1. Clinician-on-
Stephen Chu
September 2016

2. Agenda

3. – 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

4. 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+

5. 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

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

7. Resources

8. Resources

9. The US Argonaut project: A project set up to rapidly
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

11. 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?

12. 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

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

14. – quality/usability issue examples

15. – quality/usability issue examples

16. – quality/usability issue examples

17. 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

18. 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

19. tool for clinicians: clinFHIR
What clinFHIR is not
Not a FHIR resource designer

20. tool for clinicians: clinFHIR
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

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

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

23. clinFHIR – select or add new patient