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A FHIR Enabled Ecosystem for Health Information Sharing
Session 269, March 8, 2018
David Hay, Product Strategist, Orion Health
FHIR Management Group Co-Chair
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David Hay, MD
Currently employed at Orion Health
Conflict of Interest
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Learning Objectives• Analyze a FHIR enabled ecosystem
• Demonstrate the ability for health information sharing with a FHIR ecosystem
• Describe a secure FHIR ecosystem of information and services
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Agenda• The problem
• What is HL7® FHIR®?
• What is an ecosystem?
• FHIR components
• Apply to Use Case
• Final thoughts
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The clinical problem• Data and services are in many places
• Data becoming more complex – and more of it
• Clinical understanding improving
• Patients/Consumers expect more
• Single individuals or systems can’t know it all
• How to spread the load/simplify?
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Example Use Case: Thomas
• Elderly man
• Smoker, diabetic
• Chronic Lung Disease
• No family support
• Living on his own
• Hospitalized for pneumonia
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What is FHIR?
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Why FHIR• HL7 defines Interoperability Standards
• In 2011, the Board of HL7 noted:
– Interoperability requirements are increasing
– Need for real time access (API) – Mobile
– Vast increase in the amount, type and source of data e.g. Devices, Genomics
– Analytics, population health
– Implementer expectations
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Benefits of FHIR• Improved access to information - Clinician and Consumer
– Currently locked in silos of information
• Ability for Clinician to get involved
• Improved information quality
• Easier access to complex services
• Reduce duplication of services
– Reduced cost
• Ability to Innovate – as seen in finance & travel
– New models of Care
• Support Analytics & Decision Support
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Key parts of FHIR
• Resources
• Exchange definitions
– E.g. API
• Storage
• Community
– Assistance
– Tooling, Reference Implementations & libraries
ResourcesExchange definitions
Storage Community - Assistance
Community - Tooling
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Clinical Resources
General
AllergyIntolerance
Condition (Problem)
Procedure
ClinicalImpression
FamilyMemberHistory
RiskAssessment
DetectedIssue
Care Provision
CarePlan
CareTeam
Goal
ReferralRequest
ProcedureRequest
NutritionOrder
VisionPrescription
Medication & Immunization
Medication
MedicationRequest
MedicationAdministration
MedicationDispense
MedicationStatement
Immunization
ImmunizationRecommendation
Diagnostics
Observation
DiagnosticReport
ProcedureRequest
Specimen
BodySite
ImagingStudy
Sequence
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References between Resources
Patient
Diagnostic reportCondition
Subject
ReportReason
Encounter Performer
Encounter PractitionerLocation
PROCEDURE
Location
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clinFHIR: Visualizing FHIR
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Paradigms of exchange
REST
Storage
Messages Services
Documents
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Sharing resources
REST
Message
FHIR
Repository
Document
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Profiling: Defining the content
• Adapting base resources to specific Use Cases
– ’80% rule’
• Commonly
– Constrain base resource
– Add extensions
– Change ValueSets
• Machine readable ‘Conformance’ resources
• US Core, Argonaut
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A digital ecosystem
And how FHIR enables it
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A digital ecosystem is a distributed, adaptive, open
socio-technical system with properties of self-
organization, scalability and sustainability inspired
from natural ecosystems.
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Key technical components
Conformance
Registry
Terminology Provider/
Service
Registry
Record
Locator
Repository
(Db)
Decision
Support
WorkFlow Identity
FHIR API and Resources
Reporting
Example…
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Finding stuff• Locator services
– Eg Documents (IHE XDS equivalent)
– Endpoint resource
• Registries
– Patient
– Provider
• Capability Statement
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Clinical Data Repositories (CDR)• Exposed by FHIR API
– Any paradigm
– Any storage architecture
• ‘Transactional’ data
• Reconciled Lists
• Careplans
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Terminology• What is Terminology
• The value it brings
• FHIR Support
– Coded datatypes
– ValueSets
– Operations
Code System:
Defines a set of
concepts with a
coherent meaning
Code
Display
Definition
Value Set:
A selection of a
set of codes for
use in a particular
context
Resource:
Coded element
Element
Definition: Type
and Value set
referenceSelects
Refers to
Binds
Conforms
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Identifying the participants• Challenges
• Patient & Provider
• Organization
• Service
• Scheduling
• FHIR Support
Organization
Location
Healthcare
Service
Practitioner
RolePractitioner
Endpoint
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Decision Support• What is Clinical Decision Support (CDS)
• Why?
• FHIR Support
– Operations
– Definitional – including care planning
– CDS-Hooks
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Workflow
• Different Use Cases and Architectures
• FHIR Support
– Definitional
– Patterns of Use
– Operations
Draft
Active
Completed Cancelled
Suspended
Entered-in-error
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Analytics
• Population reporting
• Quality Measures
• FHIR Support
– Specific resources (Measure, MeasureReport)
– Data collection
– Data representation (different formats)
– Bulk Data Export
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Security and Privacy• Not a security standard
• ‘Physical’ security
• Privacy tag
• SMART
– OAuth2 profile
• Supporting FHIR resources
• Consent
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An example at FHIR Connectathon• Consumer Centered Data
Exchange
• Multiple Participants
– HL7
– MiHIN
– NATE
– DXC
– NewWave
– Humetrix
– Orion Health
Consumer
Data
RepositoryTerminology
Server
Consent Server
Data
Contributor
Data
Contributor
Audit
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Applying the Ecosystem
…to Thomas’ Story
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ED and Admission
Flow Components Used
Difficulty breathing
ED gather history Record Locator
Clinical Data Repository
Dx pneumonia Decision Support
Terminology
Medication List updated Clinical Data Repository
Admit for stabilization
PCP/Care co-ordinator &
daughter notified
Care Plan
Provider/service registry
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Discharge
Flow Components Used
Discharged after condition
stabilized
Continued on oral antibiotics Workflow
Medication List updated Clinical Data Repository
CarePlan updated Clinical Data Repository
Refer to PCP for follow up Provider/service registry
Workflow
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Allergic Reaction
Flow Components Used
2 days later develops a rash
Contacts Care Coordinator Provider/service registry
Diagnosis drug reaction Decision Support
Terminology
Advise stop med Clinical Data Repository
Make appointment to see PCP Provider/service registry
Workflow
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Wrapping up…
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Learning FHIR• Specification
• Blogs
• Tools
– clinFHIR
– Reference Servers
– Sample data
• Events
– HL7 training
– Connectathon
• Community
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Learnings from Connectathon
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Final thoughts• FHIR has achieved remarkable success so far
• An ecosystem way of thinking:
– Improves health data sharing
– Provides flexibility and choice
– Enables Innovation
• FHIR and related standards (SMART, CDS Hooks) underpin this.
• But: It is complicated!
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Questions
• Speaker:
• Dr David Hay
• E: david.hay@orionhealth.com
• Ln: https://www.linkedin.com/in/david-hay-423a519
• Please complete online session evaluation
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