itx presentation: fhir and the new zealand ehr
TRANSCRIPT
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HL7 FHIR AND THE NZ-EHR
DAVID HAY | JULY 2016
Page 2 • 2016 © Orion Health™ group of companies
DR. DAVID HAYMedical Doctor
Chair of HL7 New Zealand
Co-chair FHIR Management Group
Product Strategist Orion Health
Blog: fhirblog.com
Tooling: clinFHIR.com
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Agenda
▸ This talk– What are we trying to achieve with the NZ-EHR?– What are the benefits– What is FHIR, and how does it help
▸ Next session– More about FHIR
• Resources• Paradigms of exchange
– Profiling FHIR– How to get involved
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What is FHIR?
▸ Latest Interoperability standard from HL7▸ Uses modern technologies▸ Supports all paradigms of exchange
– REST (especially mobile / device)– Document– Message– Service
▸ Implementation focused– Straight forward to implement
▸ World wide support
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WHAT ARE WE TRYING TO DO?
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Our current environment
Laboratory Systems Hospital Information System
GP
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Our desired environment
Laboratory Systems Hospital Information System
GP
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Sharing healthcare information via the NZ-EHR
NZ-EHR
ConsumerGP Hospital
FHIRFHIR FHIR
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▸ Clinical Events we want to share– Encounters– Prescriptions and Dispenses– Lab results– Documents (discharge summary,
referrals)– Appointments
▸ Lists of things– Medication, Allergies, Conditions
▸ Background– Genomics, Social, Family
▸ Common functionality– Decision Support – Ordering & workflow
▸ Robust security & privacy– Consumer controlled– Access audit
What’s in the EHR?
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The ecosystem: SMART – powered by FHIR
Included in project Argonauthttp://fhirblog.com/2015/07/10/fhir-smart-and-sidecar-applications/
BENEFITS
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Benefits to Implementers and Vendors
▸Familiar tooling and technologies– XML/JSON, HTTP, REST, SSL, OAuth
▸ Predefined resources and APIs – Allows implementer to focus on the core application functionality
▸ Extensive documentation, samples and reference server implementations▸ Validation services ▸ Active and supportive community▸ Open Source code libraries
– HAPI (Java) and Furore (.Net)▸ Mobile friendly▸ Increases commercial viability of app development as FHIR compliant apps will
work with different FHIR Servers (EMRs, HIEs)
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Benefits to Clinicians
▸ Improved access to more complete, higher quality, patient information incl. genomics
▸ Easier to organise investigations and management▸ Greater choice and variety of applications and devices to support
clinical workflow▸ Increased IT development speed – solving business problems faster,
in innovative ways▸ Improving Decision Support
- E.g. Immunisation protocol▸ Clinicians can get involved in system design▸ Saving time
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Benefits to Consumers
▸ Prospect of improved patient engagement apps, enabled through FHIR APIs to clinical systems
– Can engage more deeply▸ Clinician has access to a more complete patient record
and improved decision making tools, leading to– Better decision making– More efficient diagnosis and treatment– Higher quality care
▸ Overall improved patient experience – reducing wasted time
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Benefits to Health Care Organisations
▸ Most vendors are committed to FHIR▸ Should lead to:
– faster deployments– lower cost interoperability– reduced vendor lock in as FHIR is adopted by source systems
▸ Standards based APIs to support internal application development▸ Capture data for analytics and Decision Support
– Management– Population
HOW DO WE DO THIS
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Open Standards
▸ A common, secure way for everyone to access the information
– API (Applications Programming Interface)▪ Direct access (like mobile)▪ Between computers (like in a hospital)
– Content ▪ Resources – like a web page▪ Common language - terminology
– Security• Physical, Authentication, Authorization
– Community▪ For support
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HL7 FHIR
▸ Next generation healthcare Interoperability Standard▸ Supports all interoperability paradigms▸ Mobile & Device friendly▸ Provides access to infrastructure services
– Terminology– Identity– Decision Support
▸ Implementer friendly▸ International community▸ Strong endorsement from Vendors, Providers, Funders,
Research, Government…
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Resources
GeneralAllergyIntolerance
Condition (Problem)Procedure
ClinicalImpressionFamilyMemberHistory
RiskAssessment
DetectedIssue
Care ProvisionCarePlan
GoalReferralRequest
ProcedureRequestNutritionOrder
VisionPrescription
Medication & Immunization
MedicationMedicationOrder
MedicationAdministrationMedicationDispense MedicationStatement
ImmunizationImmunizationRecommendation
DiagnosticsObservation
DiagnosticReportDiagnosticOrder
Specimen BodySite
ImagingStudy
Clinical
http://hl7.org/fhir/resourcelist.html
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Resource example
Resource Identity & Metadata
Human Readable Summary
Extension with URL to definition
Standard Data:• MRN• Name• Gender• Birth Date• Provider
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Recording a consultation
12-year-old-boy
First consultationComplaining of pain in the right ear for 3 days with an elevated temperature. On examination, temperature 38°C and an inflamed right eardrum with no perforation. Diagnosis Otitis Media, and prescribed Amoxicillin 250mg 3 times per day for 7 days.
Follow up consultation2 days later returned with an itchy skin rash. No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to Erythromycin 250mg 4 times per day for 10 days.
Patient
Encounter
Condition
Observation
Medication
Allergy Intolerance
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Encounter
Encounter
Practitioner
Patient
Asserter
Performer
Performer
Performer
Performer
Performer
Performer
Asserter
Asserter
Prescriber
Asserter
Pain right ear 3 days
Otitis media
Itchy skin rash
No breathing difficulties
Elevated temperature
Temperature 38°C
Inflamed right drum
Urticarial Rash
Amoxicillin 250mg
Erythromycin 250mg
Penicillin Allergy
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Profiling
▸ Many different contexts in healthcare, but want a single set of Resources▸ Need to be able to describe ‘usage of FHIR’ based on context▸ Allow for these usage statements to:
– Authored in a structured manner– Published in a repository– Discoverable– Used as the basis for validation, code, report and UI generation.
▸ 2 main aspects:– Constraining a resource– Adding an extension
▸ Profiling adapts FHIR for specific scenarios
Page 24 • 2016 © Orion Health™ group of companies
In Summary
▸ FHIR is the latest HL7 interoperability standard▸ Enormous interest locally and internationally▸ Allows clinicians and patients to be more involved▸ Promises to revolutionise sharing of healthcare information▸ Is not a silver bullet▸ FHIR promotes Innovation▸ FHIR is disruptive▸ FHIR IS in your future
For more information on FHIR see here: http://hl7.org/fhir/index.html
