20160817 - fhir hct workshopstandards.ehealthinnovation.org/files/fhir-overview.pdf · • fhir is...
TRANSCRIPT
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FHIR IntroductionCentreforGlobaleHealthInnovation
August17,2016
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License» These slides are licensed for use under the Creative
Commons “Attribution-ShareAlike 4.0 International” License
» Acknowledgements: Grahame Grieve, Lloyd McKenzie, Ewout Kramer, David Hay, Josh Mandel, Eric Haas, Rik Smithies
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AgendaEHR Standards The Data Model The RESTful API Open Source Tools FHIR Servers / Who’s using FHIR Profiling and Extensions Advanced Features Timelines and Process Hands On!
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• Worked with health data before? • Worked with HL7 before? • Developer? Languages?
Show of Hands
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• Primary focus on what is FHIR, how do you use the resources, how can it be applied to CGM data
• How to create a smartphone app with a FHIR service
• Consent mangement • Patient resource vs person resource • Resource extensions • New resource definition • Review resources team came up with &
validate it against FHIR
What We Heard you Wanted
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• Ask questions any time! • Lots of learning, then some time to play • We can adjust based on what you find
interesting
Structure for Today
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• Interoperability: It’s all about the people • Complexity: You can move it around, or
externalize it, but you can’t make it go away
• Healthcare Software: Cheap, Flexible, Interoperable (pick 2)
(courtesy Grahame Grieve)
3 Laws of Healthcare Interoperability
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• Data Exchange (how to we move data around)
• Vocabulary (how do we codify things)
• Imaging (pictures)
• Profiling (constraining things for use)
The Fascinating World of EHR Standards
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• Lab value: “Hemoglobin count of 6.5 grams per deci-litre”
• X-Ray: “Humerus”
Vocabulary Standards
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Vocabulary Standards
• Lab value: “Hemoglobin count of 6.5 grams per deci-litre”
• X-Ray: “Humerus”
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• LOINC codes represent the “Question” for a test/measurement • E.g. “4548-4” = “Hemoglobin A1c/Hemoglobin.total in Blood”
• Adoption is growing worldwide • Free to access, free to use
• https://search.loinc.org/
LOINC (Logical Identifiers Names and Codes)
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• SNOMED-CT models almost everything in healthcare • Body parts, devices, conditions,
symptoms, locations, services, etc etc etc etc etc……
• Multi-axial subtype hierarchy
SNOMED-CT (Systematized Nomenclature of Medicine--Clinical Terms)
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• http://browser.ihtsdotools.org
SNOMED-CT (Systematized Nomenclature of Medicine--Clinical Terms)
Humerus
Bonestructureofclavicleand/orscapulaand/orhumerus Structureoflongbone Upperarmpart
Bonestructureofdistalhumerus
Bonestructureofproximalhumerus
Structureofbonemarrowofhumerus
Humérus(fr)Bonestructureof
humerus
118495001
85050009
118495001 709294008
712956008119524001118495001
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• Nomenclature for units • E.g. “kg”, “Cel”, “mm[Hg]”
• http://unitsofmeasure.org/
UCUM (Unified Codes of Units and Measures)
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• DICOM is all things imaging • Storage data format • Transmission protocol • Query specification
Imaging: DICOM (Digital Imaging and Communications in Medicine)
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• A number of organizations are working on profiling existing standards for specific uses • IHE (Integrating the Healthcare
Enterprise) • Continua Health Alliance • SMART (more on this later)
Profiling Organizations
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• HL7 Version 2 is the dominant standard today for transactional messaging
Data Exchange Standards: A Backgrounder
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• Messages are defined as “pipe-and-hat” delimited lines of text
• Format is archaic, but support in tools and applications is very good
HL7 Version 2
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• HL7 Version 3 – The “modeller’s paradise”
HL7 Version 3
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HL7 Version 3
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Healthcare Messaging Standards The Sorry State in 2010• HL7 v2 is everywhere - it’s old but it works
• Exchanges within organizations • Exchanges between organizations
• HL7 v3 has seen limited uptake - not sustainable
• Mostly large government sponsored projects
• Apps are becoming a new reality
• No suitable standards exist
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Fast Healthcare Interoperability Resources
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The Name
23
F
H
I
R
Fast (to model and to implement)
Health (why we’re here)
Interoperability (ditto)
Resources (more on this to come)
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What else is FHIR?
24
• A terrible source of puns • Spark • Sprinkler • WildFHIR • FHIRWorks • FHIRMen • etc…..
• Don’t try to think of new ones. You are too late.
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Complexity Model
25
Complexity
(Log)
SemanticDepthText
HTTP/HTML
XML
SOAP
HL7v2
CDA
openEHR
HL7v3
FHIR?
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The FHIR Manifesto
26
• Focus on Implementers • Target support for common scenarios • Leverage cross-industry web technologies • Support human readability as base level of
interoperability • Make content freely available • Support multiple paradigms & architectures
http://wiki.hl7.org/index.php?title=Fundamental_Principles_of_FHIR
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Manifesto: Implementer Focus
27
• Specification is written for one target audience: Implementors (developers! developers! developers!)
• Every detail in the specification is tested at connectathons
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Manifesto: Common Scenarios
28
• Heavy emphasis on the 80:20 rule: • Cover only things that 80% will need • Enable and encourage extensions for remainder
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Manifesto: Be Open
29
• FHIR itself is licensed under the Creative Commons "No Rights Reserved" License (CC0)
• FHIR tutorial material is generally also CC0 • Samples are also CC0 • Software is generally MIT or Apache 2
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Manifesto: Support Multiple Paradigms and Architectures
30
• FHIR can be a document format, and a point-to-point messaging architecture
• For most of this session, we’ll assume that it’s a REST repository
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What is FHIR?
31
• FHIR is an attempt to define a free and open data API for health data, based on modern techniques
• FHIR is essentially four things:
• A robust data model for describing health and administrative data
• A RESTful API for interacting with that data using either JSON or XML
• A set of open source tools to implement and test FHIR applications
• A set of FHIR Servers that you can interact with (both public and private)
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The Data ModelRepresentingHealthDatainFHIR
The RESTful API
FHIR ServersOpen Source Tools
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The Data Model
33
• FHIR defines a set of roughly 150 resources • These are the building blocks of the specification,
examples include: • Patient (the person who receives healthcare) • Encounter (a doctor’s appointment or hospital stay) • Observation (e.g. a device reading, or lab value) • DiagnosticReport (e.g. a whole lab or Xray report) • MedicationPrescription (Rx for meds)
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What’s a Resource?
34
Examples • Administrative
• Patient, Practitioner, Location, Organization
• Clinical • Allergy,
Observation, Order, Diagnostic Report
Non-examples • Gender
• too small • Electronic Health
Record • too big
• Blood Pressure • too specific
• Intervention • too broad
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The Balance for Granularity
35
• Observation (basically a key-value pair) is a generic data model that can hold lots of things • Lab result - e.g. Hb 7.2 g/dL at 15:20 • Step count - e.g. 1007 steps between 9:00 and
10:00 • Blood Pressure - e.g. 120/77 mmHg taken on
the left arm at rest at 11:05
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The Web of Resources
36
DiagnosticReportCompleteBloodCount
forJohnSmith
Patient
Encounter
Observation
Observation
Observation
Observation
Aresourceisacontainerof
informationwhichrepresentssomething
intherealworld
Subject
Subject
Subject
Encounter
Result
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The Model
37
• FHIR’s model is available online
Developerfriendly
documentation
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Data Types: Primitives
39
string boolean date decimal integer uri base64
dateTime instant
markdown
Patient is awake true 2016-02-19 12.347000 500 http://snomed.info/sct rwr39o9h=
2015-01-26T15:33:13-05:00 2015-01-26T15:33:13.000-05:00
**woohoo**
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Data Types: Primitives
40
string boolean date decimal integer uri
dateTime instant
markdown
Patient is awake true 2016-02-19 12.347000 500 http://snomed.info/sct
2015-01-26T15:33:13-05:00 2015-01-26T15:33:13.000-05:00
**woohoo**
ISO8601-Timezoneismandatory
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Data Types: Primitives
41
string boolean date decimal integer uri
dateTime instant
markdown
Patient is awake true 2016-02-19 12.347000 500 http://snomed.info/sct
2015-01-26T15:33:13-05:00 2015-01-26T15:33:13.000-05:00
**woohoo**
HumanTimes,variableprecision
SystemTimes,fixedprecision
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Data Types: Primitives
42
string boolean date decimal integer uri
dateTime instant
markdown
Patient is awake true 2016-02-19 12.347000 500 http://snomed.info/sct
2015-01-26T15:33:13-05:00 2015-01-26T15:33:13-05:00
**woohoo**
FHIRinternallyusesmarkdowntodefineitself…willtheEHRdosotoo?
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Data Types: Composites
43
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Data Types: Composites
44
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Other Model Concepts: Identifiers
45
• FHIR resources are scoped around identifiable things (Patients, Orders, Locations, etc.)
• Identifiers consist of a System and an Identifier • For example:
• System: http://uhn.ca/ns/mrn • Identifier: 7000135
• Other systems: • http://hl7.org/fhir/sid/us-ssn
(US SSN) • urn:oid:2.16.840.1.113883.4.3.1
(Alabama Driver’s License)
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Other Model Concepts: Identifiers
46
• HL7 maintains a standard list of identifier systems (but it is very US-centric) • http://hl7.org/fhir/2016Sep/identifier-
registry.html
• It is very common for organizations to define their own identifier systems, e.g. • http://uhn.ca/ns/mrn
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Other Model Concepts: Coded Values
47
• Many things are drawn from a set of allowable coded values
• A coded value consists of a Code System and a Code, and optionally a Display Text
• For example: • System: http://snomed.info/sct • Code: 267038008 • Display: Edema (finding)
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Other Model Concepts: Coded Values
48
• HL7 also maintains a list of standard code systems: • http://hl7.org/fhir/2016Sep/terminologies-
systems.html
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Parts of a Resource
Resource
Metadata
Narrative
Body
Extensions
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Parts of a Resource
Resource
Metadata
Narrative
Body
Extensions
ResourceIDResourceVersionTagsProfiles
*moreonthesethingslater
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Parts of a Resource
Resource
Metadata
Narrative
Body
ExtensionsAnyinformationthatdidn’tfitinthe80%
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Parts of a Resource
Resource
Metadata
Narrative
Body
Extensions Human-readableversionofthecontent(optionalbutencouraged)
CDAhastaughtusthatthisisveryimportant
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Parts of a Resource
Resource
Metadata
Narrative
Body
Extensions
Theactualdata
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FHIR Wire Format• FHIR defines a wire format for serializing
resources in both XML and JSON • RDF is proposed as a 3rd wire format
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Let’s Make it Real in JSON{ "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" }, "effectiveDateTime":"2015-02-12T09:30:00-05:00", "valueQuantity":{ "value":11.2, "system":"http://unitsofmeasure.org", "code":"mg/dL" }, "device":{ "reference":"Device/23324" }
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Let’s Make it Real in JSON{ "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" }, "effectiveDateTime":"2015-02-12T09:30:00-05:00", "valueQuantity":{ "value":11.2, "system":"http://unitsofmeasure.org", "code":"mg/dL" }, "device":{ "reference":"Device/23324" }
Metadata(ID&Version)
Extensions
Humanreadablenarrative
Body
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Let’s Make it Real in XML<Observation xmlns="http://hl7.org/fhir"> <id value="287"/> <meta> <versionId value="2"/> </meta> <text> <div xmlns="http://www.w3.org/1999/xhtml">Fasting glucose of <b>11.2 mg/dl</b> </div> </text> <extension url="http://uhn.ca/fhir/readings#context"> <valueCode value="BREAKFAST"/> </extension> <status value="final"/> <code> <coding> <system value="http://loinc.org"/> <code value="41604-0"/> <display value="Fasting glucose [Mass/volume] in Capillary blood by Glucometer"/> </coding> </code> <subject> <reference value="Patient/1"/> </subject> <effectiveDateTime value="2015-02-12T09:30:00-05:00"/> <valueQuantity> <value value="11.2"/> <system value="http://unitsofmeasure.org"/> <code value="mg/dL"/> </valueQuantity> <device> <reference value="Device/23324"/> </device> </Observation>
Metadata(ID&Version)
Extensions
Humanreadablenarrative
Body
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Instantiating the Model: Primitive Types
{ "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" }, "effectiveDateTime":"2015-02-12T09:30:00-05:00", "valueQuantity":{ "value":11.2, "system":"http://unitsofmeasure.org", "code":"mg/dL" }, "device":{ "reference":"Device/23324" } }
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Instantiating the Model: Composite Types
{ "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" }, "effectiveDateTime":"2015-02-12T09:30:00-05:00", "valueQuantity":{ "value":11.2, "system":"http://unitsofmeasure.org", "code":"mg/dL" }, "device":{ "reference":"Device/23324" } }
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Instantiating the Model: References
{ "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" }, "effectiveDateTime":"2015-02-12T09:30:00-05:00", "valueQuantity":{ "value":11.2, "system":"http://unitsofmeasure.org", "code":"mg/dL" }, "device":{ "reference":"Device/23324" } }
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Instantiating the Model: Cardinalities
{ "resourceType":"Observation", "id":"287", "meta":{ "versionId":"2" }, "extension":[{ "url":"http://uhn.ca/fhir/readings#context", "valueCode":"BREAKFAST" }], "text":{ "div":"<div>Fasting glucose of <b>11.2 mg/dl</b></div>" }, "status":"final", "code":{ "coding":[{ "system":"http://loinc.org", "code":"41604-0", "display":"Fasting glucose [Mass/volume] in Capillary blood by Glucometer" }] }, "subject":{ "reference":"Patient/1" }, "effectiveDateTime":"2015-02-12T09:30:00-05:00", "valueQuantity":{ "value":11.2, "system":"http://unitsofmeasure.org", "code":"mg/dL" }, "device":{ "reference":"Device/23324" } }
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Instantiating the Model: Invariants
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The Data Model
ExchangingHealthDatainFHIRThe RESTful API
FHIR ServersOpen Source Tools
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FHIR Paradigms• FHIR aims to support these four kinds of
exchange
REST Documents
Messages Services
Ourmaininteresttoday
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REST• FHIR has a very powerful API for interacting with
resources based on the principles of REST (Representational State Transfer)
• Make “Resources” URI addressable • Use HTTP to do CRUD operations, and much more • Interactions in FHIR are described in terms of two
roles: Client and Server
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REST for Diabetes Devices: Example Use Cases• The Continua Model
• The Health Management App Model
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GlucoseProfileEnd-To-EndDemo
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{ "resourceType": "Observation", "status": "final", "code": { "coding": [ { "code": "2339-01" } ] }, "subject": { “reference": “Patient/PATIENTA" }, "effectivePeriod": { "start": "2016-08-17T07:36:29-07:00", "end": "2016-08-17T07:36:33-07:00" }, "valueSampledData": { "origin": { "value": 0, "unit": "mg/dL", "system": "http://loinc.org" }, "period": 1000, "data": "260 260 264 264 266 266 270 270 272 272 " } }
GlucoseProfileEnd-To-EndDemo
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Resource Identities• Every FHIR resource has a unique identity, which
is in fact a URL
http://fhirtest.uhn.ca/baseDstu2/Patient/1
FHIRServerEndpoint
ResourceType
ResourceID
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CRUD: CreatePOST http://fhirtest.uhn.ca/baseDstu2/Patient Content-Type: application/json+fhir
{“resourceType”:”Patient” …… }
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CRUD: Create
201 Created
Content-Location: http://fhirtest.uhn.ca/baseDstu2/Patient/1841460/_history/1
POST http://fhirtest.uhn.ca/baseDstu2/Patient Content-Type: application/json+fhir
{“resourceType”:”Patient” …… }
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201 Created
Content-Location: http://fhirtest.uhn.ca/baseDstu2/Patient/1841460/_history/1
ID Version
• Two URLs are implied here: versionless and version specific
• The server maintains a complete version history (more in this in a minute)
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CRUD: Read
GET http://fhirtest.uhn.ca/baseDstu2/Patient/1
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CRUD: Create
201 Created
Content-Location: http://fhirtest.uhn.ca/baseDstu2/Patient/1841460/_history/1
Content-Type: application/fhir+json; charset=utf-8
{
“resourceType”:”OperationOurcome”
"issue": [{
"severity": "error",
"code": "code-invalid",
"details": {"text": "The code \"W\" is not known and not legal in this context" }]
}
• The server might also return a special OperationOutcome resource with status information
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CRUD: Read
GET http://fhirtest.uhn.ca/baseDstu2/Patient/1
200 OK Content-Type: application/json+fhir { “resourceType”: “Patient” …………. }
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CRUD: Read
• Demo time
GET http://fhirtest.uhn.ca/baseDstu2/Patient/98188
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CRUD: Read
GET http://fhirtest.uhn.ca/baseDstu2/Patient/1?_format=xml
200 OK Content-Type: application/xml+fhir <Patient …………></Patient>
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CRUD: UpdatePUT http://fhirtest.uhn.ca/baseDstu2/Patient Content-Type: application/json+fhir
{“resourceType”:”Patient” …… }
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CRUD: Update
200 OK
Content-Location: http://fhirtest.uhn.ca/baseDstu2/Patient/1841460/_history/2
PUT http://fhirtest.uhn.ca/baseDstu2/Patient/1 Content-Type: application/json+fhir
{“resourceType”:”Patient” …… }
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CRUD: Delete
200 OK
DELETE http://fhirtest.uhn.ca/baseDstu2/Patient/1841460
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Try it Out» Take a resource: https://goo.gl/LclVdM
» Upload it to: http://fhirtest.uhn.ca
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The Web of Health Resources• Reading one resource can reveal a resource with
links to other resources
name: “Chest XRay” status: “complete” subject: “Patient/242” author: “Practitioner/15”
http://acme.com/DiagnosticReport/62name: “Jim Tester” birthDate: “1999-01-02”
http://acme.com/Patient/242
name: “Dr Fakie Faker” address: “Better Health Clinic”
http://acme.com/Practitoner/15
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The Web of Health Resources• Reading one resource can reveal a resource with
links to other resources
name: “Chest XRay” status: “complete” subject: “Patient/242” author: “Practitioner/15”
http://acme.com/DiagnosticReport/62name: “Jim Tester” birthDate: “1999-01-02”
http://acme.com/Patient/242
name: “Dr Fakie Faker” address: “Better Health Clinic”
http://acme.com/Practitoner/15
RelativeLinks
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ServerA:acme.com
name: “Chest XRay” status: “complete” subject: “Patient/242” author: “http://foo.com/Practitioner/15”
http://acme.com/DiagnosticReport/62 name: “Jim Tester” birthDate: “1999-01-02”
http://acme.com/Patient/242
The Web of Health Resources• Resources can be distributes across servers too
ServerB:foo.com
name: “Dr Fakie Faker” address: “Better Health Clinic”
http://foo.com/Practitoner/15
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Bundle
name: “John Smith” Patient/242
The Bundle Resource• Sometimes we need to package multiple
resources together
name: “Frank Higgins” Patient/105
name: “Ross Frinz” Patient/3998
name: “Some Name” Patient/15
Metadata• We use a special
container resource called “Bundle”
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Resource History• FHIR servers keep track of the complete history of a given resource instance • This way, the client doesn’t need to keep track
Patient/1/_history/1family: ”Agnew” given: ”Jamesss” gender: ”female”
Patient/1/_history/2family: ”Agnew” given: ”James” gender: “male”
Patient/1/_history/3family: ”Agnew” given: ”James” gender: “male” address:”342 Evergreen T.”
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The History Operationhttp://fhirtest.uhn.ca/baseDstu2/Patient/1/_history
Patient/1/_history/1family: ”Agnew” given: ”Jamesss” gender: ”female”
Patient/1/_history/2family: ”Agnew” given: ”James” gender: “male”
Patient/1/_history/3family: ”Agnew” given: ”James” gender: “male” address:”342 Evergreen T.”
Bundle
Patient/1/_history/3Patient/1/_history/1Patient/1/_history/2Patient/1/_history/1Patient/1/_history/1Patient/1/_history/1
Patient/1/_history/1
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The History Operation: Paging
http://fhirtest.uhn.ca/baseDstu2/Patient/1/_history http://fhirtest.uhn.ca/baseDstu2/Patient/1/_history?_count=100
Bundle
Patient/1/_history/15Patient/1/_history/1Patient/1/_history/14Patient/1/_history/1Patient/1/_history/13Patient/1/_history/1
Metadata
Patient/1/_history/12Patient/1/_history/1Patient/1/_history/11Patient/1/_history/1
• What if there is lots of history?
LinktoNextPage
TopNanswers
IncreaseN
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The History Operation: Modes
http://fhirtest.uhn.ca/baseDstu2/_history
http://fhirtest.uhn.ca/baseDstu2/Patient/_history
http://fhirtest.uhn.ca/baseDstu2/Patient/1/_history
• There are 3 kinds of history
Server (all resources) Type (same type) Instance (same ID)
• History can be used as a simple polling mechanism for subscription
http://fhirtest.uhn.ca/baseDstu2/Patient/1/_history? _since=2011-02-23T15:00:01.0032-05:00
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Searching for Resources• Searching is one of the most powerful parts of the
FHIR RESTful API • Searches take the form:
http://fhirtest.uhn.ca/baseDstu2/Patient?name=smith
FHIRServerEndpoint
ResourceType
SearchParams
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Searching for Resources• A basic search: find everything
200 OK
<Bundle ……>
GET http://fhirtest.uhn.ca/baseDstu2/Patient
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Searching for Resources• Every resource type defines a set of search
parameters • Let’s look at some search parameters:
http://hl7.org/fhir/patient.html
GET http://fhirtest.uhn.ca/baseDstu2/Patient?name=smith
SearchbyName
GET http://fhirtest.uhn.ca/baseDstu2/Patient?birthdate=2008-03-15
SearchbyBirthDate
GET http://fhirtest.uhn.ca/baseDstu2/Patient?gender=male
SearchbyGender
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Patient?family=smithString
[base]/Patient?family:exact=SmithExact String
LeftmatchesSMITH,smith,smithson,etc.
MatchesSmith
[base]/Patient?family:contains=smithPartial String
MatchesSmith,Smithson,andNaismith
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Patient?name=smith,jonesOR
[base]/Patient?family=smith,jones&given=johnAND
MatchessmithORjones
Matches“JohnSmith”or“JohnJones”
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Patient?birthdate=2013-02-12Date
[base]/Patient?birthdate=2013Year
[base]/Patient?birthdate=ge2013&birthdate=lt2016Range
Qualifiers:gt,ge,lt,le
Matchbothtoformarange
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Search Parameter TypesParameters can be combined
[base]/Patient?family=smith,jones&birthdate=2013-02-12
MatchessmithORjoneswithbirthdateFeb12,2013
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Encounter?length=gt30Number
Matchesencounterslongerthan30days
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Observation?code=http://loinc.org|41604-0Code
Matchesbloodglucoseobservations
[base]/Observation?code:in=http://snomed.info/sct|65533Code Hierarchy
Matchesanychildtypes
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Observation?value-quantity=ge11|mg/dl|http://unitsofmeasure.org
With Units
Matches>=11mg/dl
[base]/Observation?value-quantity=ge11Any Units
Matches>=11(anyunits)
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
• URI and Composite are defined here: • http://hl7.org/fhir/search.html
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Search Parameter TypesFHIR defines eight search parameter types: String, Date, Number, Token, Quantity, URI, Reference, Composite
[base]/Observation?subject=Patient/1Code
Matchesallobservationsforthegivenpatient
[base]/Observation?subject.family=smithChained
Matchesanyobservationsforapatientnamedsmith
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Other Search FeaturesThese parameters apply to any resource
[base]/Observation?_lastUpdated=gt2016-02-22T15:22:00ZBy Last Updated Time Matchesallobservationsupdatedafterthedate
[base]/Observation?_sort:desc=birthdateSorting resultsSortstheresultsbybirthdate
[base]/Observation?_include=Observation:subjectInclude linked resources Alsoreturnpatients
[base]/Observation?_count=100CountAdjustpagesize
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Taking Search for a Spin» Search for Systolic Blood Pressure
» http://fhirtest.uhn.ca/baseDstu2/Observation?code=http://loinc.org|8480-6
» http://goo.gl/4TWIlp
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Keep Spinning» Search for Systolic Blood Pressure
» http://fhirtest.uhn.ca/baseDstu2/Observation?code=http://loinc.org|8480-6&value-quantity=gt120
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FHIR Servers
The Data Model
WheretogetdataandwhoisusingFHIR
The RESTful API
Open Source Tools
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Open Source Tools» UHN maintains a free Java Implementation for both clients
and servers
http://jamesagnew.github.io/hapi-fhir/
» Libraries for C#, Swift, JavaScript, XML, Delphi are available under ‘code’
http://hl7-fhir.github.io/
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FHIR Servers
The Data Model
WheretogetdataandwhoisusingFHIR
The RESTful APIOpen Source Tools
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Publicly Available Test Servers• Reading one resource can reveal a resource with
links to other resources
http://fhir-dev.healthintersections.com.au/open (HealthIntersections)
http://fhirtest.uhn.ca/baseDstu2 (UHN)
http://spark.furore.com/fhir (Furore)
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Host Your Own Copy» HAPI’s Command Line Tool can give you a local
version of the FHIR test server you can play with
http://jamesagnew.github.io/hapi-fhir/doc_cli.html
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Securing FHIR: The Basics• TLS and HTTP Basic Auth is a simple but popular
approach for system level authentication
GET https://fhirtest.uhn.ca/baseDstu/Patient/1 Authorization: 329fe89hfew38fs3fs4fg3s8oh4sg=
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Securing FHIR: The Basics• OAUTH2 is being explored for AuthZ/AuthN
IdentityServer
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Why OAUTH?
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SMART Platforms / SMART-on-FHIR
• SMART is an industry-led project to combine OAUTH2 and FHIR
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The App Store for Health• Demo time:
• https://gallery.smarthealthit.org
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Project Argonaut• Project Argonaut is a collaborative project to test/
validate the FHIR data model and SMART auth standards
• Over 70 participating organizations
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Project Argonaut
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What Does The Future Hold?• Several implementations of these standards are
going live this year • Vendors are expected to start selling compliant
API modules this year
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Profiling and ExtensionsAdoptingFHIRforaspecificuse
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Curious Mathhttp://server.org/fhir/Patient/ 406 hits http://server.org/fhir/Patient?gender=M 234 hits http://server.org/fhir/Patient?gender=F 167 hits Total: 234 + 167 = 401
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Curious Mathhttp://server.org/fhir/Patient/ 406 hits http://server.org/fhir/Patient?gender=M 234 hits http://server.org/fhir/Patient?gender=F 167 hits http://server.org/fhir/Patient?gender:missing=true 5 hits Total: 234 + 167 + 5 = 406
• This highlights an important point: very little is required in FHIR
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Very Little is “Mandatory” in FHIR
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Profiling and Extensions» FHIR uses resources to profile itself » FHIR defines 3 resources which can be used to profile
resources for a specific use » StructureDefinition: This defines a resource’s
structure (including extensions) » ValueSet: This defines a set of allowable codes » NamingSystem: This defines identifier namespaces » ImplementationGuide: Packages these together
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StructureDefinition» StructureDefinition is has two main purposes:
» It defines constraints on a given resource » e.g. “Patient.gender has cardinality 1..1”
» It defines extensions on a given resource » e.g. “Patient has eye colour extension”
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ValueSet• A ValueSet is a collection of codes allowed for a
specific purpose • Individual coded fields in FHIR’s model are “bound”
to a ValueSet
CodeSystem(e.g.SNOMEDCT,LOINC)
Code(e.g.12345=Hb)
ValueSet(e.g.Codesallowedinahaematologypanel)
Defines
Composes
OtherCodes
Composes
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Value Set Bindings• Specific fields in FHIR are “bound” to a ValueSet
with a specific strength • Required: Use one of these codes • Extensible: Use one of these codes if one of
them applies, otherwise use whatever • Preferred: Try to use one of these codes • Example: Here’s some codes you could use
• Demo time: • http://hl7.org/fhir/patient.html
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NamingSystem» Defines an identifier scheme, e.g.
University Health Network MRNs could be defined as http://uhn.ca/ns/mrn
» This URL could resolve to a definition » In practice this is not used much.. yet…
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ImplementationGuide» A tool called Forge can be used to create a complete ImplementationGuide, including all required resources » http://fhir.furore.com/Forge
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Company
FHIRSpecification
NationalAuthority
RegionalAuthority
FHIRSpecification
FHIRSpecification
Profiling FHIR: Top-Down or Bottom-Up
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Profiling and Extensions» If nothing in FHIR meets your needs, you are still
allowed to create your own custom resource definitions
» This is discouraged because it is bad for interoperability! (but there are valid reasons for doing it)
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Useful ResourcesAguidetosomemodelscoveredbyFHIR
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FHIR Data Models are Found Here
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Person vs. Patient» Person is actually intended as a link between other
resources, as opposed to a standalone thing
Patient Practitioner
EncounterObservation
DiagnosticReport
Order
Schedule
Person
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Security & Consent Management» Three resources are particularly interesting to
the security domain: » Consent - Tracking Privacy Consent
Directives » Provenance - Tracking the provenance of
other resources » AuditEvent - Tracking access/disclosure of
data by a system user
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Some Advanced FeaturesWhat’sHappening
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Transactions• Transactions use a bundle to package a
number of FHIR operations into a single atomic transaction as a Bundle
Bundle
PatientPatient/1/_history/1AllergyIntolerancePatient/1/_history/1AllergyIntolerancePatient/1/_history/1
Type:Transaction
OrderPatient/1/_history/1
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Order/1Lab test order
Tagging• Resources have a set of tags which are maintained outside
of the standard versioning scheme • Often used for workflow
CreateResourceAddTag:NeedsReview
FindresourceswithTag:NeedsReviewDeleteTag:NeedsReviewAddTag:SignedOff
FindresourceswithTag:SignedOff
1
2
3
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Order/73/_history/1Lab test order
Contention Aware Updating• ETAG (RFC7232) is used to prevent race
conditions
PUT Order/73 ETag: W/“1”
<Order …></Order>
PUT Order/73 ETag: W/“1”
<Order …></Order>
BA
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Order/73/_history/1Lab test order
Contention Aware Updating• ETAG (RFC7232) is used to prevent race
conditions
200 OK
412 Precondition Failed
BA
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FHIR TimelinesWhat’sHappening
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FHIR
CDA
HL7Version3
HL7Version2
The Past
1980 1990 2000 2010 2016
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FHIR
CDA
HL7Version2
The Future
2010 2015 2020 beyond?
2010 2015 2020 beyond?
FHIRProjectStarted
DSTU1Released
DSTU2Released
DSTU3tobeReleased
Firstnormativeballot
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Plans to go Normative» FHIR will probably not have any normative content until
2019 » This does not mean it’s not ready for use! » Lots of people are using FHIR today for production
applications
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FHIR ProcessWheredoesFHIRcomefrom?
![Page 145: 20160817 - FHIR HCT Workshopstandards.ehealthinnovation.org/files/FHIR-Overview.pdf · • FHIR is an attempt to define a free and open data API for health data, based on modern techniques](https://reader036.vdocument.in/reader036/viewer/2022081607/5eda3904b3745412b570fac6/html5/thumbnails/145.jpg)
FHIR Process
PatientAdministration
OrdersandObservations
FinancialManagement
FHIRInfrastructure
ClinicalGenomics
etc…..
WorkGroups
![Page 146: 20160817 - FHIR HCT Workshopstandards.ehealthinnovation.org/files/FHIR-Overview.pdf · • FHIR is an attempt to define a free and open data API for health data, based on modern techniques](https://reader036.vdocument.in/reader036/viewer/2022081607/5eda3904b3745412b570fac6/html5/thumbnails/146.jpg)
FHIR Process
PatientAdministration
OrdersandObservations
FinancialManagement
FHIRInfrastructure
ClinicalGenomics
etc…..
WorkGroups..defineresources
ResourceDefinitions
ResourceDefinitions
![Page 147: 20160817 - FHIR HCT Workshopstandards.ehealthinnovation.org/files/FHIR-Overview.pdf · • FHIR is an attempt to define a free and open data API for health data, based on modern techniques](https://reader036.vdocument.in/reader036/viewer/2022081607/5eda3904b3745412b570fac6/html5/thumbnails/147.jpg)
FHIR Process
PatientAdministration
OrdersandObservations
FinancialManagement
FHIRInfrastructure
ClinicalGenomics
etc…..
WorkGroups..defineresources..whichgettested
ResourceDefinitions
Conn
ectathon
ResourceDefinitions
Ballot
![Page 148: 20160817 - FHIR HCT Workshopstandards.ehealthinnovation.org/files/FHIR-Overview.pdf · • FHIR is an attempt to define a free and open data API for health data, based on modern techniques](https://reader036.vdocument.in/reader036/viewer/2022081607/5eda3904b3745412b570fac6/html5/thumbnails/148.jpg)
FHIR Process
PatientAdministration
OrdersandObservations
FinancialManagement
FHIRInfrastructure
ClinicalGenomics
etc…..
WorkGroups..defineresources..whichgettested..andballotted
ResourceDefinitions
Conn
ectathon
ResourceDefinitions
Ballot
![Page 149: 20160817 - FHIR HCT Workshopstandards.ehealthinnovation.org/files/FHIR-Overview.pdf · • FHIR is an attempt to define a free and open data API for health data, based on modern techniques](https://reader036.vdocument.in/reader036/viewer/2022081607/5eda3904b3745412b570fac6/html5/thumbnails/149.jpg)
FHIR Process
PatientAdministration
OrdersandObservations
FinancialManagement
FHIRInfrastructure
ClinicalGenomics
etc…..
WorkGroups..defineresources..whichgettested..andballotted
ResourceDefinitions
Conn
ectathon
ResourceDefinitions
Ballot
![Page 150: 20160817 - FHIR HCT Workshopstandards.ehealthinnovation.org/files/FHIR-Overview.pdf · • FHIR is an attempt to define a free and open data API for health data, based on modern techniques](https://reader036.vdocument.in/reader036/viewer/2022081607/5eda3904b3745412b570fac6/html5/thumbnails/150.jpg)
Questions?
150