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HL7 FHIR - IN PRACTICE
Kevin Mayfield19/6/2014
Background (Referral)
• Health and Social Care Bill 2012-2013, The Scottish Government
• NHS eHealth strategy - must contribute to care integration and support people with long term conditions
• Replace shared assessment system with an Interagency Portal.
• Build upon existing clinical portal
Assessment - Me
• 1996-2009 EMIS (GP Systems)– 300 baud drug ordering system– MOD 'GPtoGP' late 90’s– Defence Medical Information Capability Programme
(DMICP), live streaming of clinical resources to/from operations in Iraq and Afghanistan
• 2010- NHS & Council roles (SQL)– Community, Mental Health and Acute.– 2012 First HL7 interface
Assessment - NHS Team
• Using SCIXML and NHS Scotland Data Standards• Many bespoke interfaces and multiple integration
engines.• Minimal exposure to HL7 standards. • Steep learning curve to HL7v3 and CDA.• RESTful?• Community care focused around documents
(questionnaires/forms)
Assessment - Social Services
• 4 councils• HL7v2 capable (x1)• NHS (England) ITK and
CDA interfaces. Keen to use FHIR (x2)
• Bespoke (x1)• Organisation using a Care
Plan model (x3)• RESTful
Building The 'Care' Plan
• IHE XDS, BPPC and PIX patterns. • Mostly UML focused (seen as too technical, flow
charts preferred.) • Use cases very useful but a tendency to go for
solution early.• FHIR and RESTful/CRUD used as model for
technical discussions.• IHE and FHIR proved to be resistant to project
changes (mostly consent and alerts) and change of supplier.
Goals
• Centralised recording of patients and consent • Document sharing with central index• Portal fed data by a variety of methods,
mostly web services (HL7 FHIR preferred).
Activities/Interventions (NHS)• Document Index using FHIR DocumentReference– Documents returned from many (NHS) sources using FHIR
Binary– DocumentReference doubled up as a document
notification system.• Questionnaires and other unstructured data using
FHIR Questionnaires• Encounters, Care Plan, Orders, Appointments,
Alert/Observation and Condition resources (NHS only).
• Patient with consent extension and HL7v2 A28/31/40
Progress Notes• Naturally aligning with IHE profiles• Too many new things
– FHIR being a major step towards HL7 CDA and IHE profiles– RESTful interfaces scaled down– Standard coding (SNOMED) premature
• FHIR 80/20 rule nearly always correct• Resistance due to DSTU status
– ReferralRequest– Consent– Appointments
Review• Patient identity and consent first
– Information Governance• Too much IT focus but the information model FHIR uses, especially
the CarePlan resource, showed the way.• DocumentReference/Binary allowed the adoption of an XDS
pattern and get the metadata correct– Path to HL7 CDA?
• Questionnaires useful but need to used only when other resource not available (tended to capture the 20 in the 80/20)
• Only suitable for NHS trusts/social services with EPR systems, PAS systems could stick with HL7v2
• SCRUM worked! FHIR allows sprints
Questions?