VistA on Doug Martin, MD

CareWeb Framework Architecture Interface User Order Entry Flowsheet User Preferences SMART Plug-in Chart Search Plug-in Widgets Electronic Signature Patient Selection User Authentication SMART Adaptor Plug-in Services Layout Manager Layout Designer Framework Services Internal Services User Context Patient Context Electronic Signature SMART API Registry Plug-in Services Context Management Event Management Component Discovery Help Subsystem Theme Support Framework Services External Services Data Access Security Services Messaging Services Web Services Solr Search Engine Host Services

RMRS OpenMRS VistA/RPMS The Present Interface User Document Viewer Plug-in Widgets Patient Selection Plug-in Services Layout Manager Layout Designer Framework Services Internal Services Patient Context Plug-in Services The current state of things. Context Management Event Management Component Discovery Help Subsystem Theme Support Framework Services External Services Data Access Host Services RMRS OpenMRS VistA/RPMS

Introducing Fast Healthcare Interoperability Resources Defines a common clinical domain model Resources Normative attributes by 80% rule Remaining 20% covered via extensions Defines standard operations (API) CRUDS (create, read, update, delete, search) Resource-specific operations ($expand) RESTful interface (easy to implement) Current draft specification DSTU-2

RESTful Web Service https://acme.org/fhir/Patient/1234 https://acme.org/fhir/Patient?name="Levin, Henry"

Patient Resource <Patient xmlns="http://hl7.org/fhir"> <id value=”1234"/> <identifier> <use value="usual"/> <type> <coding> <system value="http://hl7.org/fhir/v2/0203"/> <code value="MRN"/> </coding> </type> <system value="urn:oid:2.16.840.1.113883.19.5"/> <value value="12345"/> </identifier> <name> <family value="Levin"/> <given value="Henry"/> </name> <gender value="male"/> <birthDate value="1932-09-24"/> <managingOrganization> <reference value="Organization/2.16.840.1.113883.19.5"/> <display value="Good Health Clinic"/> </managingOrganization> <active value="true"/> </Patient>

RMRS OpenMRS VistA/RPMS The Present Interface User Document Viewer Plug-in Widgets Patient Selection Plug-in Services Layout Manager Layout Designer Framework Services Internal Services Patient Context Plug-in Services Again, the current state of things. Context Management Event Management Component Discovery Help Subsystem Theme Support Framework Services External Services Data Access Host Services RMRS OpenMRS VistA/RPMS

RMRS OpenMRS VistA/RPMS The Future Interface User Document Viewer Plug-in Widgets Patient Selection Plug-in Services Layout Manager Layout Designer Framework Services Internal Services Patient Context FHIR Client Plug-in Services The ideal future state using FHIR. Context Management Event Management Component Discovery Help Subsystem Theme Support Framework Services External Services FHIR Endpoint Host Services −−−−−−−−−−−−−−−−−−−−−−−−− FHIR −−−−−−−−−−−−−−−−−−−−−−−−− RMRS OpenMRS VistA/RPMS

Clinical Abstraction Layer HAPI-FHIR client library FHIR resource model FHIR-based plugins EHR platform agnostic Truly interoperable plugins Build once, run anywhere The CAL retooled to use FHIR data model/api

VistA Serialization Framework Originally developed to serialize VistA objects to JSON via RPC broker Expanded to support multiple formats XML and JSON FHIR DSTU1 and DSTU2 Added REST interface via NETSERV via HTTP via RPC broker

Serialization Control File (#.01) NAME [F] ^ (#1) CONTENT TYPE [F] ^ (#2) SERIALIZER [F] ^ (#3) VERSION [F] (#10) RESOURCE (#.01) RESOURCE [F] ^ (#1) INTERNAL [YN] ^ (#2) SOURCE [N] (#10) CUSTOM SERIALIZER [M] ^ (#20) PREFETCH LOGIC [M] ^ (#21) POSTFETCH LOGIC [M] (#30) PROPERTY (#.01) PROPERTY [F] ^ (#1) FIELD [F] ^ (#2) TYPE [S] ^ (#3) SEQUENCE [N] (#10) CONTROL [F] (#40) PARAMETER (#.01) PARAMETER [F] ^ (#1) FIELD [F] ^ (#2) TYPE [S] ^ (#3) SEQUENCE [N] (#10) CONTROL [M] (#20) COHORT [M] (#50) TEMPLATE (#.01) TEMPLATE [F] ^ (#1) CONTENT [W] ^ (#99) DESCRIPTION [F] (#20) HEADER FIELDS [1W] (#99) DESCRIPTION [1W]

http://acme. org/DSTU2/Patient/1 http://acme. org/DSTU2/Patient http://acme.org/DSTU2/Patient/1 http://acme.org/DSTU2/Patient?family=SMITH&birthDate=>1958-12-31 NAME: DSTU2 CONTENT TYPE: application/xml+fhir,application/xml,text/xml,xml SERIALIZER: RGSEFHIX VERSION: 0.5.0 RESOURCE: Patient INTERNAL: N SOURCE: 2 (PATIENT) PROPERTY: name FIELD: .01 TYPE: CUSTOM SEQUENCE: 10 CONTROL: D NAME(VL("I")) PROPERTY: birthDate FIELD: .03 TYPE: DATE SEQUENCE: 30 CONTROL: PARAMETER: family TYPE: STRING SEQUENCE: 20 CONTROL: D OPRNAME(VL("E"),1) K PVAL COHORT: S X="$$NAMEITER^RGSERPAT"

Supported Formats CWF application/json,text/json DSTU1 application/xml+fhir,application/xml,text/xml,xml DSTU1 application/json+fhir,application/json,text/json,json DSTU2 application/xml+fhir,application/xml,text/xml,xml DSTU2 application/json+fhir,application/json,text/json,json

Questions? dkmartin@regenstrief.org http://github.com/mdgeek