Learn how using FHIR for interoperability can help solve clinical and administrative issues at a fraction of the cost of other methods.

1. Presented By:
Jeff McGeath, Sr Vice President, Software Solutions
Iatric Systems
FHIR – What’s all the
FHUSS?

2. Agenda
 Goals
 Overview of FHIR
 Capabilities and benefits of FHIR
 What FHIR means to you, and how it can help
your organization
 How to leverage legacy systems to change the
way we deliver healthcare with FHIR

3. Goals
What you’ll learn today:
• This session will help you understand what a FHIR
Resource is and how it can be used
• FHIR is designed for the web, so this session will
explain how those simple XML or JSON structures that
are accessed via an http-based URL can be used in a
MEDITECH environment that is still using traditional
HL7 v2.x messaging
• This session will also cover a few easily obtainable use
cases to show that the new FHIR standard can be used
to accelerate 3rd party application integration

4. Quiz
One of the goals of FHIR is to help solve the
following Healthcare challenge.
16 letters, 8 syllables
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _R PT
Hint: If you Google this word, you’ll get 13,900,000
results. It is also is a top concern for healthcare IT
leaders.
LR IA IE O YI EN B T

5. Credit: XKCD.com -- HTTP://XKCD.COM/927/
FHIR – Is it a Standard?

6. Poll Question
What is driving your interest in FHIR?
A: Want to make our interfaces easier to manage
B: Moving toward what we think will be the national standard
C: Want to take advantage of the web services
D: Other (or Don’t know)

7. FHIR Overview
 Fast Healthcare Interoperability Resource (FHIR)
 Essentially HL7 v4
 HL7.org initiative (Grahame Grieve, Ewout Kramer, Lloyd McKenzie)
 FHIR Prioritizes Implementation
 Core principle that the standard must maintain implementability
 REST / JSON based
 80 / 20 rule – just define what is absolutely needed, extend the
other 20%. The needs in that 20% are covered by “extensions”.

8. ONC Interoperability Roadmap Timeline

9. Comparison to HL7 v2.x
Think of segments (PID, PV1, OBX, etc.) as URLs
https://www.CompanyABC.com/Patient/M234556
• You can see the value of REST here. No state is expected to
be stored before, between, or after calls to this URL.
• URLS will exist to get data, create data, update data (delete
data is possible)
• Remember Z Segments??  Think Extensions now
• Traditional HL7 messaging bundled concepts into a single
message via segments  FHIR supports messaging
(bundled resources)

10. An Analogy
FHIR Server
Order
Forms Observation
Forms
Patient Resource
File Clerk• search: Search through the folders for ones that meet a set of search criteria
• read: Get a copy of one a specific folder in one of the cabinets
• create: Add a new folder to the appropriate cabinet (with a new number)
• update: Add a new page (version) to the contents of a specific folder
• delete: Remove a folder from the cabinet (or more accurately, put a sticker on it
saying "do not open")
• history: Look at all the pages in a single folder (or in some cases a particular file
cabinet or even the whole room - though that's more for technical purposes than
clinical purposes)
• transaction: Give the server a bunch of folders all at once to update
The actions in red represent FHIR RESTful API
endpoints that you can think of as URLS. For
example:
https://www.myhospital.com/Patient/M12345 --
would be an example of a read from the list below.Patient
Forms

11. So… again, what’s all the FHUSS?
● The focus on implementation ease
● RESTful Web Services – embraced by many industries
● Underpinnings are not new technologies
● REST
● JSON
● Web API
● Generation Y companies come to healthcare quicker
● mHealth technologies are easier to connect, resulting in
advancement of a patient centered health care system
● The Argonaut Project
● Not a competitor, an accelerator
● Focused on mapping to the Common Meaningful Use
Data Set

12. FHIR: Capabilities and Benefits
● If someone is building a new iOS healthcare app (and
thousands are), what standard do we point them at?
● If someone wants to provide a cloud based health app
that integrates with social networks, what standard
should they use?
● If a vendor wants to provide a simple to use standards
based API to cloud based health integration services,
what standard should they extend?
● If a government wants to implement a national EHR,
who should they talk to?

13. FHIR: Capabilities and Benefits
(tempered with the current state of the standards work)
 Currently at DSTU1 (Draft Standard for Trial Use)
 DSTU2 expected this year
 Gartner Hype Cycle
 Companies starting to implement FHIR architecture
 Great companies will not build deep specifics (yet)
 VERY possible that FHIR becomes a defacto API for MU3
Where the
experts “think”
we are at

14. What FHIR Means to You
How it can help your organization
 Opens the marketplace for new Healthcare IT
entrants
 DIY productivity tools are simple to create
 Opens access to your EHR data (MU3 API?)
 Accelerator for the healthcare consumer movement

15. How to leverage existing systems using
FHIR
EHR
Data Repository
Meditech DR
OR…
F
H
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S
e
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v
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Mobile
TeleHealth
Population
Health
Workflow
Improvement
FHIR Consumers
Area of
interest
Iatric Systems - In place today

16. FHIR Use Case
 Create: Actor Resources (for patient, provider, service, and
location)
 Search: Schedule Resources for all actors, looking for
available Slots. Allow pagination through schedule weeks.
 Create: Appointment Resource with desired parameters
 Read: AppointmentResponse Resource
 Display confirmation to end user device, integrate with
personal calendar (Not FHIR)
Patient Engagement workflow:
A patient receives a push notification that their annual
physical is due. It is suggested in the notification that the
patient schedule and complete a calcium heart scan procedure
before the visit. The patient is then presented with buttons to
schedule the heart scan as well as the annual physical.

17. FHIR Use Case
 Search: Patient Resource (given barcode scan, or manual
patient ID entry)
 Search: Order Resource for the given Patient Resource
 History: Order Resource to determine outstanding orders
 Phlebotomist is able to confirm if his printed orders are still
up to date, and if not get the most current specimen
collection activities completed (Not FHIR)
Hospital workflow, process improvement:
A phlebotomist is currently rounding in clinical units obtaining
patient specimens. Before he takes his next draw on a patient,
he scans the patient wristband to initiate a query/response
workflow to determine if the current order set on his clipboard
is the most current, alleviating the need to visit the bedside
and stick the patient a second time hours later.

18. FHIR – What’s all the FHUSS?
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