FHIR: Progress and Future The goal of the FHIR project is to make interoperabilty an order of magnitude cheaper. Preliminary indications suggest that this might be the case. Grahame will describe existing and potential implementations and consider their likely impact on the healthcare process Why we started FHIR Approach – borrow the best ideas Ethos Timelines Purpose / Goal Adoption The hype curve The trough + clinical interoperability Grahame Grieve FHIR Product Director for HL7 May 26 2017 Sydney Copyright © HL7. Licensed under Creative Commons (CC0) FHIR® and the FHIR icon are trademarks of HL7, inc (http://hl7.org)

Status R3 published in March >2400 change proposals Implementation Experience (Trial use is working) Alignment with other standards Internal Quality Review processes Standard for Trial Use

Key Changes Added support for Clinical Decision Support and Clinical Quality Measures Broadened functionality to cover key clinical workflows Further development of Terminology Services, and support for Financial Management Defined an RDF format, and how FHIR relates to Linked Data Incremental improvements and increased maturity of the RESTful API and conformance framework

Plans for Release 4 Normative Graph retrieval Data Analytics RDF + Patterns Services Deployment FM Standard in-process development Read this slide, then explain that this because we needed a globally unique acronym, and that this works really well for implementers

Normative “Forwards Compatible” Implementations that are conformant will continue to be so This is aspirational Exact meaning: http://hl7.org/fhir/versions.html

Timeline Conceived July 2011 1st DSTU (Draft Standard for Trial Use) Feb 3rd 2014 Widespread Community Growth and Adoption 2nd DSTU Sept 23rd 2015 Substantial changes from implementer feedback Solid version for US adoption (clinical / event summary) 3rd STU Mar 23 2017 More changes (1000s) – but starting to become stable Preparing for normative next time

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, 2 Breaking changes at level 4 and 5 need community discussion

Normative FHIR For Release 4, some portions will be balloted as ‘Normative’ Platform, terminology and conformance resources 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 Time line : late 2018

Graph Retrieval GraphDefinition (http://hl7.org/fhir/graphdefinition.html) GraphQL (http://wiki.hl7.org/index.php?title=FHIR_and_GraphQL) demonstration

Data Analytics: Bulk data format Required Billions of records - efficient encoding ETL-able into MPP databases or analytic tools (Apache Drill, Impala, Presto, Spark, Hive, etc) Good array of open source tools Preferred Self-describing file format (no external schema) format is splittable (multiple threads or processes can process) Candidates: Avro – row based Parquet - Column Based

RDF + Patterns RDF: http://hl7.org/fhir/rdf.html W5: http://hl7.org/fhir/w5.html Goals Allow users to process the internal metadata and extract value Allow users to share and leverage mappings with other sources of knowledge

Services Current Terminology Service Future: Conformance Provider Registry Appointment Manager Personal Health Data Manager

Deployment Issues Move Smart-on-FHIR to be an HL7 standard http://hl7.org/fhir/smart Prepare cds-hooks for bringing to HL7 Clarify relationship with UMA/Heart

Financial Management Different development process, philosophy and architecture at play Differences to be subject of active review

Standard In-Process Development Tasks created on gForge after community discussion http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&tra cker_id=677 http://chat.fhir.org 1500 tasks processed for R3 – expect the same scale again Plans: Migration from gForge to Jira Migrate from Subversion on gForge to GitHub Build more scalable work flows as the community scales

FHIR Foundation Support community development activities Implementation Projects like Argonaut Provide infrastructure to support Community: http://*.fhir.org (support from Google) Open for membership soon Individual membership ~$250US/year Corporate membership … still planning

Certification / Credentials HL7 will offer two levels of testing Proficiency Certificate – demonstration of your knowledge of the overall specification Professional Credential – deep knowledge of the specification, qualified to advise on implementation Requires ongoing involvement/training Testing coming this year Heather will talk about education

Questions / Discussion