FIHR Poster Presentation
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Healthcare Interoperability Catching FHIR! Shaan Kassam and Boss Limlek The University of Texas at Aus;n, Health Informa;cs and Health IT Professional Educa;on Program, Summer 2016 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;on exchange. Proceedings of the 26th IEEE Interna;onal Symposium on Computer-Based Medical Systems. doi: 10.1109/cbms.2013.6627810 2. Lamprinakos, G., Mousas, A., Boufis, A., Karmiris, P., Mantzouratos, S., Kapsalis, A.,Venieris, I. (2014). Using FHIR to develop a healthcare mobile applica;on.Proceedings of the 4th Interna;onal Conference on Wireless Mobile Communica;on and Healthcare - "Transforming Healthcare through Innova;ons in Mobile and Wireless Technologies" doi:10.4108/icst.mobihealth.2014.257232 3. Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: A standards-based, interoperable apps plaborm for electronic health records. Journal of the American Medical Informa;cs Associa;on J Am Med Inform Assoc. doi:10.1093/jamia/ocv189 4. "MedAppTech: Pediatric Growth Charts." MedAppTech: Pediatric Growth Charts. N.p., n.d. Web. 23 July 2016. 5. ”MedAppTech: Pillbox." MedAppTech: Pillbox. N.p., n.d. Web. 23 July 2016. 6. 1.7 Introducing HL7 FHIR. (n.d.). Retrieved June 23, 2016, from hgps://www.hl7.org/hir/summary.html 7. Presenta;on by Dr. David McCallie (Cerner Corpora;on) at 2016 SXSW Interac;ve, hgps://www.youtube.com/watch?v=UFF9OBxPYZU&feature=youtu.be [4-7] Health Level Seven Interna;onal (HL7) organiza;on is a not-for-profit standards developing organiza;on dedicated to providing a standard framework for electronic health data 7 . “Fast Healthcare Interoperability Resources (FHIR) is the latest standard developed under the HL7 organiza;on which was introduced in response to the limita;ons of HL7 Version 2 (V2) and Version 3 (V3)” 6 . FHIR was created as a plaborm for simultaneously accessing data from different healthcare systems, regardless of how the data are stored, with the aim of “expanding EHR capabili;es, streamlining health informa;on exchange, and crea;ng opportuni;es for innova;on” 6 . FHIR has gained much agen;on in recent years because it builds on the previous data format standards from HL7 V2 and V3. Its focus is on a modern, web-based API technology, including a HTTP-based RESTful protocol which makes it easier to implement, flexible, and scalable 7 . In other words, FHIR leverages exis;ng technology, standardizes the data, and u;lizes the same architecture as the World Wide Web. The basic building block in FHIR is a resource, which is any exchangeable content 7 . FHIR u;lizes sets of resources to sa;sfy the majority of common use cases such as care plans and diagnos;c reports. Using FHIR’s standard API, external developers can develop their own applica;ons and implement them into exis;ng EHR systems. This project was completed with the consulta;on and mentorship of Dr. Leanne Field. We u;lized PubMed, Google scholar, and The University Of Texas library database to iden;fy relevant ar;cles by searching on keywords such as: FHIR, SMART, HL7, interoperability,REST, and standards API. Research ar;cles were reviewed from the Journal of American Medical Informa2cs Associa2on, Journal of Medical Systems, HIMSS 2015, and Healthcare Informa2on Management Systems. In addi;on, we researched HL7’s website for further details on HL7 V2, V3, and FHIR due to the limited number of peer-reviewed ar;cles on FHIR. We would like to thank Dr. Leanne Field, for providing mentorship and guidance. We also aknowledge the assistance of Mr. Jerry Malone, Infor Corpora;on, who provided us with valuable informa;on about FHIR. While s;ll under development, the FHIR standard has agracted a great deal of agen;on from the healthcare industry 1 . Unlike HL7 V2 messaging which followed an ad hoc development process and HL7 V3 which followed a defined top-down model process, FHIR follows the RESTful architecture, bogom up drive process and consumer-focused model 1 . The poten;al of FHIR extends beyond its standard API because of its ability to be implemented in mobile plaborms and to provide low barriers of entry for non-healthcare developers 7 . In an agempt to become the next genera;on’s standards framework, FHIR appears to combine the best features of HL7’s V2, and V3 while leveraging the latest web standards and focus on implementability 7 . FHIR APPLICATIONS: Two applica;ons that u;lize FHIR were evaluated. • MedAppTech and Harvard Medical School used a FHIR environment to develop a basic growth chart that can be incorporated in most EHRs and creates an integrated view that pa;ents understand and can update real-;me. 3 This provides providers up-to-date informa;on while educa;ng parents on important clinical informa;on. • MedAppTech and Duke University created a PillBox app designed as an interac;ve learning and communica;on tool for pa;ents to prac;ce medica;on management and crea;ng personalized treatment plans while suppor;ng academic research. 3 FUTURE OF FHIR: SMART AND FHIR SMART is a specifica;on that allows the embedding of a webpage into the EHR. 3 This creates a user-experience that builds on top of the data access provided with FHIR. The combina;on of both can be used to plug- and-play apps into mul;ple EHR vendors. 7 This provides further interoperability in healthcare where propriety products like EHRs are u;lized as plaborms and allow communica;on between pa;ents and providers. AUTHORS’ PERSPECTIVE: It is hard to determine if FHIR will be successful, but its approach has promise. The authors believe that FHIR can be useful and drive new efficiencies and innova;on while improving pa;ent care and driving down bogom line costs. HL7 Messaging STANDARDS Year IniKated Architectural Paradigm CompaKbility with other versions Development Process/ Methodology ARributes assignment Industry & Community Support Inherently Suitable for Mobile Devices Degree of AdopKon 2011 RESTful Yes IteraKve & Incremental Yes-XML & JSON Yes - Argonaut Project Yes TesKng & ImplementaKon stages 1997 Message- Oriented No Top-down Some Weak No Very low ` 1987 Message, Fields, & Records Some-V2.X BoRom-up/ ad hoc No Strong No Very High Table 1: Comparing HL7 Messaging Standards 1 Figure 2: ApplicaKons of FHIR: Duke PillBox app by MedAppTech & Duke University School of Medicine 5 Figure 1: ApplicaKons of FHIR: Pediatric Growth Charts by MedAppTech & Harvard Medical School/ Boston Children’s Hospital 4 While healthcare records are becoming increasingly digi;zed, interoperability remains to be an issue. As pa;ents move around the healthcare ecosystem, their electronic records must be available and accessible. HL7 has been addressing these challenges for over 20 years with V2 and V3 1 . FHIR is a new specifica;on that agempts to u;lize the benefits of both versions to address current challenges in healthcare. Despite HL7 V2’s ubiquitous use, it’s an;quated standards are not enough to address current interoperability issues between disparate EHR systems. HL7 V3, on the other hand, agempts to address some of the problems inherent in HL7 V3 but has not been successful due to "it’s lack of backward compa;bility and low adop;on rate" 6 . The op;mism within the healthcare community is that FHIR may mi;gate issues from both versions. Furthermore, FHIR’s API is standard and allows applica;ons to be created by third party developers and implemented in EHR systems. PURPOSE The purpose of this research was two-fold: 1) to compare and contrast the benefits and drawback of FHIR with HL7 V2 and V3, and 2) to iden;fy applica;ons of FHIR being used in a pa;ent-provider sexngs. Child’s growth chart using HL7’ FHIR standard with an integrated view to communicate with family members using icons rather than graphs. An interacKve tool uKlizing HL7’s FHIR standard to manage paKent’s use and pracKce medicaKon regimens while capturing important medicaKon use informaKon for further study. Boss Limlek: [email protected] Shaan Kassam: [email protected] Version 3.0 Version 2.0 FHIR
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Transcript of FIHR Poster Presentation
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
[4-7]
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:[email protected]:[email protected]
Version3.0
Version2.0
FHIR
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