CIMI + FHIR Grahame Grieve 10-August 2015 Salt Lake City

The place of Profiles Information requirements and solutions are fractal Things that are optimally abstract in one context should be concrete in another The transformation between these is a central challenge we’ve all been working on V2 conformance models V3 RIM / Constraint language openEHR ADL / TDL CIMI (FHIR)

FHIR take on Fractal Models We’re going to use REST Consistently with the way the rest of the world does RESTful interfaces are resolutely concrete Inheritance isn’t part of the picture RESTful scope tightly related to transaction boundaries FHIR is a platform standard There’s a tension between enabling people to talk and forcing people to talk ‘right’ Keep disagreement out of the specification

FHIR Solutions A set of base level ‘resources’ Hard coded in the system A limited number – 150? Optimal (100 now) Resources can be constrained and extended Extensions are built into the framework Pure constraint model (~compatible with ADL) There’s a conformance layer built into FHIR

FHIR Conformance Resources Value Set / Concept Map Define code systems, value sets, mappings Structure Definition Base data types & Resources Extensions Profiles – constraints on resources including extensions These are computable Conformance Statement + others Operational System Definitions

Profiles Describe how you do or should use resources Implementation Guides Working Systems Purchasers Sliding scale of governance HL7 defines profiles as part of base specification (best practice) Domain Profiles – what’s the canonical model for X? National Standards bodies / national programs Vendors Individual Projects

Profiles & Resources Systems exchange resources, not ‘profiles’ Resources don’t need to identify their profiles They can just conform to the rules Systems can test them to see if they do Resources can identify their profiles In the header (Resource.meta.profile) Helps find the relevant resources (use case based)

R E A L M S D O M A I N S

Purpose of Profiles Set common expectations about system structures and functionality Convey clinical agreements Fully detailed interoperable data (nailed down in every way possible) Cascading amount of detail And therefore cascading increase in agreement required

Terminology, Knowledge, Structure The Information/Terminology boundary is a known problem In FHIR / HSPC work, we’ve been exploring this space, and a new pattern is emerging

Terminology/Knowledge/Structure Terminology (Concepts, Codes, Definitions - Primitives) Concept Model (Grammar: How concepts relate to each other) Dictionary (A collection of identified concepts using the concept model) Structures (Mixed references into Dictionaries and Terminologies)

FHIR Instantiation Terminology (Concepts, Codes, Definitions - Primitives) Concept Model (Grammar: How concepts relate to each other) Dictionary (A collection of identified concepts using the concept model) Structures (Mixed references into Dictionaries and Terminologies) LOINCRxNorm / AMT 6 axes in documentation Medication Dictionary Grammer as documented SCT Concept Model SCT Clinical Finding DataElementMedication ConditionDefinition ObservationMedicationStatement Condition

Terminology, Knowledge, Structure Terminology defines base codes Extension: add additional base codes Concept Grammar Extension Point: add your own grammar Dictionary Extension: define your own dictionary Structures Lots of reasons to vary your amount of normalization

Models vs terminology It’s common argument: is this models or terminology? People don’t want 1000s or profiles… but they don’t mind 1000s of codes… Dictionary is the merge point of both Assumes a common overall structure Binds the concept model to a particular resource Some optionality in structure Instantiates how particular concepts are represented – codes + associated values / rules Can be used to generate terminology and/or profiles

CIMI and FHIR CIMI works with FHIR during the process of defining resources Scope proposals Details of proposals HL7 level profiles CIMI / FHIR define which dictionaries are defined CIMI populates dictionaries