HealthcareInteroperabilityCatchingFHIR!ShaanKassamandBossLimlek

TheUniversityofTexasatAus;n,HealthInforma;csandHealthITProfessionalEduca;onProgram,Summer2016

ABSTRACT

ACKNOWLEDGMENTS

CONCLUSIONS

REFERENCES

CONTACT

INTRODUCTION

RESULTS

METHODS

1. Bender, D., & Sar;pi, K. (2013). HL7 FHIR: An Agile and RESTful approach to healthcare informa;onexchange.Proceedingsofthe26thIEEEInterna;onalSymposiumonComputer-BasedMedicalSystems.doi:10.1109/cbms.2013.66278102. Lamprinakos, G., Mousas, A., Boufis, A., Karmiris, P., Mantzouratos, S., Kapsalis, A.,Venieris, I. (2014).UsingFHIRtodevelopahealthcaremobileapplica;on.Proceedingsofthe4th Interna;onalConferenceonWirelessMobileCommunica;onandHealthcare-"TransformingHealthcarethroughInnova;onsinMobileandWirelessTechnologies"doi:10.4108/icst.mobihealth.2014.2572323. Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: Astandards-based,interoperableappsplabormforelectronichealthrecords.JournaloftheAmericanMedicalInforma;csAssocia;onJAmMedInformAssoc.doi:10.1093/jamia/ocv1894."MedAppTech:PediatricGrowthCharts."MedAppTech:PediatricGrowthCharts.N.p.,n.d.Web.23July2016.5.”MedAppTech:Pillbox."MedAppTech:Pillbox.N.p.,n.d.Web.23July2016.6.1.7IntroducingHL7FHIR.(n.d.).RetrievedJune23,2016,fromhgps://www.hl7.org/hir/summary.html7.Presenta;onbyDr.DavidMcCallie(CernerCorpora;on)at2016SXSWInterac;ve,hgps://www.youtube.com/watch?v=UFF9OBxPYZU&feature=youtu.be

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HealthLevelSevenInterna;onal(HL7)organiza;onisanot-for-profitstandardsdevelopingorganiza;ondedicatedtoprovidingastandardframeworkforelectronichealthdata7.“FastHealthcareInteroperabilityResources(FHIR)isthelateststandarddevelopedundertheHL7organiza;onwhichwasintroducedinresponsetothelimita;onsofHL7Version2(V2)andVersion3(V3)”6.FHIRwascreatedasaplabormforsimultaneouslyaccessingdatafromdifferenthealthcaresystems,regardlessofhowthedataarestored,withtheaimof“expandingEHRcapabili;es,streamlininghealthinforma;onexchange,andcrea;ngopportuni;esforinnova;on”6.FHIRhasgainedmuchagen;oninrecentyearsbecauseitbuildsonthepreviousdataformatstandardsfromHL7V2andV3.Itsfocusisonamodern,web-basedAPItechnology,includingaHTTP-basedRESTfulprotocolwhichmakesiteasiertoimplement,flexible,andscalable7.Inotherwords,FHIRleveragesexis;ngtechnology,standardizesthedata,andu;lizesthesamearchitectureastheWorldWideWeb.ThebasicbuildingblockinFHIRisaresource,whichisanyexchangeablecontent7.FHIRu;lizessetsofresourcestosa;sfythemajorityofcommonusecasessuchascareplansanddiagnos;creports.UsingFHIR’sstandardAPI,externaldeveloperscandeveloptheirownapplica;onsandimplementthemintoexis;ngEHRsystems.

Thisprojectwascompletedwiththeconsulta;onandmentorshipofDr.LeanneField.Weu;lizedPubMed,Googlescholar,andTheUniversityOfTexaslibrarydatabasetoiden;fyrelevantar;clesbysearchingonkeywordssuchas:FHIR,SMART,HL7,interoperability,REST,andstandardsAPI.Researchar;cleswerereviewedfromtheJournalofAmericanMedicalInforma2csAssocia2on,JournalofMedicalSystems,HIMSS2015,andHealthcareInforma2onManagementSystems.Inaddi;on,weresearchedHL7’swebsiteforfurtherdetailsonHL7V2,V3,andFHIRduetothelimitednumberofpeer-reviewedar;clesonFHIR.

WewouldliketothankDr.LeanneField,forprovidingmentorshipandguidance.WealsoaknowledgetheassistanceofMr.JerryMalone,InforCorpora;on,whoprovideduswithvaluableinforma;onaboutFHIR.

Whiles;llunderdevelopment,theFHIRstandardhasagractedagreatdealofagen;onfromthehealthcareindustry1.UnlikeHL7V2messagingwhichfollowedanadhocdevelopmentprocessandHL7V3whichfollowedadefinedtop-downmodelprocess,FHIRfollowstheRESTfularchitecture,bogomupdriveprocessandconsumer-focusedmodel1.Thepoten;alofFHIRextendsbeyonditsstandardAPIbecauseofitsabilitytobeimplementedinmobileplabormsandtoprovidelowbarriersofentryfornon-healthcaredevelopers7.Inanagempttobecomethenextgenera;on’sstandardsframework,FHIRappearstocombinethebestfeaturesofHL7’sV2,andV3whileleveragingthelatestwebstandardsandfocusonimplementability7.

FHIRAPPLICATIONS:Twoapplica;onsthatu;lizeFHIRwereevaluated.•  MedAppTechandHarvardMedicalSchoolusedaFHIRenvironmentto

developabasicgrowthchartthatcanbeincorporatedinmostEHRsandcreatesanintegratedviewthatpa;entsunderstandandcanupdatereal-;me.3Thisprovidesprovidersup-to-dateinforma;onwhileeduca;ngparentsonimportantclinicalinforma;on.

•  MedAppTechandDukeUniversitycreatedaPillBoxappdesignedasaninterac;velearningandcommunica;ontoolforpa;entstoprac;cemedica;onmanagementandcrea;ngpersonalizedtreatmentplanswhilesuppor;ngacademicresearch.3

FUTUREOFFHIR:SMARTANDFHIRSMARTisaspecifica;onthatallowstheembeddingofawebpageintotheEHR.3Thiscreatesauser-experiencethatbuildsontopofthedataaccessprovidedwithFHIR.Thecombina;onofbothcanbeusedtoplug-and-playappsintomul;pleEHRvendors.7ThisprovidesfurtherinteroperabilityinhealthcarewhereproprietyproductslikeEHRsareu;lizedasplabormsandallowcommunica;onbetweenpa;entsandproviders.

AUTHORS’PERSPECTIVE:ItishardtodetermineifFHIRwillbesuccessful,butitsapproachhaspromise.TheauthorsbelievethatFHIRcanbeusefulanddrivenewefficienciesandinnova;onwhileimprovingpa;entcareanddrivingdownbogomlinecosts.

HL7MessagingSTANDARDS

YearIniKated

ArchitecturalParadigm

CompaKbilitywithotherversions

DevelopmentProcess/

Methodology

ARributesassignment

Industry&CommunitySupport

InherentlySuitablefor

MobileDevices

DegreeofAdopKon

2011 RESTful Yes IteraKve&Incremental Yes-XML&JSON Yes-Argonaut

Project YesTesKng&

ImplementaKonstages

1997 Message-Oriented No Top-down Some Weak No Verylow

`1987

Message,Fields,&Records

Some-V2.X BoRom-up/adhoc No Strong No VeryHigh

Table1:ComparingHL7MessagingStandards1

Figure2:ApplicaKonsofFHIR:DukePillBoxappbyMedAppTech&DukeUniversitySchoolofMedicine5

Figure1:ApplicaKonsofFHIR:PediatricGrowthChartsbyMedAppTech&HarvardMedicalSchool/BostonChildren’sHospital4

Whilehealthcarerecordsarebecomingincreasinglydigi;zed,interoperabilityremainstobeanissue.Aspa;entsmovearoundthehealthcareecosystem,theirelectronicrecordsmustbeavailableandaccessible.HL7hasbeenaddressingthesechallengesforover20yearswithV2andV31.FHIRisanewspecifica;onthatagemptstou;lizethebenefitsofbothversionstoaddresscurrentchallengesinhealthcare.DespiteHL7V2’subiquitoususe,it’san;quatedstandardsarenotenoughtoaddresscurrentinteroperabilityissuesbetweendisparateEHRsystems.HL7V3,ontheotherhand,agemptstoaddresssomeoftheproblemsinherentinHL7V3buthasnotbeensuccessfuldueto"it’slackofbackwardcompa;bilityandlowadop;onrate"6.Theop;mismwithinthehealthcarecommunityisthatFHIRmaymi;gateissuesfrombothversions.Furthermore,FHIR’sAPIisstandardandallowsapplica;onstobecreatedbythirdpartydevelopersandimplementedinEHRsystems.

PURPOSEThepurposeofthisresearchwastwo-fold:1)tocompareandcontrastthebenefitsanddrawbackofFHIRwithHL7V2andV3,and2)toiden;fyapplica;onsofFHIRbeingusedinapa;ent-providersexngs.

Child’sgrowthchartusingHL7’FHIRstandardwithanintegratedviewtocommunicatewithfamilymembersusingiconsratherthangraphs.

AninteracKvetooluKlizingHL7’sFHIRstandardtomanagepaKent’suseandpracKcemedicaKonregimenswhilecapturingimportantmedicaKonuseinformaKonforfurtherstudy.

BossLimlek:isarabosslimlek@gmail.comShaanKassam:Shaan.Kassam@icloud.com

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