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FHIR Architecture 
Overview 
for non-programmers 
René Spronk (Ringholm) 
FHIR Developer Days 
November 26, 2014 
© 2014 H...
FHIR Overview 
for executives 
René Spronk (Ringholm) 
FHIR Developer Days 
November 26, 2014 
© 2014 HL7 ® International....
3 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Heal...
4 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Heal...
5 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Heal...
What does FHIR stand 
for? 
 F – Fast (to implement) 
 H – Health 
 That’s why we’re here 
 I – Interoperable 
 R – R...
Design Philosphy of 
FHIR 
Focus on Implementers 
Target support for common scenarios 
Leverage cross-industry web technol...
Contextual drivers for 
FHIR 
 Shift in healthcare 
patient in control, sharing data across organizations 
 Shift from o...
What is a FHIR ‘Resource’ ? 
 Small, discrete concepts that can be 
maintained independently 
 Akin to HL7v2 segments, D...
FHIR Resources 
10 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered t...
Example – Patient Resource 
References 
to other 
Resources 
© 2014 HL7 ® International. Licensed under Creative Commons. ...
Data types 
12 
 Based on cross-industry data types (w3c schema and ISO 
data types) 
 Stick to the “80% rule” – only ex...
13 
Extension with 
reference to its definition 
Human Readable 
Summary 
Standard Data 
Content: 
 MRN 
 Name 
 Gender...
Narrative 
14 Note: could be JSON as well 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level...
Extensions 
15 Note: could be JSON as well 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Leve...
FHIR references 
16 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered ...
RESTful FHIR Examples 
GET http://myfhirserver.com/patient/123 
GET http://myfhirserver.com/encounter/904?_include=patient...
FHIR Messages 
18 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered tr...
FHIR Documents 
19 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered t...
FHIR profiles 
 Resources have nearly no restrictions. 
Parties exchanging data define the way 
they want to use resource...
StructureDefinition 
Resource (profile) 
“Before” 
“After” 
GET http://myfhirserver.com/StructureDefinition?xxxxxxxxxxxxx ...
OperationDefinition 
Resource (Profile) 
22 
Standard 
FHIR REST 
Update 
Custom 
Operations 
Read 
Search 
Check Drug 
In...
Computable Profiles 
GET http://myfhirserver.com/Conformance 
© 2014 HL7 ® International. Licensed under Creative Commons....
Summary: What does 
FHIR provide? 
 Resources (building blocks) 
 Extensions 
 Methodology 
 Bundles, Profiles, Confor...
Application of FHIR 
 FHIR is suitable for application in a variety 
of settings: 
 the classic in-institution exchange ...
FHIR 
 Is being implemented right now: 
 (US) ONC, SMART, Intermountain, (UK) NHS, 
(NZ) Orion Health, (NO) Helse Vest (...
FHIR 
 Is easier and cheaper than other 
comparable standards: 
 It is faster to learn, implement and troubleshoot 
 It...
FHIR 
 Is likely to significantly impact Health IT: 
 scales well from simple to complex 
 flexible 
 free and fully o...
29 
Questions? 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trade...
FHIR Example 
for clinical users 
René Spronk (Ringholm) 
FHIR Developer Days 
November 26, 2014 
Modified from a presenta...
Theme: a mobile 
application 
 A mobile application for a clinician 
 Collect and present clinical information about 
a ...
Assumptions 
 Requirements known 
 Data Sources known and 
available 
 Not considering security 
 Not considering app ...
Main Clinical resources 
 Observation / Condition (Problem) / Alert 
 DiagnosticReport 
 MedicationPrescription (and ot...
Important Supporting 
Resources 
 Patient / Practitioner 
 List 
 Encounter / EpisodeOfCare 
 Order / OrderResponse / ...
Local Notes - Clinical 
Scenario 
 First consultation 
5 year old boy 
 Complaining of pain in the r) ear for 3 days wit...
Looking at the relationships 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are re...
Lists of things 
 Examples 
 Medication list 
 Problem List (Conditions) 
 Allergies 
 Past Medical History 
 Past S...
Scheduling patients 
 Appointment / AppointmentResponse 
 Availability 
 Slot 
 HealthCareService 
 Recalls (care pla...
Ordering stuff 
 Order / OrderResponse 
 Detailed resources in request 
 MedicationPrescription 
 DiagnosticOrder 
 R...
Medications 
 Medication 
 MedicationPrescription 
 Order / OrderResponse 
 MedicationAdministration 
 Provenance 
 ...
Viewing investigations 
 Diagnostic report 
 Imaging Study 
 Specimen 
 Attachment 
© 2014 HL7 ® International. Licens...
Decision Support 
 ContraIndication 
 AllergyIntolerance 
 Alert 
 OperationDefinition 
 ImmunizationRecommendation 
...
Doing things to people 
 Procedures 
 Specimen 
 DiagnosticReport 
© 2014 HL7 ® International. Licensed under Creative ...
Referrals 
 Order/OrderResponse 
 ReferralRequest 
 Many resources as 
content 
© 2014 HL7 ® International. Licensed un...
Data collection 
 Forms 
 Questionnnaire / QuestionnaireAnswers 
 Free form 
© 2014 HL7 ® International. Licensed under...
Creating a summary 
document 
 ddd 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven...
Returning to the App… 
 Interact with Local Server 
 RESTful exchange of resources 
 Local server will mediate other se...
Winding Up 
FHIR is fit for (clinical) purpose 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health ...
49 
Questions? 
© 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trade...
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FHIR architecture overview for non-programmers by René Spronk

  1. 1. FHIR Architecture Overview for non-programmers René Spronk (Ringholm) FHIR Developer Days November 26, 2014 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  2. 2. FHIR Overview for executives René Spronk (Ringholm) FHIR Developer Days November 26, 2014 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  3. 3. 3 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  4. 4. 4 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  5. 5. 5 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  6. 6. What does FHIR stand for?  F – Fast (to implement)  H – Health  That’s why we’re here  I – Interoperable  R – Resources  Building blocks – more on these to follow 6 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  7. 7. Design Philosphy of FHIR Focus on Implementers Target support for common scenarios Leverage cross-industry web technologies Require human readability as base level of interoperability Make content freely available 7 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  8. 8. Contextual drivers for FHIR  Shift in healthcare patient in control, sharing data across organizations  Shift from off-line to on-line shift from PC to tablet, from web to app, from desktop to cloud  Shift towards data transparency FHIR acts as an ‘open API’ to access data in these silo-like EHR’s.  Shift towards analytics FHIR uses data structures that allow one to easily slice and dice the data for analytics. 8 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  9. 9. What is a FHIR ‘Resource’ ?  Small, discrete concepts that can be maintained independently  Akin to HL7v2 segments, DICOM IEs.  Resources are smallest units of transaction  Built-in extension mechanism  Elements used by 80% of implementers are part of the base resource.  All other elements are handled as extensions  Resources have a ‘textual description’ 9 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  10. 10. FHIR Resources 10 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  11. 11. Example – Patient Resource References to other Resources © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  12. 12. Data types 12  Based on cross-industry data types (w3c schema and ISO data types)  Stick to the “80% rule” – only expose what most will use  Data types can have extensions © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  13. 13. 13 Extension with reference to its definition Human Readable Summary Standard Data Content:  MRN  Name  Gender  Date of Birth  Provider © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  14. 14. Narrative 14 Note: could be JSON as well © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  15. 15. Extensions 15 Note: could be JSON as well © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  16. 16. FHIR references 16 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  17. 17. RESTful FHIR Examples GET http://myfhirserver.com/patient/123 GET http://myfhirserver.com/encounter/904?_include=patient PUT http://myfhirserver.com/encounter/707 {XML or JSON Resource expression} GET http://myfhirserver.com/document/800511 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  18. 18. FHIR Messages 18 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  19. 19. FHIR Documents 19 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  20. 20. FHIR profiles  Resources have nearly no restrictions. Parties exchanging data define the way they want to use resources  Profiles define what ‘your jurisdiction’ needs to communicate and store when it comes to Resources and their extensions. 20 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  21. 21. StructureDefinition Resource (profile) “Before” “After” GET http://myfhirserver.com/StructureDefinition?xxxxxxxxxxxxx © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  22. 22. OperationDefinition Resource (Profile) 22 Standard FHIR REST Update Custom Operations Read Search Check Drug Interaction Merge Patient Search on Maiden name © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  23. 23. Computable Profiles GET http://myfhirserver.com/Conformance © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  24. 24. Summary: What does FHIR provide?  Resources (building blocks)  Extensions  Methodology  Bundles, Profiles, Conformance  Syntax (XML, JSON)  Human readability  Support for multiple Paradigms  REST, Messaging, Documents, Services 24 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  25. 25. Application of FHIR  FHIR is suitable for application in a variety of settings:  the classic in-institution exchange of data between systems  in a regional setting (Regional Health Information Organizations)  on a national scale, e.g. in national health hub’s or EHR's  in social media and mobile applications  FHIR is expected to be initially used for social media and mobile application use-cases. 25 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  26. 26. FHIR  Is being implemented right now:  (US) ONC, SMART, Intermountain, (UK) NHS, (NZ) Orion Health, (NO) Helse Vest (NL) Mental health apps  IHE Profiles  70 implementations, 20 countries (2014) 26 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  27. 27. FHIR  Is easier and cheaper than other comparable standards:  It is faster to learn, implement and troubleshoot  It has a vibrant and open source community and has frequently held connectathons.  It uses modern technologies, the same as used by e.g. Facebook, Twitter and Google.  There are more people familiar with these technologies (thus less expensive consultants). 27 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  28. 28. FHIR  Is likely to significantly impact Health IT:  scales well from simple to complex  flexible  free and fully open 28 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  29. 29. 29 Questions? © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  30. 30. FHIR Example for clinical users René Spronk (Ringholm) FHIR Developer Days November 26, 2014 Modified from a presentation by David Hay, Orion © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  31. 31. 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 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  32. 32. Assumptions  Requirements known  Data Sources known and available  Not considering security  Not considering app architecture  System Architecture © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  33. 33. Main Clinical resources  Observation / Condition (Problem) / Alert  DiagnosticReport  MedicationPrescription (and others)  AdverseReaction / ContraIndication / AllergyIntolerance  Immunizations / ImmunizationRecommentation  Assessment / RiskAssessment / CarePlan  Questionnaire / QuestionnaireAnswers © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  34. 34. Important Supporting Resources  Patient / Practitioner  List  Encounter / EpisodeOfCare  Order / OrderResponse / ReferralRequest  DocumentReference  Provenance  Appointment / AppointmentResponse / Availability / Slot / HealthcareService © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  35. 35. Local Notes - Clinical Scenario  First consultation 5 year old boy  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. Patient Encounter Condition Observation Med Adverse Reaction Allergy © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  36. 36. Looking at the relationships © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  37. 37. 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’ © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  38. 38. Scheduling patients  Appointment / AppointmentResponse  Availability  Slot  HealthCareService  Recalls (care plan)  Alerts © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  39. 39. Ordering stuff  Order / OrderResponse  Detailed resources in request  MedicationPrescription  DiagnosticOrder  Referral © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  40. 40. Medications  Medication  MedicationPrescription  Order / OrderResponse  MedicationAdministration  Provenance  MedicationDispense  MedicationStatement  AllergyIntolerance  ContraIndication © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  41. 41. Viewing investigations  Diagnostic report  Imaging Study  Specimen  Attachment © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  42. 42. Decision Support  ContraIndication  AllergyIntolerance  Alert  OperationDefinition  ImmunizationRecommendation © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  43. 43. Doing things to people  Procedures  Specimen  DiagnosticReport © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  44. 44. Referrals  Order/OrderResponse  ReferralRequest  Many resources as content © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  45. 45. Data collection  Forms  Questionnnaire / QuestionnaireAnswers  Free form © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  46. 46. Creating a summary document  ddd © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  47. 47. 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 © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  48. 48. Winding Up FHIR is fit for (clinical) purpose © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
  49. 49. 49 Questions? © 2014 HL7 ® International. Licensed under Creative Commons. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
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FHIR architecture overview for non-programmers by René Spronk

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