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Future Directions:FHIR in New Zealand (a personal opinion)
Dr David HayChair HL7 New ZealandOrion Health Product Strategist
October2013
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Agenda
• Interoperability Architecture• Progress• (possible) place for FHIR
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Interoperability Reference Architecture
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Interoperability Reference Architecture
• Developed at the end of 2011
• Supporting the Vision– A patient focused,
integrated healthcare model, based on shared care
• Scope of document– An architecture for
inter-system exchange of Health Information
• 3 Pillars– CDA documents as units of exchange– XDS as the registry/repository
infrastructure– openEhr Archetypes as models
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Health Information Exchange
Regional Data Store
FHIR Resources
FHIR REST/Service
Clients:BrowserOther system (HSA, GP PMS)
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Progress since then
• Some completed projects– GP2GP– eReferrals– ePrescribing– Canterbury eSCRV (Shared repository Clinical Data)– Auckland testsafe (Shared Lab data)
• Currently developing CDA ‘profiles’– Highly constrained– Common templates– Medications & Allergies
• XDS– Recent EOI– Not actual users at the moment
• Archetypes– Pilot using CKM for medications (Thanks to Ocean Infomatics)
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Where FHIR could make a difference
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Possible Use Cases for FHIR
• Will consider 3 possible scenarios for FHIR– Identity Service– XDS Document Registry / Repository– Master List of Medicines
• High level only– Eg security/privacy not discussed
• Not official NZ policy!
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Quick techie summary
• Examples using REST– Real time interaction– Would use messaging / documents where appropriate
• HTTP Verbs (CRUD)– POST: Create– GET: Retrieve (specific resource & search)– PUT: Update– DELETE: Deactivate– OPTIONS: Conformance
• Profiles– Statement of use
• Conformance – What can a server support
• FHIR supporting an ecosystem
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1. Identity Service
• Existing Patient and Provider Registries– Patient identity Service
• National Health Identifier (NHI)• First established in 1993• Recently re-platformed
– IBM Initiate– Exposing some web services
– Provider Identity Service• Health provider Identifier (HPI)• Part of the NHI re-platforming
• Why FHIR– Simple lookup (90% of use)– Increase uptake – especially in community care
• Current progress– Just an idea
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Architecture
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Identity Service: possible FHIR interfaces
• Resource– Use Patient resource with extensions (Iwi, Hapu...)
• Interfaces– Find (search for) a patient
• GET /patient?name=eve– Get details for a known patient
• GET /patient?identifier=PRP1660– Notify of updates
• PUT /patient?identifier=PRP1660– Likely have workflow not direct update
– Register new patient• POST /patient
– Likely have workflow not direct update
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2. Document Registry: IHE XDS
• An architecture to support distributed document repositories within an ‘affinity domain’ managed by a single registry/index– Allows repositories to maintain stewardship with common governance– A number of existing repositories– Many ways to extend if needed
• Well accepted internationally• In NZ, we only need 1 Registry
– And we already have the Identity registry
• Why FHIR – ‘Native’ XDS interfaces are complex. FHIR interfaces are simpler to implement– Other deployment possibilities– Resource tags for fine grained privacy– Other functionality – eg Notifications, Audit trail to consumers
• Current progress– Current project to develop pilot
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The standard IHE Model
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Document Registry: FHIR Equivalent
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3. My List of Medicines
• Key importance of a common view of current medications and medication history
• Some existing infrastructure– Testsafe & eSCRV (Auckland & Christchurch) with dispensing data– Is an ePrescribing pilot
• Why FHIR– CDA model is complex – especially with local extensions– No obvious alternative transport (other than CDA documents via XDS)
• Current progress– Concept of the shared repository of medication data well established– Working on model for medications
• Archetypes– CDA templates for medications
• Constrained to our models• Mapped to FHIR resources (experimental)
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Big Picture
Resources• Medicine• MedicationPrescription• MedicationDispense• MedicationAdministration
• Order• Provenance• List
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Interactions / Use Cases: Examples
• Get current list of medications (MLOM)– GET /Patient/<patient ID>/List?code=meds (if you have the patient ID)– GET /List?code=meds&subject.identifier = <identifier> (if you don’t)
• Update the MLOM– PUT /List/<listID> (with an updated List)
• Get history of changes to the MLOM– GET /List/<listID/_history
• Get all dispensings– GET /MedicationDispense?patient=<patient ID>
• Get all administrations• GET /MedicationAdministration?patient=<patient ID>
•Prescribe• POST /Order (Containing MedicationPrescription in Order)
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Local Activity
• Vendors– Orion Health
• Putting significant resources into FHIR developments• Attendance at connectathons• XDS interfaces• Mobile Medication Administration project
– Sysmex• Attendance at connectathons• XDS interfaces• Lab Order interfaces
• HINZ 2014 Developer challenge– Encourage innovative development, especially new entrants– Encompass connectathon concept– In planning stage now...
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Conclusion
• The ‘shared repository’ model is established in NZ• FHIR
– Adds missing parts (especially the transport & query)– Much easier to implement– Enables the ecosystem– Enables the patient
• Progressing with a number of pilot implementations– XDS– Some internal projects
• HINZ Developer Challenge• Shameless self-promotion
– www.fhirblog.com
www.orionhealth.com