1. Creating fhir® Clinical Documents with Trifolia & Camara
For Industry-Standard Clinical Profiles, Templates & Notes
HL7 FHIR® Application Roundtable Boston, July 27, 2016
Rick Geimer, CTO, Lantana Consulting Group
Liora Alschuler, CEO, Lantana Consulting Group

2. Consulting: Interoperability, Reporting & Analytics
About Lantana
Consulting: Interoperability, Reporting & Analytics
Software: Internal, Open Source, Commercial
Services:
Standards-based implementation
Terminology & data governance
Standards development
Program management
Strategic planning
Education & training
Industry leadership
lantanagroup.com

3. About Rick
Lantana CTO SDWG Co-chair Co-Editor of Consolidated CDA and other IGs C-CDA on FHIR project lead
lantanagroup.com

4. Agenda
FHIR Documents
Trifolia
Camara
lantanagroup.com

5. FHIR Documents
lantanagroup.com

6. Position: FHIR is the document future, just not yet Call to action:
FHIR Documents
Position: FHIR is the document future, just not yet
Call to action:
Define, document, and promote a future where clinical documents and Application Programming Interfaces (APIs) share a common syntax and set of resources
Establish, in technical and regulatory policy, a smooth roadmap to the future of clinical document exchange
lantanagroup.com

7. The dual nature of the clinical record: Data Narrative
Why FHIR Documents?
The dual nature of the clinical record:
Data
Narrative
CDA® supports that duality
Persistence, stewardship, authentication, readability, and context required
Essential for disparate teams—different disciplines, contexts, or clinical systems
CDA-on-FHIR documents do the job
Composition profiles + DAF
Fall 2016 ballot
lantanagroup.com

8. Trifolia Overview Trifolia Workbench:
Template/profile database and management
Browser-based
Open source
Focus on clinical document templates and profiles
Design and document CDA templates and FHIR profiles
Versioning – Identify and track changes
Value sets – Create, edit, bind
Import/Export (XML/JSON)
Validation: Schematron for CDA
Validation: StructureDefinition for FHIR
Can do non-document profiles, but we prefer to do those in other tools like Forge, import into Trifolia, and assemble into document profiles.
lantanagroup.com

9. Trifolia Demo
Show how to localize a profile. Localize the CCD, take an optional section and make it required. Save as FHIR roundtable CCD. Later show it in Camara.
lantanagroup.com

10. Camara Overview Clinical Document Editor Stand-alone, cloud-based
Application layer in EHR, other platform
Template/profile driven
Completes the interoperability picture
FHIR is Internal Model
Formats:
C-CDA
FHIR DSTU 1
FHIR STU 3 (preliminary support through transforms)
Completes the picture: Integrated, value-based care requires close coordination between a wide range of care providers supporting diet, behavioral health, even the school nurse need to participate.
MEAN stack (Mongo, Express, AngularJS, AND Node.js)
lantanagroup.com

11. Camara Features: Complete documents: narrative and coded data
De novo documents
New versions, revisions, of existing documents
Integrates with HIE, clinical, and administrative systems for information reuse
Small footprint
Mobile or browser deployment from cloud-based platform
Native standards compliance
Validates against current standards
Localized for business requirements
lantanagroup.com

12. Camara Demo
Start with a nearly complete document, using the same profiles used in Trifolia. Show validation error, fix and finalize.
Add narrative to a section. Add a problem (diabetes).
Show localization from Trifolia (optional section now required).
lantanagroup.com

13. Key Benefits Trifolia Single source for CDA & FHIR
Production-ready application
Users: 933
Implementation Guides: 152
Templates/Profiles: 3218
Build, constraint, extend current work
Source for the majority of US Realm IGs
Consistent quality profiles and templates
Export profiles to Camara ….
Camara
Author C-CDA and FHIR documents using a single application.
Valid documents meet MU requirements
Integrates with FHIR API
Bridge to the future
Focus on clinician-to-clinician communication
Rick – I edited
lantanagroup.com

14. Thanks you for your interest.
Questions
Thanks you for your interest.
lantanagroup.com