1. A SUPPLIER PERSPECTIVE IN THE LINE OF FHIR BRINGING HEALTHCARE INTEGRATION AND APPLICATION DEVELOPMENT INTO THE 21 ST CENTURY DAVID HANCOCK | 26 TH MARCH 2015

2. Page 2 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE Introduction to Orion Health Why are we using FHIR? What are we doing with it? –What can we do more easily than before? –Practical Issues –FHIR in a Healthcare Platform Conclusion AGENDA

3. COMPANYOVERVIEW RHAPSODY INTEGRATION ENGINE

4. Page 4 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE OFFICE LOCATIONS DEVELOPMENT CENTER SALES OFFICE

5. Page 5 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE ABOUT US | ORION HEALTH Founded by Ian McCrae in 1993 100% Healthcare focused 1100+ Employees 26 offices Around the world in 15 countries 1,000+ customers in 5 continents and over 30 countries. 45 HIE customers worldwide, linking over 700 facilities. 50+ million patient records accessed 110 organisations use OH software to manage Health information in UK

6. Page 6 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE Why are we using HL7 FHIR?

7. Page 7 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE ANYONE KNOW THE JOKE? Why are Healthcare Standards like toothbrushes? Everybody says they have one, but nobody is prepared to share

8. Page 8 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE HL7 v2 is more of a guide than a standard. It has come to the end of its natural life (or should have!) HL7 v3 contains messages and documents starting from a common model of exchange. –HL7 v3 Message standard is more aimed for informatics NOT integration. Laudable aims but too complex for existing systems to conform to. Very hard to enrich messages to make them v3 compliant –HL7 CDA is simpler but only document exchange and is not a data interchange standard. It is complex to extract coded information from (and interpret). Previous HL7 standards have not been designed for the internet or for mobility HL7 standards did not support integration of Health and Social Care (and Child Protection, Domestic Violence Protection etc.) –Difficult to extend out of Healthcare –To use, organisations had to belong to HL7 ISSUES WE FACED AS A SUPPLIER…….

9. WHAT ARE WE DOING WITH FHIR?

10. Page 10 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE WHAT ARE WE DOING WITH HL7 FHIR? Our Integration Engine RHAPSODY will support mapping and transformation of HL7 v2  HL7 FHIR –Map messages to FHIR bundles –Include standardised templates for message types; starting with ADT. Also look up external REST services Also using Rhapsody to solve development problems such as migrating data from our HL7 v2 platform to our HL7 FHIR platform Building our new data platform to be accessed by FHIR Services FHIR enabling our existing data platform D ATA IN F LIGHT D ATA AT R EST All APIS are now starting to use FHIR as far as possible –First decision is therefore “why not use FHIR” –E.g. this week alone we discussed creating a Provider Index using FHIR and Circle of Care capability using FHIR P LATFORM SERVICES

11. Page 11 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE FHIR works with other standards –For Privacy and Security - OAuth2 –Smart Enabled HIT Medical apps that integrate into diverse EHR systems at the point of care Now have SMART on FHIR FHIR works with any Terminologies Working with Apps, Devices and Internet of Things: –Taking data out of Apple Webkit using an iPhone and putting them into our data platform using a FHIR interface. The use of Profiling allows to both Extend FHIR and Restrict FHIR (after all, we often need to increase the scope of FHIR resources, but sometimes we want less). WHAT IS EASIER TO DO THAN BEFORE?

12. Page 12 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE It is still DSTU 1 – means we have to make compromises –We will be supporting the FHIR operation mechanism post DSTU-2 We are using FHIR as our standard approach for Care Plans, Circle of Care and Goals –Care Plan is a single resource and Participant is PART of the care plan –Adding or Removing a participant to a care plan is an important operation but FHIR operators (CRUD) only allow us to deal with the whole resource –We are having to define our own operations to support what we want here. At a general level, our Developers are continuing to ask fundamental questions and challenging always the current status quo of FHIR if it does not seem to fit what we want to do The fact that FHIR is so developer friendly, extensible and straighforward to change make it an extremely viable platform even though it is still DSTU 1. PRACTICAL ISSUES | HAVING TO BE ADAPTABLE

13. Page 13 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE Worldwide even Healthcare is moving to multi-tenanted SaaS deployment Ever increasing specialism in Healthcare means: –Greater demand for wider variety of specialist professional apps –Near insatiable demand for consumer apps No single vendor can provide for this, so there needs to be a Platform Approach and building it on HL7 FHIR makes lots of sense –We should compete on features rather then data/service and Vendor lock-in Suddenly we have to think about a whole lot more in developing and integrating healthcare applications. CONSIDERATIONS AS HEALTHCARE PLATFORM

14. Page 14 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE READING Small DataREADING Large Data Small Compute Request to Access Demographics or Lab Result Extracting data out of the system via APIs, or pulling all Radiology results with imaging from a cohort of patients. Large Compute An analytics request that searches across the population for all members with COPD that live at high altitude and have had an ED encounter in the last 30 days An ETL job to transform one representation of our system data to another. an example would be an API that creates arbitrary disease registries, INTERNET APPLICATIONS | DESIGNING AND RUNNING SYSTEMS THAT ARE HOSTED We are having to consider the following resources. Costs are proportional to: Computing Power Storage Data Transfer We need to define different forms of API with different characteristics Data

15. Page 15 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE A Platform means we can have AND WANT 3 rd parties develop apps on it We need to manage the Computing, Data Transfer and Storage Costs 3 rd parties could write massive read or read/write functionality that could massively affect these costs –How do we build defensive APIs? PLATFORM | MANAGING THE TCO

16. CONCLUSION ORION HEALTH EXPERIENCE

17. Page 17 2014 © Orion Health™ group of companies THINKING SOFTWARE FOR LIFE FHIR is the way of the future and Orion Health’s involvement is genuine –We have a history of innovation and are excited to part of this It is important to implement it and really test it to the limits and where necessary get things changed. –Improving by Using FHIR then forces us to think about issues in IT architectural patterns that we have not to think about before –Be careful what you wish for! FHIR DOESN’T GIVE US ALL THE ANSWERS, BUT IT GIVES US THE TOOLS TO WORK OUT AN ANSWER