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WHAT IS FHIR

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Università degli Studi di Trieste

Dipartimento di Ingegneria e Architettura

Corso di Laurea Magistrale in INGEGNERIA CLINICA

HEALTH INFORMATICS STANDARD

Corso di Informatica Medica

Docente Sara Renata Francesca MARCEGLIA

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WHAT IS FHIR

FHIR

A standard describing health data formats and

elements (“resources”)

An application

programming interface (API) for exchanging

electronic health records

FHIR enables health data to be moved using standard Web protocols and allows developers to more easily

interact with health data across diverse systems

(4)

FHIR USE

(5)

FHIR USE

(6)

FHIR TIMELINE

(7)

FHIR USE

Apple Health uses FHIR CommonHealth is a similar initiative for Android

(8)

FHIR RESOURCES

- Specification of information structure in FHIR

- Basic building blocks to manage any type of information

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DIFFERENT VIEWS

(10)

DIFFERENT VIEWS

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REST API

• REST = REpresentational State Transfer

• It is an architectural style used to build Web services that are lightweight, maintainable, and scalable in nature.

• A service which is built on the REST architecture is called a RESTful service.

• The underlying protocol for REST is usually HTTP, which is the basic web protocol. However, other protocols (SMTP etc) can be used.

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REST KEY COMPONENTS

Resources – Element that contains the information.

Request Verbs - Description of what you want to do with the resource.

• The basic request is GET ( = retrieve data)

• POST (=create a new element)

• PUT (= update an existing element)

• DELETE (= delete an element)

Request Headers – Additional instructions sent with the request (type of response required, authorization details)

Request Body - Data is sent with the request (usually in a POST call

Response Body – This is the main body of the response (XML document, JSON) Response Status codes –General codes which are returned along with the response from the web server. (200 = OK, 404 = NOT FOUND)

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JSON

JSON = JAVASCRIPT OBJECT NOTATION

Format to represent data exchanged in the Internet based on the concept of key = value

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FHIR JSON EXAMPLE

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RESOURCES EVOLVE IN TIME

LIST OF

RESOURCES FOR THE DRAFT STANDARD FOR TRIAL USE (DSTU)

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RESOURCES EVOLVE IN TIME

LIST OF

RESOURCES FOR R4 (FIRST

NORMATIVE)

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FHIR SERVER

https://fhirtest.uhn.ca/home?encoding=null&pretty=true

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CONFORMANCE STATEMENT

TYPES OF RESOURCES SUPPORTED

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EXAMPLES

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SMART ON FHIR

Authentication framework between EHR and FHIR

Allows the FHIR app to work

without

knowing the FHIR server

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SMART ON FHIR

When the patient’s authentication is done, you can retrieve data without knowing the patient (works with the “current” patient) à smart.patient.api

At the population levelà smart.api

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FHIR vs CDA2

FHIR

• Atomic access to medical data via a RESTful API

• Allows interaction with data (update, create,

etc)

• Modular approach, no limitation on contents

• Human readable

• Based on HL7 v3

CDA-2

• Definition of a

structured document for patient’s record

• Built as a read-only document

• The content of the

document is expressed using a complex and extremely abstract

model based on HL7's

"Clinical Statement”

• Human readable

• Based on HL7 v3

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IHE

100

(24)

Integrating the Healthcare Enterprises

101

IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively.

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IHE aims

• Born in 1998 in USA from Radiological Society of North America

(RSNA) e Healthcare Information and Management Systems Society (HIMSS)

• IHE is not a communication standard à it has the aim to define how the available standards have to be used in practice to implement system integration:

To facilitate health information integration;

To provide support functionalities for EHRs;

To boost standard adoption;

To promote the communication aming vendors;

To improve efficacy and efficiency in clinical practice;

To improve ICT security and privacy;

• Interoperability à definition of an information exchange process known as profile.

102

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IHE domains

103

• IHE is organized by clinical and operational domains.

• In each domain users with clinical and operational experience identify integration and information sharing priorities and vendors develop consensus, standards-based solutions to address them.

• Each domain includes a technical committee, whose primary task is developing and

documenting the solutions (= integration profiles).

• Each domain includes a planning committee à long-term scope planning and organizing

deployment activities.

• Each domain develops and maintains its own set of Technical Framework documents.

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IHE profiles

• A profile is an abstract representation of the real world that defines the implementaion specifications of one or more “use cases”:

• Communication processes

• Type of information exchanges

• Actions to be done when the information is received

• Each profile is characterized by:

• ACTORS: healthcare information systems that mange the

communication activities (es. ADT, Order Placer, Order Filler, etc.);

• TRANSITIONS: standard-based information exchange among actors (ex. HL7). Each transaction is characterized by the refernce standard and other information.

• In each profile, a table lists the actors and the transactions of the specific case.

104

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Example: the Laboratory Testing Workflow (LTW) overview

105

(29)

Example: LTW actors and transactions

106

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Example: LTW actors and transactions reference messages

107

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Example: LTW process flow for placer ordering

108

(32)

Example: OML^O21 message for the LAB-1 transaction in LTW

109

(33)

Connectathon

110

Annual plenary session among all the vendors and clinical and operational experts that test the profile

implementations to define the integration level

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