Introduction to use of FHIR Documents in ABDM

Supported by HL7 India
HL7 FHIR Basics Learning - FHIR India Community Initiative
ABDM & FHIR
Kumar Satyam
02nd May 2024
1

House Keeping
• Be on mute while the session is in progress
• Use your full name in zoom participant's profile.
• Ask questions on zoom chat .
• Follow up & discussions on zulip.
• Ensure that you are on zulip*.
2
Join FHIRIndia

Session Expectation
Introduction to ABDM
ABDM Health Information Exchange
FHIR Documents
ABDM FHIR Profiles
Questions & Answers and discussions.
3

FHIR India Community
Open community of HL7 FHIR & Interoperability enthusiasts.
#fhirIndia
https://fhirindia.zulipchat.com/
https://www.linkedin.com/groups/13932672/
https://www.linkedin.com/pulse/fhir-india-community-kumar-satyam-7t1ac/
4
Join the LinkedIn Group

ABDM Vision
5

ABDM Objectives
6

ABDM Key Components
7

ABDM common terms
8
• ABHA Address, ABHA Number, ABHA App
• Health Facility Registry (HFR)
• Health Professional Registry (HPR)
• Federated Health Records (FHR)
• HL7 FHIR
• Health Record linking
• HIU & HIP
• DSC
• Consent Manager

Hospital/Lab registers itself on
Health Facility registry
1 3
The Hospital/lab instantly gets
accurate info about the patient
including Name, Age, Gender,
Mobile
Facility sends a consent request
to the patient requesting access
to their medical history
4 1
Patient chooses what data to
share with the hospital/lab &
for how long the facility can
have access
5
Consulting doctor/lab has
medical history of patient
available when they walk into
chamber
6 7 1
1 Notification
Post treatment & before leaving the
premises, patient gets a notification
that their medical reports are ready
Medical Report
The doctor’s treatment plan
and prescription show up on
any PHR app & medical history
is never lost
8
Patient walks up to a facility.
They scan their Health ID at
the registration desk
2
Illustrative ABDM Enabled Workflow

Federated Health Record Exchange
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ABDM Milestones
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Health Information
Provider (HIP) which can
link and share digital
records on ABDM network
to Health information users
and to the citizens via any
Personal Health Records
(PHR) certified app.
Health Information User (HIU)
which can request and provide
view of patient’s medical history
to authorized healthcare
workers with citizen consent.
M1
Request &
Display
Link and Share
ABHA
ABHA number
creation and capture &
verification for
seamless patient
registration and
issuance of token
number.
M3
M2
https://sandbox.abdm.gov.in/abdm-docs/ABDMCompliant

ABDM Integration journey
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FHIR
13
• Standard from HL7.
• Web standards.
• Free and Open.
• Resources are the basic building
blocks
• Interoperability paradigms
supported by FHIR
• Restful API,
• Messaging,
• Documents
• Services
Specification:-
https://www.hl7.org/fhir
F-Fast
H-Healthcare
I-Interoperability
R-Resources

FHIR Resources
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 Small logically discrete units of
exchange
 Defined behavior and meaning
 Known identity / location
 Smallest unit of transaction
 “of interest” to healthcare

FHIR Documents
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A document is a set of resources with a fixed presentation
that is authored and/or attested by humans, organizations
and devices.
FHIR resources can be used to build documents that
represent a composition: a coherent set of information
that is a statement of healthcare information, including
clinical observations and services.
Persistence
Stewardship
Potential for authentication
Context
Wholeness
Human readability
Document use
• Persistence
• Order & presentation of information is
important
• Signature & validity
• Data spans across multiple resources

FHIR Document Structure
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A Bundle of resources of type "document" that has a Composition resource as the first
resource in the bundle, followed by a series of other resources, referenced from the
Composition resource, that provide the supporting details for the document.
The bundle gathers all the content of the document into a single XML or JSON document
which may be signed and managed as required.
The resources include both human readable and computer processable portions.
In addition, the bundle may include CSS stylesheets icon, Provenance statements and a
signature.

ABDM FHIR Documents
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 FHIR Version : R4
 Document definition
maintained at
nrces.in/ndhm
 Additional encryption
requirement for end to
end security

ABDM Data posting guidelines
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The encrypted data must be pushed to the HIU by the HRP within a short time frame. Current
timeout is set to 20 minutes.
If the data is very large, for example: running into 100s of MBs for CT scans, MRIs etc, the data
can be pushed in parts.
It is also encouraged for large files to use a streaming approach instead of pushing data to
HIU.
Once the data push is complete, the HRP must notify the HIE-CM that it has transferred the
data (health-information/notify).
•DataPush URL - can be any URL specified by the HIU. The HRP system must ensure that its
firewall rules are setup in such a way that the outbound HTTPs requests can be to any URL

Unstructured to Structured Data
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Currently Indian HIMS / LIMS players have very limited adoption of digital health standards like LOINC, SNOMED CT, ICD 11, etc.
• Currently Integrators can attach
existing formats as PDFs as part
of the ABDM report formats
• ABDM will provide a limited time
certification for such solutions
• Patients can get access to
existing reports and share it with
health facilities
• Integrators need to share
reports in structured data
formats – e.g., Diagnostic line
items coded with LOINC
codes
• This will enable better use of
data especially for trends,
aggregated data reporting,
research, etc.
Trend
Analysis
Aggregated
Data Sets
ND
HM
Diagnostic
Report
Profile
ND
HM
Diagnostic
Report
Profile
<…>
<..>

Resources
• ABDM Sandbox
• https://sandbox.abdm.gov.in/
• NRCES FHIR IG
• https://nrces.in/ndhm/fhir/r4/index.html
• Devforum
• https://devforum.abdm.gov.in/
20

Thank You
21

Introduction to use of FHIR Documents in ABDM

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