© 2013 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Introduction to FHIR Grahame Grieve March 25, 2015

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Today / Tomorrow Versions for today/tomorrow:  FHIR is a rolling target right now (>100 commits/day)  Server:  Stable version of spec:  HAPI: .Net RI: 2

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. WHAT IS FHIR?

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Answer: An instigator of bad puns FHIR is the hottest thing since... This spec is spreading like... Committee X is really on FHIR Feel free to come up with your own  (but please, not here ) 4

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The acronym F – Fast (to design & to implement)  Relative – No technology can make integration as fast as we’d like H – Health  That’s why we’re here I – Interoperable  Ditto R – Resources  Building blocks – more on these to follow 5

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Adoption FHIR is a draft standard  A ‘beta’ standard  subject to ongoing change In spite of this, it is being adopted quickly  Cited in US MU3 regulations (implicitly)  Argonaut / HSPC projects – large US vendors  National EHRs going live this year 6

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Introduction Enables information exchange to support the provision of healthcare Standard industry RESTful practices  But more than just REST Scope of FHIR is broad  human and veterinary  clinical care, public health, clinical trials  administration and financial aspects

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Framework Common features of all resources: A URL that identifies it Common metadata A human-readable XHTML summary A set of defined common data elements An extensibility framework Represented as either XML or JSON 8

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Human Readable Summary Standard Data Content:  MRN  Name  Gender  Date of Birth  Provider Extension with reference to its definition Identity & Metadata

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resources Each resource consists of: resourceType id : The id of the resource Meta : Common use/context data text : XHTML - human readable Extensions : extensibility framework data - data elements for each resource type 10

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Create = POST Read = GET Update = PUT Delete = DELETE Search = GET parameters... History = GET Transaction = POST (POST a tranasction bundle to the system) Operation = GET 11

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Creating a resource POST {some base path}/Patient HTTP/1.1 Authorization: Bearer 37CC0B0E-C15B AC1-D83DCED2B2F9 Accept: application/json+fhir Content-Type: application/json+fhir Content-Length: 1198 { "resourceType": "Patient",... } 12

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Server Response HTTP/ Created Content-Length: 161 Content-Type: application/json+fhir Date: Mon, 18 Aug :43:30 GMT ETag: "1" Location: { "resourceType": "OperationOutcome", "text": { "status": "generated", "div": " The operation was successful " } 13

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Server Failure HTTP/ Unprocessable Entity Content-Length: 161 Content-Type: application/json+fhir Date: Mon, 18 Aug :43:30 GMT { "resourceType": "OperationOutcome", "text": { "status": "generated", "div": " MRN conflict - the MRN is already assigned to a different patient " }, } 14

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Reading a Resource GET /Patient/347?_format=xml HTTP/1.1 Host: example.com Accept: application/xml+fhir Cache-Control: no-cache 15

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Read response HTTP/ OK Content-Length: 729 Content-Type: application/xml+fhir Last-Modified: Sun, 17 Aug :43:30 GMT ETag: "1" 16

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Search Request GET GET [base]/MedicationPrescription?patient=347 17

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. { "resourceType": "Bundle", "id" : "eceb4882-5c7e-4ca4-af62-995dfb8cef01" "meta" : { "lastUpdated" : " T15:43:30Z" }, "type" : "searchSet", "base": " "total": "3", "link": [ { "relation" : "next", "url" : " &searchId=ff15fd40-ff71-4b48-b366-09c706bed9d0&page=2" }, { "relation" : "self", "url" : " " } ], "entry": [ { "resource" : { "resourceType": "MedicationPrescription", "id" : "3123", "meta" : { "versionId" : "1", "lastUpdated" : " T05:31:17Z" },... content of resource... },... 2 additional resources.... ] } 18

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. "entry": [ { "resource" : { "resourceType": "MedicationPrescription", "id" : "3123", "meta" : { "versionId" : "1", "lastUpdated" : " T05:31:17Z" },... content of resource... },... 2 additional resources.... ] } 19

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Update Request PUT /Patient/347 HTTP/1.1 Host: example.com Content-Type: application/json+fhir Content-Length: 1435 Accept: application/json+fhir { "resourceType": "Patient", "id" : "347", "meta" : { "versionId" : "1", "lastUpdated" : " T01:43:30Z" } 20

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Update Response HTTP/ OK Content-Length: 161 Content-Type: application/json+fhir Date: Mon, 18 Aug :43:30 GMT ETag: "2" { "resourceType": "OperationOutcome", "text": { "status": "generated", "div": " The operation was successful " } 21

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Base Resource { "resourceType" : "X", "id" : "12", "meta" : { "versionId" : "12", "lastUpdated" : " T01:43:30Z", "profile" : [" "security" : [{ "system" : " "code" : "EMP" }], "tag" : [{ "system" : " "code" : "needs-review" }] }, "implicitRules" : " "language" : "X" } 22

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR RESOURCES

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resources “Resources” are:  Small logically discrete units of exchange  Defined behaviour and meaning  Known identity / location  Smallest unit of transaction  “of interest” to healthcare  V2: Sort of like Segments  V3: Sort of like CMETs 24

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. What’s a Resource? 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 total

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. DSTU Resource List

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Human Readable Summary Standard Data Content:  MRN  Name  Gender  Date of Birth  Provider Extension with reference to its definition Identity & Metadata

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Documentation For each Resource: Scope and Usage Notes Resource Content (UML and XML) Terminology Bindings Constraints Implementation Issues Search Parameters Examples, Profiles, Formal Definitions Mappings to RIM, CDA, v2, etc 28

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Definitions

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Definitions

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Definitions

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Resource Definitions 32

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example Resource Definitions 33

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Web of resources Lab Report Related Person Patient Practitioner Location

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. References Resources are independent – don’t need to other resources to correctly interpret a resource But resources reference each other extensively to form a web of information Need to resolve references to fully understand the data Reference is relative to server base URL …

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Rules for references References can be relative or absolute References don’t have to be to the same server Server does not have to enforce integrity Clients need to cater for broken links Targets can be ‘contained’ in the resource:

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Narrative All resources carry an html representation of their content It’s a clinical safety issue  The receiver has a fall back option if the system is not sure it fully understands the content It is not mandatory, but SHOULD be present In a closed eco-system, with extremely tight control and strong conformance testing, it may not be necessary  But things often change over time  So using narrative is highly recommended  Saves a lot of money downstream from the author

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Narrative XHTML Narrative is XHTML. Formatting allowed:  Tables, lists, divs, spans  Bold, Italics, styles etc  E.g. all static content Features not allowed:  Objects, scripts, forms – any active content  Links, Stylesheets, iframes – web context  Local storage, Microdata (no active content) Concerns are security and clinical safety

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR EXTENSIONS 39

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Problems we face No central authorities Permutation of biological and sociological complexity Fractal use cases Economics favours balkinization Externalizing complexity Much confusion about the problem 40

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

Sources of Complexity Inherent in problem & description business variability between instances incompetence / inappropriate solutions

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Complexity Model Difficulty (log) Semantic Depth HTTP / HTML XML WS HL7 v2 Snomed CDA HL7 V3 open EHR How? Text

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Three Laws of Interoperability 1. Interoperability: It’s all about the people 2. You can hide the complexity, or make it worse, but you can’t make it go away 3. Cheap, flexible, and interoperable: when developing healthcare software, you can have two of these

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The Case for Extensions Extensions are a problem Engineering – not handled by CASE Poorly described and carelessly done W3C rules: must interoperate without extensions This is not possible in healthcare Choice – design for absolutely everything or allow extensions

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Extensions FHIR has a standard extension framework Every FHIR element can be extended Every extension has:  Reference to a computable definition  Value – from a set of known types Every system can read, write, store and exchange all legal extensions All extensions are valid by schema etc.

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. No pain… Extensions are built into the wire format & handled by CASE tools All conformant systems can “handle” any possible extension - Just a bucket of “other stuff” Extensions rendered in human readable portion

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Governing Extensions Extensions are not a silver bullet FHIR has a sliding scale governance for extensions  Local Projects  Domain standards (e.g. Best Practice Cardiology)  National Standards (e.g. Standard Finnish Extensions)  HL7 published extensions (corner cases with international scope)

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. What’s the goal here? In most areas of healthcare standards, there is wide variability  Between systems, countries, institutions, clinicians Choices:  Specification only supports core – no one can use it  Specification adds everything – no one understands it  Specification picks winners – only they can use it  Allow extensions that people can use Extensions tame the specification

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Example Extension Eye Colour to patient resource: Need to pick a URL Need to choose a type Have to declare and publish the extension (at the URL) …

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Publishing an Extension FieldValue ContextThe patient resource NameEye Colour DefinitionEye Colour as chosen by clerical staff based on visual inspection RequirementsRefer to policy 23B section A Cardinality0..1 TypeString BindingCodes: blue, brown, green, mixed, violet Modifierfalse Constraints Mappings.

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. PROFILES & CONFORMANCE 55

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Conformance Resources Conformance – a state of system capabilities Profile – a set of rules about a resource is used Value set – describes a set of codes that can be used for something

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Conformance There’s a resource for documenting conformance to FHIR Can be used for:  Stating how a specific system instance behaves  Defining how a software system is capable of behaving (including configuration options)  Identifying a desired set of behavior (e.g. RFP) To declare themselves “FHIR Conformant”, a system must publish a Conformance instance 57

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. StructureDefinition Document how a resource structure  What is has in it  How it’s used Aka Profile, Template, Clinical Model Defined as a resource (defines itself) Provided as part of the spec 58

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 59 Profile (cont’d)

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Using Profiles You can just go ahead and use a resource  No need for a profile But you can write a profile  Document your usage in detail for partners You can mark a resource with a profile  It’s just a claim – can test conformance with that  Denormalization for performance 60

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Value sets A list of codes  Define your own, include codes from other code system (e.g. LOINC) Used to define conformance rules, UI functionality, system capabilities Functional service built around this

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Vocabulary 62 Support for coded data of varying complexity Some codes defined as part of resource, others referenced from external vocabularies  LOINC, SNOMED, UCUM, etc. Recognition some will differ by implementation space Can use Value Set resource to define more complex code lists

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR PRINCIPLES 63

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 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

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Implementer Focus Specification is written for one target audience: implementers  Rationale, modeling approaches, etc. kept elsewhere Multiple reference implementations from day 1 Publicly available test servers Starter APIs published with spec  C#, Java, Pascal, ObjectiveC – more to come Connectathons to verify specification approaches Instances you can read and understand Lots of examples (and they’re valid too) 65 using HL7.Fhir.Instance.Model; using HL7.Fhir.Instance.Parsers; using HL7.Fhir.Instance.Support; XmlReader xr = XmlReader.Create( new StreamRead IFhirReader r = new XmlFhirReader // JsonTextReader jr = new JsonTe // new StreamRead // IFhirReader r = new JsonFhirRe ErrorList errors = new ErrorList( LabReport rep = (LabReport)Resour Assert.IsTrue(errors.Count() == 0

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Support “Common” Scenarios Focus on scenarios implementers ask for Inclusion of content in core specification is based on core content rule  “We only include data elements if we are confident that most normal implementations using that resource will make use of the element”  Other content in extensions (more on this later)  Easy to say, governance challenge to achieve Resources are simple and easy to understand and use 66

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Web technologies Instances shared using XML & JSON Web calls work the same way they do for Facebook & Twitter Rely on HTTPS, OAuth, etc. for security functions 67

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Human Readable Clinical Documents has both narrative and data The data / narrative dynamic exists throughout the process In FHIR, every resource is required to have a human-readable expression  Can be direct rendering or human entered 68

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Freely available Unencumbered – free for use, no membership required 69

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. FHIR & Cost of Integration These factors will drive down the cost of integration and interoperability  Easier to Develop  Easier to Troubleshoot  Easier to Leverage in production  More people to do the work (less expensive consultants) Competing approaches will have to match the cost, or disappear – effect is already being felt

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Future impact of FHIR Impact of FHIR on the market:  Drive interoperability prices down  Higher Expectations  Increased spend on integration (N x 2!) Overall Market focus  PHR on the web  Healthcare repositories (MHD+)  Device Data management  Retooling existing connections 71

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. IMPLEMENTING FHIR

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Documents Similar to CDA Collection of resources bound together  Root is a “Composition” resource  Just like CDA header Sent as a bundle One context Can be signed, authenticated, etc. 73 Documents

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Messages Similar to v2 and v3 messaging Also a collection of resources as a bundle Allows request/response behavior with bundles for both request and response Event-driven  E.g. Send lab order, get back result Can be asynchronous 74 Messages

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Service Oriented Architecture (SOA) Do whatever you like  (based on SOA principles)  Ultra complex workflows  Ultra simple workflows  Individual resources or collections  Use HTTP or use something else  Only constraint is that you’re passing around FHIR resources in some shape or manner 75 Services

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Paradigms Regardless of paradigm the content is the same This means it’s straight-forward to share content across paradigms  E.g. Receive a lab result in a message. Package it in a discharge summary document It also means constraints can be shared across paradigms  E.g. Define a profile for Blood Pressure and use it on resources in messages, documents, REST and services 76

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Where can FHIR be used? Classic in-institution interoperability Back-end e-business systems (e.g. financial) Regional Health Information Organizations (RHIO) National EHR systems Social Web (Health) Mobile Applications 77 Near Term

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Architecture Standalone FHIR Server A FHIR Server in front of an existing application (e.g. SQL)  FHIR as front end to an XDS server (“MHD”) An interface engine that ‘speaks’ FHIR A tablet/mobile phone application Web portal uses FHIR to access other systems A healthcare application that access information from multiple systems as well as it’s own server Smart-On-FHIR – an EHR plug-in framework 78

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Implementation Assistance Reference Implementations – object models, parsers, serializers, clients, validators, utilities Schema, Schematron, Validation Pack 1000’s of examples Live Servers to test against  e_FHIR_Servers_for_testing e_FHIR_Servers_for_testing Connectathons 79

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Servers Use the servers to explore how it works Write clients that use the test data Test that you got your own system right Most developers:  use the servers to learn  consult the documentation occasionally  I do recommend to read the specification a little 80

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Other Free software See ce_FHIR_implementations ce_FHIR_implementations Coming shortly:  “Sprinkler” – a conformance test tool for servers  “Forge” – an editor for conformance statements  A Value set Editor  Several implementation guide publishers 81

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Connectathons Open invitation to any interested party to come and write software that exchanges FHIR resources Always hold one before HL7 meetings (last week) + Others by invitation Mix of skills  Newbies (“where is the spec?”)  Old hands who’ve been to every connectathon  Experiment with new features We have a virtual connectathon all the time… 82

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Implementation Assistance Stack Overflow – ask implementation questions  Link from front page  Search for answers first  Don’t ask for changes to the spec (get deleted!) gForge Tracker – ask for changes to the spec  Link from bottom of every page  But have discussion somewhere first Disqus – on every page of the specification Skype – implementers channel – 105 participants FHIR list, Connectathons, Tutorials 83

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 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

© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Today / Tomorrow Versions for today/tomorrow:  FHIR is a rolling target right now (>100 commits/day)  Server:  Stable version of spec:  HAPI: .Net RI: