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connecting the world for better health
2
Global Goods FHIR
Discussion
July 2019
Agenda
• Digital Square Announcements – Amanda BenDor, Digital Square
• Introduction of Speakers – Amanda BenDor, Digital Square
• Overview of FHIR – James Agnew, Smile CDR
• Global Goods applying FHIR for data exchange
• OpenIMIS – Uwe Wahser, GIZ
• OpenMRS – Kamil Madej, Soldevelo
• OpenLMIS – Josh Zamor, Village Reach
• OpenCRVS – Ryan Crichton, Jembi Health Systems
• FHIR Discussion – facilitated by Carl Fourie, Digital Square
3
Announcements
Digital Square Announcements
• Notice D Update
• Digital Square RFI on Digital Financial
Services
• Upcoming Digital Square Webinars:• August Global Good Community Manager Discussion
• September Global Good Webinar – WHO Accelerator
Toolkits Overview
5
Digital Square Announcements Continued
• Guidebook updates• Please use the Global Goods
Guidebook Feedback Smartsheet
to provide updated information on
your global good entry and
general feedback.
• We’ll confirm receipt and follow
up with you by November 4,
2019.
6
Speakers
Introduction to Webinar Presenters
• James Agnew
• Kamil Madej
8
• Uwe Wahser
• Josh Zamor
• Ryan Crichton
Presentations
FHIRThe Emerging Global Standard for Data
Exchange and Community Building
Jul 2019 - http://bit.ly/2M7m4Zs
SMAR
TFHIR
FHIR
Fast Healthcare
Interoperability Resources
HL7 FHIR
What is FHIR?
● A set of data models for healthcare
● A set of API specifications for exchanging those data
models
● A set of tools and servers to building and interacting with
those APIs
● A global community
HL7 FHIR: The Data Models
Designed with Humans in Mind
Easy to navigate
Easy to read
FHIR != Top-Down Specs.
FHIR == Bottom-Up
Community.
Connectathon Event - US
Connectathon Event - Vietnam
SMART
SMART
SMART: OAuth2
http://apps.
smarthealthit.
org
This is only the beginning...
openIMIS Interoperabilitythrough HL7 FHIR Standards
Uwe Wahser, PATH FHIR Webinar
25.07.2019
openIMIS Playground
25
Beneficiaries
Provider
Payer
25.07.2019Uwe Wahser: openIMIS Interoperability
UHC
USP
From MS IMIS to openIMIS
26
2012
IMIS for Tanzania CHFby SwissTPH,
Exact Software,MicroInsuranceAcademie 2014
IMIS Customization
for Nepal
2013
IMIS Customization for Cameroon
2016
openIMISInitiative
(SDC & GDC)
2018
openIMISCommunity
2017
openIMISMaster Version
(TZ+CM+NP)
2019
Modular Architecture
Transformation
25.07.2019Uwe Wahser: openIMIS Interoperability
openIMIS
Modular Transformation (current)
27
Web User Interface
Business Logic
Data Access Layer
Data Base
monolithic
openIMIS
Web User Interface
Business Logic
Data Access
Data Base
modular
Claims
WUI
Claims
DB
DA
Mz
25.07.2019Uwe Wahser: openIMIS Interoperability
Claims
MS IMIS
Slow Transition (Roadmap)
28
Framework openIMIS
Claiming
Module X
Module Y
Indicator Dashboard
April 2019 October 2019 April 2020
25.07.2019Uwe Wahser: openIMIS Interoperability
Releases:
(Fraud Detection - AI)
BAHMNI
Integrating into OpenHIE
25.07.2019Uwe Wahser: openIMIS Interoperability
29
openIMIS
Odoo
OpenHIM
DHIS2
OpenMRS
OpenELIS
BlueSquare
SolDevelo
Possible Health
HISP India
OpenMRS
Vision: Integrated Workflows (Example: Claiming)
30
Insurance Mgmt
Insurance Adjudication
openIMIS
FHIR Data Store:Hearth
Interop Layer: OpenHIM
2
EMR:OpenMRS
1
3
Client Registry: Medic CR
5
25.07.2019Uwe Wahser: openIMIS Interoperability
Source: Carl Leitner @ AEHIN Conference 2018
API Design
25.07.2019Uwe Wahser: openIMIS Interoperability
31
Digital Development Principles:Use Open Standards
openIMISRESTful APIs1 - Legacy System 3 - Implementers
2 - Standards
• Existing Data• Existing API
• Notice C calls• Business needs
• FHIR STU 3 (v3.0.0)
• Joint Learning Network (JLN)
Standard: Joint Learning Network (2012)
25.07.2019Uwe Wahser: openIMIS Interoperability
32
Working Group from 10 Countries:• Requirements Analysis• Glossary• Process Map
Documents:Original report @ JLNWorkspace @ OpenIMIS Wiki
Wordings for Module:• JLN: Process Groups with Business Processes• Developers: openIMIS Plugins
Update Workshop:• Kathmandu, June 2019
Join our Discussions
• Getting started …
• Weekly Meetings
• Monthly Gumzo (next Monday)
• Some channels – Ways to contribute
25.07.2019Uwe Wahser: openIMIS Interoperability
33
SolDevelo FHIR work
● OpenMRS Sync 2.0 module - synchronization between different OpenMRS
instances via FHIR API
● OpenIMIS FHIR module - separate module for new OpenIMIS version
which exposes data via FHIR API
● OpenMRS FHIR module - module converting and exposing OpenMRS API.
It is used in Sync 2.0 and will be used in OpenMRS Claim module which will
be connected with OpenIMIS
openIMIS -Business Logic
(relational DB)
FHIR Data Store(multiple choices of data store,
relational + document)
DHIS2
OpenMRS
Bahmni
openIMIS FHIR
API
openIMIS
FHIR
module
OpenMRS instance
OpenMRS instance
Sync 2.0 module -
synchronization via FHIR API
OpenMRS
FHIR module starter pack
● At the start of FHIR implementation, it would be great to always have a
person with really good domain knowledge.
● Prepare mapping documentation accepted by product community
● Communication with the community is very important.
● Adding resource one by one
● Acceptance tests after added resource
● It would be great to create FHIR module implementation process
● FHIR documentation - https://www.hl7.org/fhir
Challenges
● Lack of project model knowledge.
● Choosing FHIR version
● CDA to FHIR converters not easy to use
● FHIR extensions - we do not use it. Problem with FHIR compatibility
● FHIR module performance. Converting data without FHIR database.
● Python vs Java. It is much easier to write FHIR module in Java.
OpenLMIS and FHIR
Master Data Alignment Interoperability with the HL7®
FHIR® standard
JOSH ZAMOR • July 25, 2019
Interoperability - A Source of Truth
• Source of Truth
– A Registry in HIE
– A peer system
– Self, OpenLMIS (an OpenLMIS Service)
• Derived Data & Enrichment
– Derived data is when I hold data for which another system is
the source of truth for that data.
– I may enrich that data with more data by adding to and linking
other data to.
– It’s very rare that we need to change a source of truth - most
data is derived, enriched, and published.
40
Interoperability - Wider lens
● Launch OpenLMIS we consider:
○ Is it by itself
○ Does a Registry exist
○ Does another system exist, is it a source of truth
Above all else we need to agree on the basics: there is a facility.
We don’t “sync” data. We see data as published, we can enrich it,
and optionally re-publish it.
Data provenance should be clear. Versioning and unique URI’s go a
long way.
41
Interoperability - Locations
• Locations– Place stock is stored, supplied/received by
– Needs to link to GS1 Global Location Number (GLN)
– Enriched with supply-chain information
42
FHIR
Location Facility
Create from
Supply Hierarchy
Supplied from
OpenLMIS
Enrichment
FHIR
Location
Interoperability – CCE Inventory
• Cold Chain Equipment (CCE) Inventory
– Refrigerators, Freezers, cold boxes, etc
– FHIR Device.location captures CCE installed (inventory) at a Location
43
L
CCE CCE
L
CCE CCE
Alert
OpenLMIS ColdTraceSource of Truth:
Locations and CCE Inventory
Interoperability – DHIS2
44
● FHIR Measure defines a Metric or Indicator
● FHIR MeasureReport is a published set of metrics or indicators for a Location
● Measure and Location can store additional identifiers to aid in mapping data between systems
and establishing meaning.
Next Steps
• Support:
– FHIR Website: http://hl7.org/fhir/
– OpenLMIS API docs: http://docs.openlmis.org
• Areas to improve:
– Need an administrative area concept, support hierarchy and shapes.
– Communicate Program through MeasureReport.
– Better on-boarding for concepts such as sources of truth, derived
data, enrichment and publishing. Communicate the big picture to
avoid mistakes.
– FHIR support for supply chain concepts (e.g. Inventory and
Consumption), which work with existing efforts (e.g. GS1)
– Product Master Data: New tool to assist in the works:
https://gitlab.com/pcmt/pcmt/wikis/home to which standards work
should apply.
45
FHIR in action.
How FHIR is used in OpenCRVS and other projects at Jembi
OpenCRVS.- Why FHIR?
1. OpenCRVS is a civil registration tool supporting birth and death - in
future marriage, divorce and adoption
2. Closely tied with health events - birth and death
3. Therefore, need to interoperate with health systems as they will often
be first know about the event
4. FHIR gave us an easy way to interoperate with health systems and a
data model on which to base our application
OpenCRVS exposes a FHIR
based API and uses a FHIR based
data store for primary data
storage.
From the web-based UI we
choose to use GraphQL to
communicate with a gateway that
transforms the request to FHIR.
This is because it is much easier
to use GraphQL in the browser as
it allows you to fetch all data in a
single request and it solves some
performance issues where we
have to resolve multiple
references in FHIR.
Hearth
OpenCRVS API +
micro services
3rd party
Health
systems
OpenCRVS
UI
GraphQL
gateway
FHIR
FHIR
GraphQL request
Other uses of FHIR
1. Jembi is using FHIR in a number of other places, example include:
a. A perioperative questionnaire tool for anesthetists
b. In general interoperability work, even when other system don’t
speak FHIR it provides a good canonical language to use
c. As our go-to standard when setting up HIE registries as it
provides a base level of interoperability in an easy to use format
for developers
1. You still need to profile FHIR to be
truly interoperable, we need some
common profiles for LMIC
2. Better tooling/libraries for
developing FHIR clients
3. Continued support and investment
into existing tools, everyone is still
catching up
4. Standardization and adoption of
supporting technologies - e.g. an
auth strategy
1. Easy for developers to pickup
2. Provides a canonical format to use
3. Easy to use from any application
type
4. Mostly good documentation
5. Becoming a defacto standard
The good. The bad.
Discussion
Discussion
• What are examples of other use cases in the
community?
• What are the challenges?
• How do we as a community address gaps?
• What kinds of support or engagement on FHIR
would you like to see at upcoming events such as the
OpenHIE meeting in November?
• How can Digital Square support you in harnessing
FHIR for data exchange?53
digitalsquare@path.org
connecting the world
for better health
www.digitalsquare.org
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