Wednesday, September 30, 2015

#NATE/HIE Sid Thornton Intro to #HL7 #FHIR

I am at the NATE/HIE Conference in Deer Valley, UT.

#Intro to HL7 FHIR

Sid Thornton at InterMountain Healthcare.

Connectivity was always a challenge.
Data Aggregation with semantic interoperability was impossible
Unable to understand a specific patient in context of a transaction amongst a care team.

Care Coordination was stymied.

InterMountain looked to better interoperability standards. This caused them to look at FHIR.

Aren’t today’s standards good enough? Do we need another standard.

Can FHIR solve the challenge of Health Information Exchange?.

Data Movement has been a problem.
Data needs to move in anticipation of its necessary use.

Check out

FHIR – Next Generation standards Framework

FHIR maintains information context as it travels between systems.

FHIR is open source.
FHIR is a “Public API” for healthcare.

FHIR Resources are snippets of data. They get compiled in to profiles.

FHIR Resources are modular components that can be combined.

The goal of FHIR is to enable connections to be built in a day rather than months.

FHIR Resources:

Resource: Observation
Profiles could include: :Lab Obs, PAtient Obs, Family Hx Obs. etc…

FHIR Advantages:

  • Focus on implementation
  • Implementation Libraries
  • Specification is Free.
  • Evolves from HL7 V2 and CDA
  • Strongly based on Web standards that operate at scale
  • Human Readable component goes with the machine readable content.
  • Concise and well documented

In the real world of care coordination:
– We don’t know what data will be needed
– We don’t know where it needs to go and be consumed

This drives the need for PULL on Open but secure networks.

FHIR Adaptation in Utah

Utah is known for it’s high birth rate.

Intermountain delivers 35,000 new borns each year.

Newborn data bundle challenges:
– Linked results from state lab screenings
– Demographic changes
– Relevant data from prenatal and delivery care.
– Relevant Family History
– New Pediatrician
– High admission and readmission rates

Newborn FHIR APIs

  • Person disambiguation, record link
  • Demographic Update
  • Data GET for Prenatal and Delivery Care
  • Data GET for Family History
  • Provider Schedule Link
  • Provider attestation link thorough search

Hardest issue is a listener to detect provider attestation – looking at scheduling links.

Using HL7 V2 Interfaces would result in a 12-13 year project.

Poison Control Center Use Case and FHIR APIs

  • Demographic ambiguities (“I have a friend….”) record Link
  • Referral Uncertainties
  • Lab Result consultation (Push/Subscribe)
  • Case Resolution – Administrative Closure

HIE-Assisted Care Coordination

  • HIE Demographic Sync
  • HIE Activity Listener
  • HIE Privacy advocate
  • HIE Forwarding Delivery Service

UHIN has had a decade long experience/discovery of the challenges in acquiring consent.

Privacy model needs to be applied at the atomic data level. Traceability is required to the Privacy declarations as data flows around the system.

Care Coordination Broker

  • Logical processes and message handling workflows are required at the center.
  • Need backward compatibility to allow prior standard formats to be used.

The FHIR Opportunity

  • FHIR may be efficient and precise
  • Document-based HIE Care Coordination requires substantial processing overhead
  • Document-based HIE Care Coordination discloses more than minimum clinical data.

There is a significant effort to model data upfront.

  • Clinical Element Models:

CIMI – International Standard modeling effort

SMART on FHIR App Gallery

SMART APPs include SMART Neonatal Bilirubin Alerts.

Monitoring happens outside the Delivery system.

There is a concept of a Care Plan delivered as a SMART App.
This is portable across organization publishing FHIR data.

SMART Apps do NOT have to be aimed at Medical Professionals.
Consumers can use SMART Apps.

Next up I am presenting “Direct on FHIR” with Aaron Seib of NATE.

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[tag health cloud, bluebutton]

MaMrk Scrimshire

IT and Health Data Ninja

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark


I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. This involves creating a Data API. Watch out for more about BlueButton on FHIR.

The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.

Medyear: Less Hassle, Better Care.

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