Clinician-on- Stephen Chu September 2016

Agenda

– What is it? FHIR = Fast Healthcare Interoperable Resources It is a set of [evolving] standards to support exchanging healthcare information electronically Fast = Fast to design/develop (80/20 rule) Fast to implement Fast to learn Light weight: compared to HL7 v3

Why ? Healthcare has been using Health Level 7 (HL7) standards (information exchange protocol) to exchange health information electronically for a long time: HL7 version 2.0 was published in 1992 HL7 version 3 was released in 2005 with the goal to replace HL7 v2.x family of standards Problems/Issues HL7 v2.x: old, and limited by their (comparatively) simplicity and rules HL7 v3: too complex, too hard, too slow Need light-weight interoperability standards capable of supporting information exchange and sharing for Healthcare 2.0+

Interoperability complexity Snomed + HL7 V3 Snomed + openEHR WS Difficulty (log) CDA XML The challenge: How? HL7 v2 Need light-weight interoperability standards of sufficient semantic depth HTTP / HTML Text Semantic Depth

What can offer? The FHIR interoperability paradigms REST Documents Messages Services Exchange Conformance Structure Meaning Resources FHIR Administrative Resources Clinical Resources Foundation Resources

Resources

Resources

The US Argonaut project: A project set up to rapidly http://searchhealthit.techtarget.com/video/FHIR-gaining-support-as-interoperability-standard The US Argonaut project:  A project set up to rapidly develop a first-generation FHIR-based API and Core Data Services specification to enable expanded information sharing using FHIR resources As of May 2016, there are 89 Argonaut project sponsors and testing community members, examples: Accenture Allscripts Cerner Epic US DoD/VA, Mayo GE Orion Health, etc http://argonautwiki.hl7.org/index.php?title=Main_Page/Implementation

Can provide the answer? FHIR asserted benefits: Light weight Fast to develop and implement (80/20) Fast to learn “Interoperable” Key Questions: Sufficient semantic depth? Truly interoperable?

The Challenges Key FHIR development philosophies: Fast to develop Fast to learn Fast to implement Design by developers for developers Weak clinical governance Clinical usability and quality issues

– quality/usability issue examples (September 2016 ballot comment examples)

– quality/usability issue examples

– quality/usability issue examples

– quality/usability issue examples

Clinician-on- Established by HL7 Patient Care Work Group clinician leaders to implement clinical governance and assurance over FHIR resources development Objectives: To improve clinical usability and quality of FHIR resources through clinical review and quality assurance processes To provide clinicians with opportunities to learn about FHIR resources and to develop and test clinical requirements driven FHIR extensions/profiles http://wiki.hl7.org/index.php?title=Clinicians_on_FHIR

Clinician-on- Clinician-on-FHIR activities International Workgroup meetings Clinician-on-FHIR events – 3 times/year September 2016 – six test tracks Care plan, Medication, Family history, allergy & Intolerance, Diagnostic request & report, clinical documentation using publicly available tool: clinFHIR Weekly Patient Care WG – FHIR resources review and QA conference calls (clinicians led, but not limited to clinicians) FHIR clinical design http://wiki.hl7.org/index.php?title=Clinician_on_FHIR_-_September_Baltimore http://clinfhir.com/

tool for clinicians: clinFHIR http://clinfhir.com/ What clinFHIR is not Not a FHIR resource designer

tool for clinicians: clinFHIR http://clinfhir.com/ What clinFHIR can be used for? Create FHIR resource instances from Base FHIR resources FHIR resource profiles/extensions Unable to handle complex extensions (yet) Retrieve, review, and edit FHIR resource data

clinFHIR – Getting Started screen Click here to dismiss “getting started” screen to continue

clinFHIR – select or add new patient Step 1 – select a FHIR server Step 2 – search for or add new patient

clinFHIR – select or add new patient