HL7 FHIR Update

There are no conflicts of interest to disclose.

Bob Milius, PhDPrincipal Research Scientist, CIBMTR ITCo-chair, HL7 Clinical Genomics Work Group

• Non-profit, ANSI-accredited healthcare Standards Developing Organization (SDO)

• “HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients”

Health Level 7 International

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What would healthcare exchange look like if we started from scratch using modern approaches?

HL7 asked a question...

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HL7® FHIR®

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• Newest standard • FREE!• History

– 2011 Proposed– 2012 First version– 2017 Standard for Trial Use 3 – 2018 Next release

• Normative

• Aligns with REST services– XML, JSON

• Active Testing– Three Connectathons a year – 17th in Jan 2018 (over 5 yrs)

• Immense interest– Argonaut

• Vendor initiated project• Epic, Cerner, Intermountain, Mayo,

MEDITECH, Athena, McKesson, Partners, etc

– ONC• Sync For Science• Sync For Genes

– ASCO workshops

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Resources• “Resources” are:

– The "R" in "FHIR"– Small logically discrete units of exchange– Defined behaviour and meaning– Known identity / location– Smallest unit of transaction– “of interest” to healthcare

© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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Profiles• Constraints and extensions on one or more

resources for a use case

• May also define new extensions search terms, new messaging events, etc.

© 2015 HL7 ® Int’l. Licensed under Creative Commons. HL7, Health Level Seven, FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.

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Resources + Profiles = Solution80% 20% 100%

CIBMTR work in progress...

Work in progress...• HLA

– FHIR resources and profiles representing HLA genotyping report with allele assignment and the sequence data supporting the interpretation

• Reporting to CIBMTR: AGNIS– Adopt, adapt, validate and implement a HL7 FHIR-based

electronic exchange infrastructure as a foundation of AGNIS

– Develop, validate and implement HL7 FHIR based electronic reporting of Patient data by a Transplant Center EMR to the CIBMTR

• New FHIR Resource– BiologicallyDerivedProduct

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Work in progress...• HLA

– FHIR resources and profiles representing HLA genotyping report with allele assignment and the sequence data supporting the interpretation

• Reporting to CIBMTR: future of AGNIS– Adopt, adapt, validate and implement a HL7 FHIR-based

electronic exchange infrastructure as a future foundation of AGNIS

– Develop, validate and implement HL7 FHIR based electronic reporting of Patient data by a Transplant Center EMR to the CIBMTR

• New FHIR Resource– BiologicallyDerivedProduct

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Transplant Center DB

Transplant Center UI(s)

FormsNet UI

FormsNet DB

AGNIS On FHIR Client

AGNIS On FHIR Service

AGNIS Client

Physician

DataManager

TransplantCenter

CIBMTR

AGNIS Translator

AGNIS Service

Research Database

Internal LabsCTMS EMR

Admin Etc.

Research ETL

Research Extracts

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21. Build infrastructure

2. Patient demographic data

Reporting to CIBMTR

Current systems

New

AGNIS

External Labs

Collaborative Research Groups

e.g., BMT CTN

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• Founding member of Argonaut Project

• Integral FHIR Server in all current installations

• https://open.epic.com/Interface/FHIR

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OpenEpic & FHIR

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OpenEpic & FHIRResources available:• Patient• Provider• AllergyIntolerance• Medication • MedicationList• MedicationStatement• Condition• Observation• FamilyMemberHistory• DiagnosticReport• Immunization• CarePlan• Goal• Procedure• Device• DocumentReference• Binary

• https://open.epic.com/Interface/FHIR

Epic App Orchard• Identify mappings of

CIBMTR patient data to FHIR resource

• Using these mappings, develop a free Epic App for transplant centers to collect Patient demographic data to report to CIBMTR

• Mappings are public, and may be applied to other EMRs

• https://apporchard.epic.com/

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HL7 FHIR is used by...Project Argonaut

“The purpose of the Argonaut Project is to rapidly

develop a first generation FHIR-based API and

Core Data Services specification to enable

expanded information sharing for electronic

health records and other health information

technology based on Internet standards and

architectural patterns and styles.”

http://www.healthcareitnews.com/news/epic-cerner-others-join-hl7-project

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Argonaut Implementation Guide

http://www.fhir.org/guides/argonaut/r2/

Implementation Guides

• set of rules to solve a particular problem

• composed of a set of Profiles, each describing a different aspect of the problem

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• Client– Java, AngularJS

• Server– Java open source,

HAPI FHIR• Security

– SMART on FHIR

• Mapping– FHIR Mapping Language

• CRID assignment• Data flow

– integration into CIBMTR research ecosystem

• Implementation Guide– Set of profiles for

reporting to CIBMTR

Developing the FHIR infrastructure

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Work in progress...• HLA

– FHIR resources and profiles representing HLA genotyping report with allele assignment and the sequence data supporting the interpretation

• Reporting to CIBMTR: AGNIS– Adopt, adapt, validate and implement a HL7 FHIR-based

electronic exchange infrastructure as a foundation of AGNIS

– Develop, validate and implement HL7 FHIR based electronic reporting of Patient data by a Transplant Center EMR to the CIBMTR

• New FHIR Resource– BiologicallyDerivedProduct

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Work to do...

Transplant Center DB

Transplant Center UI(s)

FormsNet UI

FormsNet DB

AGNIS On FHIR Client

AGNIS On FHIR Service

AGNIS Client

Physician

DataManager

TransplantCenter

CIBMTR

AGNIS Translator

AGNIS Service

Research Database

External Labs

Internal LabsCTMS EMR

Admin Etc.

Research ETL

Research Extracts

Collaborative Research Groups

e.g., BMT CTN

Current systems

New

AGNIS

• Labs – HLA

• EMR – GVHD

• BMT CTN - Emmes

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Links to information and tools• HL7 FHIR

– Home

• http://hl7.org/fhir

– Current Build

• http://build.fhir.org

– Chat

• http://chat.fhir.org

– Wiki

• http://wiki.hl7.org/index.php?title=FHIR

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Tutorials/Webinar slides found in...

• https://github.com/nmdp-bioinformatics/dash/tree/master/fhir

– Introduction to FHIR– FHIR for Executives 1– FHIR for Executives 2– FHIR for Architects– FHIR for Developers

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Leadership• Doug Rizzo• Dennis Confer• Martin Maiers• Matt Prestegaard• Erik Bergman

Project Management• Tom Wiegand

Architects/Analysts/Developers• Bob Milius • Jane Pollack• Robinette Renner• Kirt Schaper• Bridget Wakaruk• Joel Schneider• Andrew Brown• Jason Brelsford• Pradeep Bashyal• Enoch Kan• others...

People

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Thank you!Questions?

Contact Bob Milius, PhDbmilius@nmdp.org