HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F...

HL7 FHIR Overview

Dave Shaver, HL7FCo-Chair of FHIR Governance Board andInfrastructure and Messaging Committee.

Founder and CTO Corepoint Health

Dave.Shaver@CorepointHealth.com

Thanks Lloyd et al

Portions based on “FHIR for Executives” licensed under CreativeCommons and available for download:

– http://gforge.hl7.org/gf/project/fhir

As– /trunk/presentations/2016-04 Webinars

Portions based on “FHIR for Executives” licensed under CreativeCommons and available for download:

– http://gforge.hl7.org/gf/project/fhir

As– /trunk/presentations/2016-04 Webinars

1. Survey

2. Market Context

3. Standards Context1. Technologies

2. Relationships

3. Details

4. Q&A

1. Survey

2. Market Context

3. Standards Context1. Technologies

2. Relationships

3. Details

4. Q&A

HL7 in one sentence

• “HL7 makes it easier to integrate!”

• “HL7 is a framework for negotiation”

• “When you have seen one HL7 interface you’ve seen… one”

– Wes Rishel

• "Communication and interoperability are not a science. Theyare an art form perfected over time.“

– Keith Boone(@motorcycle_guy) "On Models" (http://motorcycleguy.blogspot.com/2013/08/on-models.html)

• “HL7 makes it easier to integrate!”

• “HL7 is a framework for negotiation”

• “When you have seen one HL7 interface you’ve seen… one”

– Wes Rishel

• "Communication and interoperability are not a science. Theyare an art form perfected over time.“

– Keith Boone(@motorcycle_guy) "On Models" (http://motorcycleguy.blogspot.com/2013/08/on-models.html)

Pick Two

• Fast, Good, Cheap

• Scope, Time, Budget

• Risk, Resources, Quality

• Privacy, Accuracy, Security

• Cheap, Light, Strong

• Fast, Small, Flexible

• Cheap, Flexible, Interoperable

• Fast, Good, Cheap

• Scope, Time, Budget

• Risk, Resources, Quality

• Privacy, Accuracy, Security

• Cheap, Light, Strong

• Fast, Small, Flexible

• Cheap, Flexible, Interoperable

Dave’s Triple Constraint

• Usable– Specific department

– Across many facilities (customers)

• Flexible– Supporting many workflows

– Configurable

• Interoperable– Across departments, workflows, and care settings

– For “Free”

• Usable– Specific department

– Across many facilities (customers)

• Flexible– Supporting many workflows

– Configurable

• Interoperable– Across departments, workflows, and care settings

– For “Free”

Boiled down, HL7 is all about…

• Moving data between two applications

• Apps written by different vendors

• Vendors created the apps in a vacuum

Consequently:

• Data models differ

• Application uses differ

• Moving data between two applications

• Apps written by different vendors

• Vendors created the apps in a vacuum

Consequently:

• Data models differ

• Application uses differ

The not so rare…

SquamelCommitteeous

The not so rare…

SquamelCommitteeous

Different data models

Peanuts

Pencillin

Loss of app, rash, hives

Peanuts

Hives, Rash

Intro to FHIR

What is FHIR?

Historical Relationships to OtherStandards

Context & Examples

What is FHIR?

Context & Examples

Dave ShaverPresident & CTO

http://xkcd.com/927

Fast (to design and implement)

Health

Interoperable

Resources

Fast (to design and implement)

Health

Interoperable

Resources

• Old: Transactions sent at a point-in-time

• New: API to Source of Truth

• Old: Data only pushed by Source of Truth

• New: Consumer pulls data when needed

• What would healthcare exchange look like if we started anew?– RESTful based API

– Exemplar: Highrise (https://github.com/37signals/highrise-api)

• Old: Transactions sent at a point-in-time

• New: API to Source of Truth

• Old: Data only pushed by Source of Truth

• New: Consumer pulls data when needed

• What would healthcare exchange look like if we started anew?– RESTful based API

– Exemplar: Highrise (https://github.com/37signals/highrise-api)

http://en.wikipedia.org/wiki/Hype_cycle

Dave’s 30 second take

1. V3 RIM(ish) + RESTful +(JSON|XML)

2. Semantic rigor + implementation-focus

3. Design for the 80% yet allow forthe 100%

1. V3 RIM(ish) + RESTful +(JSON|XML)

2. Semantic rigor + implementation-focus

3. Design for the 80% yet allow forthe 100%

Dave’s Additional 90 Seconds

1. Interfaces based on a statement of capabilities

2. Data stays in the application that is source of truth

3. “API-like” query to data – pull not push

Paradigms

• FHIR supports four interoperability paradigms– REST – Lightweight, leverages web stack

– Documents – Long-term persistence

– Messages – Request/response paradigm

– Services – other SOA-based interfaces

• Regardless of approach, content stays the same– Can leverage same models, same profiles everywhere

• FHIR supports four interoperability paradigms– REST – Lightweight, leverages web stack

– Documents – Long-term persistence

– Messages – Request/response paradigm

– Services – other SOA-based interfaces

• Regardless of approach, content stays the same– Can leverage same models, same profiles everywhere

Advantages

• Based on RESTful web services– IHE profiles are based on SOAP

– Many modern applications (Twitter, Amazon, etc.) based on RESTful

• FHIR is encoded using XML or JSON

• FHIR data can be pushed or pulled

• Off-the-shelf Security– HTTPS, OAuth

• Based on RESTful web services– IHE profiles are based on SOAP

– Many modern applications (Twitter, Amazon, etc.) based on RESTful

• FHIR is encoded using XML or JSON

• FHIR data can be pushed or pulled

• Off-the-shelf Security– HTTPS, OAuth

Intro to FHIR

What is FHIR?

Context & Examples

What is FHIR?

Context & Examples

2.X2.X2.X2.X

2.5.12007

2.31997

2.42000

2.72009

2.21994

2.3.11999

2.52003

2.62008

Pre 2.11987-88

2.11990

2.82011

Vocabulary1997

USAM1999 2006 2008 2010

2.92016?

HL7 Timeline

2.8.12014

2.8.22015

Normative Editions

3.X3.X3.X3.X

2005Concept1996

Methodology1998 2007

Vocabulary1997

USAM1999 2006 2008 2010

2011 2013

FHIRFHIRFHIRFHIR

2014 DSTU2012 Conceived 2015 DSTU2

FHIR Timeline (planned)

FirstDraft

DSTU2nd

DSTU~ 1st

Norm.~ 2nd

Norm. . . .

2012 20162014 2018 20202011 20152013 2017 2019

DSTU 2.1

What does STU mean?

“…all aspects of the FHIR specificationare potentially subject to change

Maturity levels

• Intended to indicate level of stability– FMM1 – Resource is “done”, no build warnings

– FMM2 – Tested at approved Connectathon

– FMM3 – Passes QA, has passed ballot

– FMM4* – Tested across scope, published, prototype implementation

– FMM5* – 5 distinct production implementations, multiple countries

• Non-compatible changes at level 4 and 5will face increased hurdles

• Intended to indicate level of stability– FMM1 – Resource is “done”, no build warnings

– FMM2 – Tested at approved Connectathon

– FMM3 – Passes QA, has passed ballot

– FMM4* – Tested across scope, published, prototype implementation

– FMM5* – 5 distinct production implementations, multiple countries

• Non-compatible changes at level 4 and 5will face increased hurdles

Normative FHIR

• Will include– Core specification– Structural resources– Subset of other resources

• Some resources won’t go normative right away

• Future releases– Add more resources– Add profiles on existing resources– May add elements to resources

• Very rare

• Will include– Core specification– Structural resources– Subset of other resources

• Some resources won’t go normative right away

• Future releases– Add more resources– Add profiles on existing resources– May add elements to resources

• Very rare

Migration

• No expectation that people will migrate existing interfaces –any time soon if ever

• Initial adopters will be green-field, new technology

• FHIR may see use behind the scenes in v2 systems before it seesuse over the wire

• Forthcoming policy initiatives may necessitate revisiting existinginterfaces

• No expectation that people will migrate existing interfaces –any time soon if ever

• Initial adopters will be green-field, new technology

• FHIR may see use behind the scenes in v2 systems before it seesuse over the wire

• Forthcoming policy initiatives may necessitate revisiting existinginterfaces

“In the wild” HL7 Interfaces

2.52.6

FHIR 2.1

2.52.6

Message Data and Message DeliveryRepository

Point InTime CCR

Snippet Documents

Real TimeHL7 v2

Summary

Data Depth and Finality

FHIRMsgs

Pulled FHIR

Changing Health IT Landscape

Why vendors care

1.Regulations2.Customers1.Regulations2.Customers

Metcalfe’s Law

Network Value = (number of users)2Network Value = (number of users)2

Value = 22 = 4

Value = 52 = 25

Value = 122 = 144

Dave’s Corollary to Metcalfe’s Law

• The value of a healthcare standard toa new user is driven by number ofprior adopters.

• Few prior adopters = little value

• The value of a healthcare standard toa new user is driven by number ofprior adopters.

• Few prior adopters = little value

Intro to FHIR

What is FHIR?

Context & Examples

What is FHIR?

Context & Examples

Export

HL7 2.X Connectivity

Import

Export

LISImport Export

Import

AceLISI

AceDietaryI

SpringfieldEMR

Hospital – Point-to-Point

AcmeHIS

AceRISI

AceDietaryI

AceHHIE

Hospital – Engine

AceLISI

AceDietaryI

SpringfieldEMR

CorepointIntegration

Engine

AcmeHIS

AceRISI

AceHHI

AceRxI

Engine

Community: Dream

AceLISI

SpringfieldEMR

St Luke’s Hospital

Elsewhere Health System

St Francis’ Hospital

AcmeHIS

AceRISI

AceDietaryI

AceHHI

AceRxI

SpringfieldEMR

Engine

Community: Reality

St Luke’s Hospital

Elsewhere Health System

West Clinic

Metro Radiology

St John’s HospitalI

St Francis’ Hospital

AcmeHIS

AceLISI

AceRISI

AceDietI

AceHHI

AceRxI

SpringfieldEMR

ECorepointIntegration

Engine

Mobile App – FHIR Connectivity backboneLeveraging a standard in a proprietary manner

BloodCollection

HIS LIS

Real World: HL7 2.X + FHIR IntegrationMultiple sources of truth

BloodCollection

HIS LIS

FHIRFHIR

Mobile App – FHIR IntegrationMultiple sources of truth

ReferringPhysicianPortal

PathologyFHIR

HIS LIS

FHIRFHIR

BedsideCart

FHIR-to-HL7 V2 ORU

AceLISI

AceDietaryI

SpringfieldEMR

AcmeHIS

AceRISI

AceHHI

AceRxI

Corepoint IntegrationEngine

FHIR-to-FHIR

AceLIS

AceDietaryI

Coastal EMR I

FHIRFHIR

AcmeHIS

AceRISI

AceHHI

AceRxI

Corepoint IntegrationEngine

Context: Standard

FHIR Manifesto

• Focus on Implementers

• Target support for common scenarios

• Leverage cross-industry web technologies

• Require human readability as base level of interoperability

• Make content freely available

• Support multiple paradigms & architectures

• Demonstrate best practice governance

• Focus on Implementers

• Target support for common scenarios

• Leverage cross-industry web technologies

• Require human readability as base level of interoperability

• Make content freely available

• Support multiple paradigms & architectures

• Demonstrate best practice governance

Support for Common Scenarios

Content inspecificationBased on 80% rule

Include only data elements that 80% of normalimplementations will likely use

Remaining 20% of content can be included inextensions

ResourcesData elements used inthe common scenarios

Goal: Simple to use and understand

Example: HL7 2.X AD Data type as of 2.3.1

Example: HL7 2.XXAD Data type as

of 2.8.2

Example: HL7 2.XXAD Data type as

of 2.8.2

Example – ISO AD type

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (GTS – no room onthe slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physical, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic

• 0..* parts, each with:– value, code, code system, code system name, code system version,

language, type:• address line, additional locator, unit identifier, unit designator, delivery address

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipality, delimiter, post box, precinct, state or province,postal code, delivery point identifier

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (GTS – no room onthe slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physical, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic

• 0..* parts, each with:– value, code, code system, code system name, code system version,

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipality, delimiter, post box, precinct, state or province,postal code, delivery point identifier

Example – FHIR Address

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (low, high) (GTS –no room on the slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physicalvisit, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic, old

• 0..* parts, each with:text– value, code, code system, code system name, code system version,

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipalitycity, delimiter, post box, precinct,state or province, postalCode, delivery point identifier

• isNotOrdered, updateMode, flavorId, nullFlavor, controlAct root &extension, validTime low and high, useable period (low, high) (GTS –no room on the slide), use

– home, primary home, vacation home, workplace, direct, public, bad,physicalvisit, postal, temporary, alphabetic, ideographic, syllabic, search,soundex, phonetic, old

• 0..* parts, each with:text– value, code, code system, code system name, code system version,

line, delivery installation type, delivery installation area, delivery installationqualifier, delivery mode, delivery mode identifier, street address line, buildingnumber, building number numeric, building number suffix, street name, streetname base, street type, direction, intersection, care of, census tract, country,county or parish, municipalitycity, delimiter, post box, precinct,state or province, postalCode, delivery point identifier

Example: HL7 FHIR DSTU 2 Address Datatype

FHIR & Cost of Integration

• Cost Factors:– Easier to Develop

– Easier to Troubleshoot

– Easier to Leverage in production

– More people to do the work

• Competing approaches must match the cost ordisappear – already being felt

• Cost Factors:– Easier to Develop

– Easier to Troubleshoot

– Easier to Leverage in production

– More people to do the work

• Competing approaches must match the cost ordisappear – already being felt

Long term: 100-150 Resources

Examples

• Administrative– Patient, Practitioner,

Organization, Location,Coverage, Invoice

• Clinical Concepts– Allergy, Condition, Family

History, Care Plan

• Infrastructure– Document, Message, Profile,

Conformance

Non-examples

• Gender– Too small

• Electronic Health Record– Too big

• Blood Pressure– Too specific

• Intervention– Too broad

• Administrative– Patient, Practitioner,

Organization, Location,Coverage, Invoice

• Clinical Concepts– Allergy, Condition, Family

History, Care Plan

• Infrastructure– Document, Message, Profile,

Conformance

• Gender– Too small

• Electronic Health Record– Too big

• Blood Pressure– Too specific

• Intervention– Too broad

STU 2 Resource List

Human ReadableSummary

Extension with referenceto its definition

Identity & Metadata

Standard DataContent: MRN Name Gender Date of Birth Provider

Resource Definitions

Bonus Topics

HL7 FHIR Overview - Health Level Seven International · HL7 FHIR Overview Dave Shaver, HL7F...

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