1. Rhapsody
Rhapsody FHIR
Brendon McAlevey – Nov 2018

4. 24th July 2017 this arrived in my Inbox, announcing NHS Digital’s plan to move from using CDAs to FHIR when sending discharge summaries and outpatient clinic correspondence to GPs.
Much easier to move structured information using FHIR than CDA so there was a really good really reason for making the shift – worldwide experience has shown it’s easier to get structured information out of the FHIR –
Move beyond sending a document someone can read -> shredding the document

5. Hospital Discharge Summary - Today
GP Practice
Post
Discharge?
Discharge Summary written
Rhapsody Integration Engine
Send to GP Practice
Manually file into GP record
Transcribe clinical codes e.g. diagnosis, allergies, medication
Patient attends ED
Yes No
System
Format
Transport
PAS
RTF/PDF with flat file metadata
Medical Interoperability Gateway
Patient admitted to ward
EDIS
Digital Dictation
ITK wrapped CDA document
EDT DocMan
Document Management
Decision to discharge*
Electronic Patient Record
XML
NHS.net
HL7 MDM
DTS/MESH
Clinical Portal with e-Forms
Fax
Kettering XML
Shared Care Record
*alternatively patient dies
HTML

6. NHS Standard Contract – Changes and Technical Guidance
Must use FHIR
Must use PRSB headings
Semantically interoperable
SNOMED coded Allergies
dm+d coded Medications
Delivered nationally i.e.
able to send to GPs outside usual catchment area
Stop using NHS.net
Straight-forward to import the data under the guidance of a clinician in the practice

7. Transfer of Care – Future
Hospital
GP Practice
Discharge?
Discharge Summary written
Rhapsody Integration Engine
Send to MESH
GP system retrieves from MESH
Automatically file in GP record
Patient attends ED
Yes No
Import clinical codes e.g. diagnosis allergies, medication
Patient admitted to ward
Certain data sets can be automatically parsed into GP Record
Output as XML
Mapped to FHIR Document
Sent over MESH
Decision to discharge*

8. NHS Standard Contract – Achieving Compliance

9. Open APIs - Contract
NHS Standard Contract 2017/19 - Service Conditions (Full-length) - SC23 Service User Health Records
The Provider must use all reasonable endeavours to ensure that its clinical information technology systems provide open interfaces in accordance with Open API Policy and must ensure that, by no later than 31 December 2018, all of its major clinical information technology systems enable the Key Clinical Data Fields to be accessible as structured information through open interfaces, subject to the provisions of GC21 (Patient Confidentiality, Data Protection, Freedom of Information and Transparency) to other providers of services to Service Users.
NHS Standard Contract 2017/19 - General Conditions (Full-length) - Definitions
Open API Policy - Guidance available at:
Interopen - adapt resources for use within the UK

10. Rhapsody Support for FHIR
Javascript and HTTP REST client comm points
Template based mapping filter (Freemarker mapper)
XML/JSON conversion
Server comm points for hosting FHIR endpoints.
Can use client to listen for Atom feeds or TCP, HTTP com points PH

11. Case Study
Discharge Summaries
Rhapsody

12. FHIR Documents Rhapsody Analogous to CDA
Clinical summary at a point in time
Can be signed, authenticated, etc
Collection of resources in a Bundle
Rhapsody can be used to convert between CDA & FHIR Documents
Bundle
Composition
Resource 1
Resource 2

13. Mapping from HL7 v2 Rhapsody
HL7v2 messages can be mapped to either FHIR messages or FHIR documents.
The FHIR website even provides mapping specifications e.g mappings.html. However the mappings highlight how there are difficult mapping options or no clear equivalent mappings.
This means any HL7v2 to FHIR mapping needs to allow for customisation as an out of the box mapping filter will ever be able to map from HL7 to FHIR.

14. Free Marker Mapper Rhapsody
The FreeMarker Mapper filter transforms the input message from one format to another using the FreeMarker template engine. Its probably the best solution to map from any fomat into FHIR.
It has the following advantages over other mapping methods in Rhapsody
You don’t need to import an XSD schema, you only specify the output message and map fields into it.
It allows importing files so the mapping logic can be reused and kept separate.
What you see if want you get. The output isn’t restricted or post processed by an XML parser.
It can output JSON. PH

15. Getting Started Rhapsody Basics
The Input message can be XML or EDI (such as HL7v2, CSV, X12 etc)
The Output message can be any format, but typically XML or JSON.
Input as EDI
When using EDI messages as input use the “inputEDI” template parameter to access the input message body context , for example
And “getElementAt” is used to access fields.
Input as XML
For XML use “inputXML” and then the XML elements, for example PH

16. Inbuilt Functions Rhapsody
Rhapsody includes some useful inbuilt functions. For FHIR generating UUID’s is common as well as converting date/time fields to other formats.
Other functions also allow users to access the messages properties and Rhapsody lookup tables and the entire input message itself as text.

17. Mapping basics - Variables
Rhapsody
Mapping basics - Variables
Free Marker Mapper has a concept of variables. This is useful for creating UUID’s that need to be used in multiple places.
To use them use the “#Assign” element, the following example creates a variable “identifier_UUID” with the value from the result of calling the Rhapsody UUID.Generate function:
The next example creates an “lastUpdated” variable to store an HL7 datetime value and then uses an datetime formatting function to convert it to an specific format. PH

18. Mapping basics – if then else statements
Rhapsody
Mapping basics – if then else statements
Every mapping language needs an if-then-else statement. In Free Marker Mapper this is an example of how its used: PH

19. Mapping basics – List (For Loops)
Rhapsody
Mapping basics – List (For Loops)
The Free Marker Mapper allows users to use “lists” to loop though repeating elements. The example below uses an “list” to loop through HL7 repeating OBX segments. PH

20. Mapping basics – Importing templates
Rhapsody
Mapping basics – Importing templates
The template file is included as an auxiliary file in Rhapsody. Other FreeMarker templates can be added to the auxiliary files on the filter and referenced from within the main template using the “#import” element.
This allows mapping to be modelled around the structure of an FHIR document or Message. The main template can be used to store the “Bundle” object and import the necessary resources contain in individual template files. PH

21. Case Study – Mapping an HL7v2 MDM to FHIR
Rhapsody
Case Study – Mapping an HL7v2 MDM to FHIR ed PH

22. Case Study – Mapping an HL7v2 MDM to FHIR - Approach
Rhapsody
Case Study – Mapping an HL7v2 MDM to FHIR - Approach
The approach used here was to use the Free Marker Mapper filter
An sample output message (FHIR bundle with Composition resource and related resources was used as a base).
The main template models the FHIR Bundle which imports other templates containing either Resources or Lists.
By storing the Resources in separate template files allows for the mapping to be easier debugged and designed. It is also hoped the templates for each Resource can be reused by other projects.
The input message was an deidentified actual HL7 v2 MDM message from Cerner that has a lot of the required Composition section information, although not all. PH

23. This is an example of an main template containing an FHIR bundle and importing Composition, Patient and Encounter resources.
Bundle
Composition
Patient
Encounter
XX Resource

24. Mapping Composition Sections
Rhapsody
Mapping Composition Sections

25. Mapping Composition Sections
Rhapsody
Mapping Composition Sections
A number of section text is stored in OBX segments in the HL7v2 message. The Free Marker Mapper loops though these segments and extracts the data for the appropriate FHIR composition section.

26. Rhapsody
Input and Output ed PH

27. Message Distribution Bundle
Rhapsody
Message Distribution Bundle

28. Message Exchange for Social Care and Health (MESH)
Rhapsody
Message Exchange for Social Care and Health (MESH)
The Message Exchange for Social Care and Health (MESH) is the main messaging service used across health and social care.
It works on the Spine infrastructure. It's used to transfer electronic messages directly from one application to another, so different organisations can communicate securely.
As an example, pathology labs use MESH to communicate test results to GP practices. MESH replaced the Data Transfer Service (DTS).

29. Message Exchange for Social Care and Health (MESH)
Rhapsody
Message Exchange for Social Care and Health (MESH)

30. Message Exchange for Social Care and Health (MESH)
Rhapsody
Message Exchange for Social Care and Health (MESH)

31. Case Study
Implementing a simple
FHIR Server
Rhapsody

32. Simple FHIR Server Rhapsody
This demo shows how to implement a simple FHIR server in Rhapsody using an HTTP Server to return a patient resource
The demo has two parts:
An non FHIR REST API to retrieve an HTML page with an list of patients read from an database
An FHIR API to retrieve a Patient Resource for a patient in the list above in either XML or JSON format. PH

33. Rhapsody
Patient List
The URL invokes an HTTP server communication point that retrieves a list of Patients from a SQL Server database, then uses an Free Marker Mapper filter to create an HTML page which is returned to the HTTP Server communication point . PH
Users can click on the “FHIR XML” to retrieve the patients FHIR Patient Resource in XML format or “FHIR JSON” to receive the resource in JSON.

34. Get Patient Resource Rhapsody
The second route uses an HTTP Server to process an REST request like by selecting an patient to obtain the patient (eg 11112) record from the database and the uses an Free Marker Mapper to map it to XML. Depending on the format requested it could be transformed into JSON format.

35. Free Marker Mapper Filter
Rhapsody
Free Marker Mapper Filter
The Free Marker Mapper filter is used to transform the database output into an FHIR Patient Resource by mapping the input fields into the appropriate places.

36. Rhapsody
Patient List
The returned result is either XML or JSON

37. Rhapsody
INTEROPen Hackathon

38. Rhapsody
INTEROPen Hackathon

39. Rhapsody
INTEROPen Hackathon
extenstions