1. FHIR in the NHS
Birth Notification FHIR Message - Central London Community Hospital (CLCH) & GPSoC IM2 FHIR Demonstrator Project
Presented by
Prashant Trivedi and Richard Kavanagh

2. Background
Central London Community Hospital (CLCH) provides community healthcare in 4 boroughs of Barnet, Hammersmith and Fulham, Kensington and Chelsea, and Westminster.
Use case for following interactions
Birth Notification (Work in Progress)
Maternity Discharge
Antenatal Notification
Emergency Care Attendance
FHIR (DSTU1) is used in messaging context to develop message specifications

3. FHIR Messaging and ITK ITK Web services (ITKServices.wsdl)
Distribution Envelope
Atom Feed and FHIR resources
Do not spend time on this slide as this is Architecture and not in the scope of today’s (HL7 UK) talk

4. FHIR Message – Requirements
Requirements of data elements from CLCH
Terminology bindings consultancy from HSCIC Snomed Terminology team
Mapping data elements to FHIR resources
National objectives like NHS Number taken into account
HL7 v2 provided the structure to contain the data. The extension segment mechanism was not well controlled and therefore every v2 implementation was different. HL7 v3 is the monolithic model and requires to constrained for the specific use case. Resolves the problem of defining both semantics and structure well but the development of v3 constrained model requires time and expertise. The implementers view is not taken into account when the constrained model is created in v3. FHIR has some answers to the short comings of the v2 and v3.

5. FHIR Message (Vocabulary)
HSCIC FHIR vocabulary infrastructure
Vocabulary (value sets) registry
URN/URI registry for value sets
Not using profiles (Yet!)
e.g. urn:fhir.nhs.uk:vs/EthnicCategory is the URN idenitifier for the national vocabulary containing codes for ethnic category. The codes are derived from NHS data dictionary. The intent is to provide the national vocabularies as value set FHIR resource for machine consumption.

6. FHIR Message (Contd.) URN used
urn:fhir.nhs.uk:id/NHSNumber
urn:fhir.nhs.uk:fhir/vs/MessageEvent
urn:fhir.nhs.uk:vs/MaritalStatus
urn:fhir.nhs.uk:extension/DeliveryPlace
Registry of URN maintained (currently as an excel sheet) but the intent is to provide registry as a service.
URNs are the simple replacement of OIDs which are used in HL7 V3 messages.

7. DMS (Domain Message Specifications) Preview
Created using Open Source tooling
DSTU1 Forge profile editor
HL7 Norway / Furore FHIR publishing tools
DEMO

8. GPSoC IM2 and FHIR
GP Systems of Choice (GPSoC) Framework Phase 2 - consistency of Interface Mechanisms provided by the GP IT Clinical Systems updating them, at the same time, to take advantage of up-to-date architectural approaches.
Strategy Meetings to decide the approach and stake holders buy in.
FHIR in RESTful way is decided to be one of the interface mechanism.

9. GPSoC IM2 FHIR Demonstrator Project
Create vendor neutral API to exchange patient information RESTfully.
FHIR DSTU2 version will be used.
HSCIC will support the development by providing –
URN/URI registry
National value set registry and vocabularies
Patient Profile (Not using FHIR profile resource(Yet!), but defining patient structure and constraints/extensions/bindings as an excel table)

10. Questions