1. FHIR projects in the NHS 1 Presented by Richard Kavanagh Head of Data Standards – Interoperability Specifications

2. HL7 in NHS within England NPfIT introduced HL7v3 at scale in to the architecture of the NHS. National applications deployed at scale PDS, SCR, EPS, GP2GP, CAB Implementation demonstrably possible, though at a cost.

3. The “challenge” of HL7 V3 Creating HL7v3 specifications uses niche skills not readily available. Implementing HL7v3 specifications uses niche skills not readily available. Expensive to specify, expensive to build. “Cost” and “Benefit” are they proportional? Semantic rigour often not used or even required due to the “templating” processes

4. Set the data free Access to data via APIs is a strong design requirement for future systems. #Code4Health desire to make access to data simple to promote innovation The age of the “App” is upon us. Smaller devices requiring simpler technology stacks XML vs. JSON Web Service vs. REST

5. Technology Refresh Choose and Book to be redeveloped and transformed to eReferrals Service. Supplier consultation (via Intellect) not positive about using HL7v3 JSON and REST technology skills commonly available in the “IT Development” workforce. APIs are prevalent (http://www.programmableweb.com lists s10,394 APIs)http://www.programmableweb.com HL7v3 discounted, supplier engaged to build API

6. The “FHIR” opportunity What we need is some thing that supports XML and JSON Web Services and REST Allows fine grained APIs Is more accessible to innovators Is extensible

7. Getting buy in Initial scepticism – some antibodies to HL7 Reviewed by supplier – positive feedback Internal HSCIC governance Interoperability Design Authority Architecture Governance Group FHIR now an accepted architectural solution for future use by HSCIC

8. Setting Expectations FHIR is a “work in progress” showing lots of promise but not yet a “standard” The painful “bleeding” edge The alternatives to FHIR, bespoke solution or early adoption? The development has started Stability has yet to materialise

9. Managing the risk of going first We will accept deviation We will be pragmatic New resources We will report back JSON serialisation QUERY resource It will not be 100% FHIR

10. Development through collaboration No proven process for profiling FHIR FHIR is online and freely available – don’t reinvent the wheel. FHIR is a standard not an implementation Evolve the process to meet demand Not another “MIM”

11. What to expect from eReferrals The delivery will be a mix of existing HL7v3 messages and FHIR The APIs will be released as per the eReferrals delivery schedule The resources will be for a mixture of clinical and non clinical concepts.

12. What we expect so far Custom resources will be published profiles for all resources will be published Examples in XML and JSON for resources FHIR System namespaces FHIR valueSets Validation rules and generated data

13. Other projects underway Two projects in discussion, too early to publish. Training underway in the central team Sharing the learning and early feedback

14. FHIR is not the only way GP2GP changes being discussed using HL7v3 ETP changes being discussed using HL7v3 Public Health England messages using CDA

15. Feedback is welcome richard.kavanagh@hscic.gov.uk @rkavanagh uk.linkedin.com/in/richardkavanagh/