Clinicians on FHIR

Last week we held our first New Zealand ‘Clinicians on FHIR‘ seminar at the HINZ conference in Rotorua. This was really important for me, as it was the first ‘public outing’ of a seminar format that I’d like to see could be repeated wherever Clinicians are getting their first taste of FHIR, and showing how they can participate more fully in FHIR based Interoperability projects.

We had around 30 attendees and excellent participation – especially as the event was a combination of presentations and practical exercises. Thanks to John Fountain for presenting the clinical perspective. Talking to participants after the event was also very positive, with some good suggestions for improvement of the seminar.

It was also the first public outing of a process that I’ve been working on to facilitate this work (aided by my colleague Dr. Amir Mehrkar). Here’s a graphic that summarizes the process (The shaded arrows show the overall skill set required at the various steps):

Screen Shot 2017-10-29 at 7.27.36 AM

The steps are as follows:

  1. Start with a real clinical problem involving interoperability. We used ‘Adverse Reactions’ reporting at last weeks event. Flesh out the Use Cases and artifacts to be shared.
  2. Create an Information Model (or perhaps multiple) to represent the details of the information to be shared that was identified in the previous step. This uses FHIR Logical Models – so an understanding of FHIR datatypes is desirable (though not mandatory). In particular, identification of coded elements – and where the codes come from (aka ValueSets) – is a useful output of this step.
  3. Next, create a ‘Resources Model‘ that represents this information as ‘real’ FHIR resources (along with any required extensions). This does require FHIR expertise, and effectively identifies the FHIR resources that will be needed – along with the other conformance artifacts such as Profiles, Extension Definitions and ValueSets.
  4. Now a ‘references graph‘ (need to think of a better name – it uses the Scenario Builder) can be generated. This takes the resources identified in the previous step and creates an interconnected graph of resource instances to represent in a graphical form what a real exchange would look like. You can add sample data to this graph to check that all the needed information is included in the models. This can be done with minimal FHIR knowledge, in fact I can imagine it as a ‘Clinical QA’ step for the overall design.
  5. Finally the actual FHIR Conformance artifacts can be generated. If they are simple, then they could (eventually) be generated by clinFHIR, but I suspect that in many cases a more sophisticated tool like Forge will be needed. In many cases, there will be existing artifacts that could be re-used – the FHIR registry is going to be invaluable for this. The whole thing is wrapped up into an Implementation Guide that brings all the artifacts (FHIR and business) into one coherent whole.

I’m certainly not imagining that the process will be as ‘waterfall’ as this – in all likelihood as later models are developed (especially the references graph with sample data) questions will be raised and the models will be updated, but the whole idea is that it should allow good communication between Clinician, Business Analyst and FHIR expert

This page is a slightly more detailed description of the process, and also an index to a number of other pages that are a more ‘how to’ guides to using clinFHIR modules for the various steps (though it is by no means dependent on clinFHIR – especially for the production of the FHIR conformance artifacts).

There are a couple more events that are planned:

If you can make either event it would be great to see you!

We’re also planning to use it as we develop the Adverse Reaction reporting standard in New Zealand – incorporating a ‘Developers on FHIR‘ challenge from HL7 New Zealand as well. Should be fun!

And if you have any comments on the process, feel free to contact me – either in a comment on this post or my email – david dot hay25 at gmail.com.  At this stage, it’s just a proposal so will be good to see how it works out in practice!

 

 

 

About David Hay
I'm a Product Strategist at Orion Health, Chair emeritus of HL7 New Zealand and co-Chair of the FHIR Management Group. I have a keen interest in health IT, especially health interoperability with HL7 and the new FHIR standard.

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