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Overview of Argonaut Initiatives
Brett Marquard, WaveOne
Instructor
Brett Marquard
• Principal, WaveOne Associates
• Extensive EHR experience
• Primary Editor, Consolidated CDA (C-CDA)
• Primary Editor, Argonaut Data Query IG / US FHIR Core IG
Outline
Background on Argonaut
Key Prior Initiatives
• SMART on FHIR support
• Data Query and Document Query
• Scheduling
• Provider Directory
• CDS Hooks support
Future
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What is the Argonaut Project?
The Argonaut Project is an implementation community comprising leading
technology vendors and provider organizations to accelerate the use of FHIR and
OAuth in health care information exchange.
We are:
• Private sector initiated and funded
• Working collaboratively with other FHIR initiatives such as SMART-on-FHIR, the Health
Systems Platform Consortium, and the FHIR Foundation
• Creating open industry Implementation Guides in high priority use cases of importance to patients, providers and the industry as a whole
We are NOT:
• A standards development organization
• A separate legal entity
• A proprietary activity
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Technology Vendors Provider Organizations
• Accenture • Beth Israel Deaconess Medical Center
• Apple • Intermountain Health
• athenahealth • Mayo Clinic
• Cerner • Partners Healthcare
• Epic • SMART at Boston Children’s Hospital • Change Healthcare
• MEDITECH
• Surescripts
• The Advisory Board Company/Optum
Staff (current and past)
• Prime contractor: HL7
• FHIR initiatives: Grahame Grieve, Josh Mandel, Brett Marquard, Eric Haas
• OAuth initiatives: Dixie Baker, Josh Mandel
• Project Management: Micky Tripathi, Jennifer Monahan
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Argonaut Project Timeline
JASON Task Force
Recommendations
Oct 2014 Dec 2014 Oct 2015
Call to action for
APIs and FHIR
Launch of
Argonaut Project
EHR certification
includes API requirement
Dec 2016
S&I Initiative
Data Access
Framework
Data Query
Implementation Guide published
Provider Directory
Implementation Guide published
Jun 2017 Mar-May 2018
Scheduling Implementation Guide
CDS Hooks Implementation Guide
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Four Short Years from Inception to Market Adoption
50% of 100+ certified
vendors use FHIR APIs
Jan 2018
CommonWell includes
Argonaut FHIR specifications in core services – MEDITECH goes live on FHIR
Carequality implements
Argonaut Provider Directory specifications
Apple enables secure iPhone
access to medical records using Argonaut
Implementation Guide
Prior Argonaut Initiatives
SMART on FHIR support
Data Query and Document Query
Provider Directory
Scheduling
CDS Hooks support
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SMART on FHIR Support
When
Summer 2015
What SMART Health IT is an open, standards based technology platform that enables innovators to create apps that seamlessly and securely run across the healthcare system. SMART on FHIR provides reliable, secure authorization for a variety of app architectures through the use of the OAuth 2.0 standard.
Outcomes • Application Authorization Profile available: http://docs.smarthealthit.org/authorization/
• Use Cases Description, Version 1.1 available: http://argonautwiki.hl7.org/images/4/4c/Argonaut_UseCasesV1.pdf
• Security Risk Assessment: http://argonautwiki.hl7.org/images/e/ed/%282015May26%29RiskAssessment_ReportV1.pdf
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https://smarthealthit.org/
http://www.hl7.org/fhir/smart-app-launch/
Data Query and Document Query
When ~2015 - 2017
What Guidance to meet the 2015 Edition certification criterion for Patient Selection 170.315(g)(7) and Application
Access – Data Category Request 170.315(g)(8). The Argonaut Data Query Implementation Guide is based upon
the core FHIR DSTU2 API. Original work built on the Data Access Framework (DAF).
Use Cases This specification describes four use cases and sets search expectations for each. For complete details and
background, see Use Cases for the Argonaut Project:
1. Patient uses provider-approved web application to access health data
2. Patient uses provider-approved mobile app to access health data
3. Clinician uses provider-approved web application to access health data
4. Clinician uses provider-approved mobile app to access health data
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Data Query and Document Query
Outcomes • Published Data Query guide: http://www.fhir.org/guides/argonaut/r2/
• Published DocumentReference profile: http://www.fhir.org/guides/argonaut/r2/StructureDefinition-argo-documentreference.html
• Guidance on ‘Must Support’, free text units, vocabulary binding: http://www.fhir.org/guides/argonaut/r2/definitions.html
• Implementation: many Argonaut vendors support FHIR according to Argonaut DSTU2
…oh, and US Core
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US FHIR Core
The US FHIR Core is a labeled subset of all HL7 US-Realm produced FHIR profiles.
The label is designed to provide the community with a single point of reference to
foundational US FHIR profiles that:
1) should be used by US stakeholders when implementing FHIR; and
2) always be used as the basis for creating further US-Realm profiles.
Bottom line • Argonaut IG = US Profiles on DSTU2
• US Core = HL7 balloted US Profiles on STU3
Future • Argonauts – encouraged to use US FHIR Core rather than writing their own FHIR STU3 guide.
• US Core – discussions at HL7 US Realm Steering Committee to add new profiles to US Core, such as Clinical Notes.
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For more details checkout
Data Query US Core
Today 6/20 at 14:20
Provider Directory
When
2016
What The Argonaut project Provider Directory guide is based upon the FHIR STU3 API and contains the foundation for a robust provider directory. It describes the use cases and search expectations for finding a practitioner or organization. It outlines the key data elements for any provider directory and basic query guidance.
Outcomes • Published Implementation Guide: http://www.fhir.org/guides/argonaut/pd/
• Developed organization relationship guidance: http://www.fhir.org/guides/argonaut/pd/guidance.html
• Carequality Implementation
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Provider Directory Use Cases
Search for Practitioner by demographics • Name • Specialty
Search for Practitioner within a region (city, state) • Practitioner or specialty within a specified distance - 10 miles from patient home • Show me every one of this specialty in the city
Search for Organization and facility by: • Name • Address
Search for Practitioner by organizational relationships • Practitioner in a specific health organization (e.g. Baptist Health Organization) • Practitioner in a specific clinic (e.g. West Clinic)
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Patient and Provider Scheduling
When
2017
What The Argonaut Scheduling Project is a vendor agnostic specification providing FHIR RESTful APIs and guidance for access to and booking of appointments for patients by both patient and practitioner end users. This specification is based on FHIR Version 3.0.1 and specifically the Scheduling and Appointment resources.
Outcomes • Published Implementation Guide: http://www.fhir.org/guides/argonaut/scheduling/
• Several new Scheduling operations: http://www.fhir.org/guides/argonaut/scheduling/operations.html
• Implemented by a subset of Argonaut participants
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For more details checkout
The Argonaut Scheduling
Project session
Thursday 6/21 at 09:00
CDS Hooks Support
When
2017 - 2018
What A vendor agnostic remote decision support specification.
The specification describes a "hook"-based pattern for invoking decision support from within a clinician's EHR workflow. The API supports: Synchronous, workflow-triggered CDS calls returning information and suggestions, Launching a user-facing SMART app when CDS requires additional interaction.
Outcomes • Supported march to CDS Hooks 1.0 (currently under HL7 ballot): http://cds-hooks.org/specification/1.0/
• Quick Start guide: http://cds-hooks.org/quickstart/
• Security Risk Assessment
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CDS Hooks 1.0
http://cds-hooks.org/specification/1.0/ 18
CDS Hooks Sandbox
http://sandbox.cds-hooks.org/ 19
Setting Priorities for 2018
Once a year the sponsors brainstorm and select projects
10+ were suggested at end of 2018
Broad categories for 2018
- New FHIR profiles
- Administrative use cases
- Additional app integration guidance
- Continue advancing prior initiatives
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Argonaut Project 2018 Projects
1. Clinical Notes
• Shouldn’t there be a Common Clinical Note Set to accompany the Common Clinical Data Set?
2. Bulk Data Access to Clinical Data
• A roster of patients rather than one patient at a time
3. Simple Assessment Questionnaires
• Import from external experts and capture/export data consistently
• Implement custom assessments across disparate systems and aggregate responses
Selected 2018 Priorities
Bulk Data + Back-end Services authorization - Josh Mandel/Dan Gottlieb
Clinical Notes - Brett Marquard/Eric Haas
Questionnaire & Questionnaire Response - Eric Haas/Brett Marquard
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https://github.com/argonautproject
Bulk Data
December 2017 ONC Meeting on Bulk Data
January 2018 SMART Bulk Data Reference Implementation Server
Initial Connectathon for interested parties to start experimenting with proposed technical
specification
2018 FHIR Connectathon events to refine and develop the technical specification
Argonaut Project to bring together pilot implementations
Publish Draft Implementation Guide
2019 Publish version 1.0 of FHIR Implementation Guide For Bulk Data
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https://github.com/smart-on-fhir/fhir-bulk-data-docs/
Clinical Notes Timelines
March 2018 Launch!
April – May 2018 May connectathon scenarios
5/12 - 5/13: HL7 Connectathon at Cologne Working Group
Review outcomes from May connectathon
Summer 2018 Argonaut Stakeholder review of IG
Develop additional examples
Determine interest in pushing recommendations into US Core STU4
Sept 2018 FHIR Connectathon events to refine and develop the technical specification
Fall 2018 Updates from connectathon
Support US Core STU4 ballot reconciliation or hand over to HL7
Winter 2018 Published IG
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https://github.com/argonautproject/clinicalnotes
Questionnaire & Questionnaire Response
April 2018 Argo Questionnaire Kickoff
Refine Scope
Define Content and technical Specifications for Draft Implementation Guide
Summer 2018 Initial Connectathon for interested parties to start experimenting with proposed technical
specification
Publish and refine Draft IG
Sept 2018 FHIR Connectathon events to refine and develop the technical specification
Fall 2018 Publish and refine Draft IG
January 2019 Published IG
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https://github.com/argonautproject/questionnaire
Participation
Review existing designs and comment use issues on GitHub
Zulip Chat Channels
• Bulk Data
• Argonaut
Upcoming HL7 Connectathon in Baltimore, MD (9/29 - 9/30)
Contact
• Eric Haas
• Josh Mandel
• Brett Marquard
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