FHIR for clinicians

FHIR:Clinical Resources (from the perspective of a Clinical App developer)

Dr. David HayChair HL7 New Zealand

Co-Chair FHIR Management GroupBoard Member HINZ

Member HISOInformation Architect, Orion health

www.fhirblog.com

Page 2 • HL7 New Zealand

Agenda

• A sample application– Choosing a standard…

• Thinking in Resources

• Thinking Clinically with Resources

• Clinical Connectathon


Theme: a mobile application

• A mobile application for a clinician

• Collect and present clinical information about a patient– Previous encounters

– Lab Data

– Documents

• Record details of an encounter

• Schedule encounters

• Make orders for Labs, meds etc.

• Get Decision support

• Save a summary in a Document Repository


Assumptions

• Requirements known

• Data Sources known and available

• Not considering security

• Not considering app architecture

• System Architecture


What exchange Paradigm

• Options– Document

– Message

– REST

– Service

• Need all– REST for usual operation

– Document to save a summary

– Message when creating an order

– Services less likely

REST

DocumentsMessages

Services


What data format/model to use

• FHIR because:– Light weight

• Supports JSON– Web based– Commonly available tooling– Includes model

• Can be extended– Emerging Standard

• Large Community• Active development

– Supports all paradigms– I can understand the spec!

• Options:– CDA

– HL7 v2

– Bespoke

– FHIR

So we need to learn

more about FHIR…

Thinking in Resources


Resources

• “Resources” are:– Small logically discrete units of exchange

– Defined behaviour and meaning

– Known identity / location

• (usually)

– Smallest unit of transaction

– “of interest” to healthcare

9



ResourceNarrative

Elements

Extensions Extensions

Structure of a Resource

Metadata



Resource as a bag of DataTypes


References between resources


Other things about resources

• Profiles and Extensions• Collections (bundles)

– Query result– Transactions– Documents– Messages

• Versioning• Tools

– XML Editor– REST client– Libraries– Test Servers

33, v12 – 2012-12-04

33, v13 – 2012-12-05

33, v14 – 2012-12-08

Patient/33/_history/12


33, v15 – 2012-12-09



Patient/33

Thinking Clinically


Theme: a mobile application

• A mobile application for a clinician

• Collect and present clinical information about a patient– Previous encounters

– Lab Data

– Documents

• Record details of an encounter

• Schedule encounters

• Make orders for Labs, meds etc.

• Get Decision support

• Save a summary in a Document Repository


Main Clinical resources (DSTU-1)

• Observation

• Condition (Problem)

• DiagnosticReport

• MedicationPrescription (and others)

• AdverseReaction / AllergyIntolerance

• Immunizations / ImmunizationRecommentation

• CarePlan

• Questionnaire / QuestionnireAnswers

• Alert


Important Supporting Resources

• Patient

• Practitioner

• List

• Encounter / EpisodeOfCare

• Order / OrderResponse

• DocumentReference

• Provenance


Resources to come (DSTU-2)

• Appointment / AppointmentResponse / Availability / Slot / HealthcareService

• Assessment

• ReferralRequest

• ContraIndication

• RiskAssessment

Specific Scenarios


Finding external documents (XDS-ish)


Local notes

• Encounters

• EpisodeOfCare

• Observations

• Conditions

• Assessment

• Lots of clinical resources


Clinical Scenario

• First consultation– Complaining of pain in the r) ear for 3 days with an

elevated temperature. On examination, temperature 38.5 degrees and an inflamed r) ear drum with no perforation. Diagnosis Otitis Media, and prescribed Amoxil 250mg TDS for 5 days

• Follow up consultation– 5 days later returned with an itchy skin rash. No

breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to erythromycin and advised not to take penicillin in the future.

Condition

Observation

Med

Adv Rean.

Allergy

Encounter

5 year old boyPatient


Looking at the relationships


Lists of things

• Examples– Medication list

– Problem List (Conditions)

– Allergies

– Past Medical History

– Past Social History

– Social History

– ‘Organizer’ in Document

• Manage ‘points in time’ and changes

• Explicit ‘none known’


Scheduling patients

• Appointment / AppointmentResponse

• Availability

• Slot

• HealthCareService

• Recalls (care plan)

• Alerts


Ordering stuff

• Order / OrderResponse

• Detailed resources in request– MedicationPrescription

– DiagnosticOrder

– Referral


Medications

• Medication

• MedicationPrescription– Order / OrderResponse

• MedicationAdministration– Provenance

• MedicationDispense

• MedicationStatement

• AllergyIntolerance



Viewing investigations

• Diagnostic report

• Imaging Study

• Specimen

• Attachment


Decision Support


• AllergyIntolerance

• Alert

• OperationDefinition

• ImmunizationRecommendation


Doing things to people

• Procedures

• Specimen

• DiagnosticReport


Referrals

• Order/OrderResponse

• ReferralRequest– Many resources as content


Data collection

• Forms– Questionnnaire / QuestionnaireAnswers

• Free form


Creating a summary document

• ddd


Returning to the App…

• Interact with Local Server– RESTful exchange of resources– Local server will mediate other services

• Query document repository (XDS-ish)– Use DocumentReference against Registry– Simple GET for documents

• Query data repositories (eg Lab)– RESTful query

• Record Clinical data– Create resource graph– Submit as transaction

• Decision Support– Send a Message to the DSS, get a bundle back

• Update the document repository– Create a FHIR document and submit via FHIR transaction to repository

Clinical Connectathon


Purpose of Clinical Connectathon

• Resource coverage

• Resource detail

• Patterns of use– Eg condition vs observation

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http://198.199.94.37:9001/main.html


Winding Up

• FHIR is fit for (clinical) purpose– Guide in the right direction

• As a clinical app developer I will:– Become familiar with the spec

– Interact with the community

– Play with the test servers

– Play with the Clinical Connectathon tooling

– Get started!

Thanks for listening!