, Caching, Workflow

SMART DATA – FHIR Resources

SMART APPS – Angular Apps

SMART Paas – OpenShif 3.0

SMART Containers – Docker

SMART SOA – Data Virtualizaton

Current Layers Evolving Layers

Open Source with Commercial License Support

Fabric layers under the hood

FHIR on FABRIC – The APIs

ClinicalAllergiesConditonsProcedureClinical ImpressionAssessment…

AdministratonPatentsPracttonerRelated PersonOrganizatonHealthcare Service…

DiagnostcsObservatonDiagnostc ReportBodySiteQuestonnaireResponse….

MedicatonsMedicatonMedicatonOrderMedicatonAdminImmunizaton….

FinancialCoverageEligibilityEnrollmentClaimEOB….

WorkfowTaskEncounterAppointmentScheduleSlotSupplyRequestSupplyDelivery….

SecurityProvenanceAuditEventConsent….

DocumentCompositonDocumentManifestDocumentReference….

FABRIC

eCC eCFFHIR

BPM ESB

MS SQL MS SQL

EAP, SPING BOOT

HL7 FHIR API STU-3

JBOSS FUSE INTEGRATION

JBOSS BPM SUITE

COMPONENTS

Security Audit

Cache

PharmRx

MS SQL

KCNG KC EMPIOPEN SOURCE

Oracle

onBase

SMART DATA BPMFHIR Workfow, Business ProcessDual Data Center HA Actve-Actve

JBPM Suite, KIE Knowledge Is Everything (Drools, jBPM, OptaPlannern

BPMN 2.0, BEPLUser, Role and Credental BasedAuthoring, SimulatonData Modeler ted to FHIR Object ModelDeployment Management, Analytcs

BPM under the hood

SMART DATA BPMFHIR Workfow, Business ProcessDual Data Center HA Actve-Actve

BPM and FHIR under the hood

WHY BRMSWe Hear Yes

• Business automaton

• Segregate Rules and applicaton code

• Business user friendly

• UI tools for business

• Developer tool with eclipse• Marketplace -> Redhat developer studio

• Decision service -> Rules Engine

• Business Process Module

Use Case

• FEA drugs are expensive.

• Requires extensive approval process.

• Process is / was manual.• Clinics submits requests for a patent on a paper form.

• FEA department reviews each requests – approve or deny.

• Operatonal integrity team enters assessments in the EMR for each approved patent.

• Approval requires the patent to be Financially eligible and Clinically eligible for certain drugs. Clinical Eligibility is required.

P&T (Pharmaceutical and Therapeutics) Project

•Phase I (Sensipar and Parsabivn

•Phase II (Dialyser and other FEA drugsn

P&T (Pharmaceutical and Therapeutics) Project • Phase I

• Nightly Process (Sensiparn• Run a query for Financially Eligible(FEn Patents – add them to group in FHIR / FABRIC

• Run rules for Clinical Eligibility (CEn

• If clinical eligible (passed thru all rulesn

• Add this patent to CE group.

• Create an assessments – approved for the drug to be added to their order (treatmentn

• Find patents from FE group that are not CE and run rules to see if the have become CE.

• P&T UI (Sensipar denials and Parsabiv Approvals and other FEA drugs Approvalsn

• Check if the Patent is FE

• Run rules for Clinical Eligibility (CEn

• If clinical eligible (passed thru all rulesn.

• Create an assessments – approved for the drug to be added to their order (treatmentn

P&T Deployment

FHIR DATA MODEL

BRMS MODEL

BUSINESS RULES – Denial Rules

BUSINESS RULES – Acceptance Rules

Data passed to Rules Engine

"valueString":"{\"patentMrn\": \"5000307404\",\"patentVoid\": \"2026253\",\"userLoginId\": \"TPTCommitee\",\"clinicId\": \"1271\",\"formUsage\": \"Excepton Medicatons\",\"formUsageDisplayName\": \"Formulary Excepton Medicatons\",\"formElementName\": \"FE_4%SodCitBox\",\"assessmentData\": [{\"name\": \"SCH_EnttyName\",\"value\": \"1271\"}, {\"name\": \"FE_SensiAuth\",\"value\": \"FHIRAUTOMOTIVE\"}, {\"name\": \"FE_SensiStDt\",\"value\": \"20180105\"}], \"medRequestJPAId\":\"MRP1170106328\"}"

ROI – automated process

Automated Manual

Form Submissions

Form Submissions

ReviewReview

Manual EntryManual Entry

Nightly ProcessNightly Process

Denials using UIDenials using UI

Times 1000 clinics

ROI – Cost Beneft

• Time spent on one approval• 1-2 hours per request

• 100 requests per day• Hours saved per day 100 to 200 person hours

• Projected 500 requests per day with Sensipar

• Manual hours saved

• Cost of project recovered in 2 -3 months

BRMS Challenges – Worth Investing time and money Time consuming at frstInital setupTrainingConsultant help – extremely helpful

Initalizing variables

Learning MVEL dialect

Understanding of Rules group

Ataching rules in the Process

Conversion of FHIR objects

Executon of Rules

List of resources htps://access.redhat.com/documentaton/en-us/red_hat_jboss_bpm_suite/

https://www.drools.org/learn/documentation.htmlhtps://www.drools.org/learn/video.htmlhtps://www.drools.org/learn/slides.htmlhtps://www.drools.org/download/download.htmlhtps://docs.jboss.org/drools/release/6.5.0.Final/drools-docs/html_single/htps://github.com/gigamailer/simplenin/blob/master/Mastering%20JBoss%20Drools%206-Packt%20Publishing%25282016%2529.pdf

htps://github.com/marianbuenosayres/jBPM6-Developer-Guidehtps://www.amazon.com/jBPM-Developer-Guide-Mariano-Nicolas/dp/178328661Xhtps://www.javacodegeeks.com/minibook/jboss-drools-cookbookhtps://github.com/kiegroup/droolshtps://github.com/kiegroup/drools/tree/master/drools-exampleshtps://github.com/kiegroup/drools/tree/master/drools-examples/src/main/resources/org/drools/exampleshtps://developers.redhat.com/products/red-hat-decision-manager/download/htps://developers.redhat.com/products/bpmsuite/download/?sc_cid=701f2000000tvRKAAY&gclid=EAIaIQobChMIhMaNjf202gIVDBBpCh2PcAR3EAAYASAAEgJxyPD_BwE

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