SMART, CIMI, FHIR & Argonaut

March 4, 2015 1 Comment

Saw an interesting question and answer on the SMART support forum about the relationship between SMART and FHIR which Josh has allowed be to copy here (as it’s so topical might now). The question was:

Anyone who happens to know … I’d appreciate it if you could clue me in…

Other than the kick ass implementations done on the SMART-on-FHIR side of world, is there something that SMART adds definitionally to the pile of stuff at documented in a very scattered fashion (not a criticism – it’s the nature of what these things) over at HL7 FHIR? Or is it Boston Children’s/Harvard’s project working to implement the HL7 FHIR standards in a coherent way? Or … what?

Also, via CIMI (which I get the purpose of, I think), I came across Health Services Platform Consortium (HSPC). What are they doing that SMART-on-FHIR isn’t doing? Even all of the posted “apps” that “they” have developed that are running come from you. Do they (above and beyond what the mission is here) have a technical purpose? Or is it politics or marketing or something of the like that I don’t understand.

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Clinical resources in FHIR

November 13, 2014 3 Comments

I gave a talk on Clinical resources in FHIR at the recent seminar in Melbourne, which was actually a bit more work to prepare than I had anticipated. I’ve given a few FHIR talks, but generally they were about the fundamentals of FHIR or more technical training, and this was intended to be aimed more at a clinical audience.

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Processing FHIR Bundles using HAPI

August 18, 2014 6 Comments

A month or so back, we talked about a project we had to import glucose results into a repository using FHIR. That post was focused on using the transaction search facility to indicate that there was a resource in the bundle that may or may not exist on the server, and giving the search parameters for the server to use to make the determination. The example we looked at was the Patient resource – specifying the identifier value to use as the lookup.

We didn’t really talk about the other aspects of processing a bundle such as this, so let’s see how we can implement this scenario using the HAPI library.

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SMART on FHIR – adding OAuth2

August 12, 2014 2 Comments

You may recall that a week back we had a look at one of the connectathon scenarios – the SMART scenario.

In this post we’re going to take the work that we had done in the last post, and make it secure using the SMART version of the OAuth2 standard. As always, a primary reason I’m writing it down is so that when I forget what I did to make it work – I’ll have this as a reference to remind me <s>. And a reminder – I’m using the Java based HAPI FHIR client, in a web based application running in a Tomcat servlet engine, with IntelliJ IDEA as my IDE.
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Referral requests in FHIR

August 4, 2014 5 Comments

In conjunction with the Patient Care workgroup, we’re currently working on the ReferralRequest Resource. You can see a draft here, and the here is the resource request (but do be aware that it is very much a work in progress, and WILL change prior to appearing in the next DSTU).

Referrals are one of the most interesting (and contentious) aspects of the ‘art of medicine’ – particularly in this era of increasing ‘shared care’ where many providers (clinical and other) are going to be involved in a patients care.
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SMART on FHIR: Part 1

August 2, 2014 3 Comments

With the 7th connectathon coming up, we’ve looked at the first scenario (Patient access) in a couple of posts and how we can use a couple of the libraries (.net and java) to make this almost trivial to achieve. (btw you don’t have to use these libraries of course – FHIR by itself uses standard technologies so there are a ton of different ways to do this if you already have the technology to do so, or use a different language).

In this post we’re going to take a look at the 3rd connectathon scenario – SMART on FHIR. There’s a lot of information about what this is trying to achieve (the connectathon site has links) so we won’t repeat that here – the ‘elevator pitch’ is that it establishes standards that enable the development of independent applications that can securely access data in any server supporting those standards – this could be an EHR, EMR, Portal or HIE.

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FHIR Clinical scenarios: Nutrition Assessment

July 30, 2014 1 Comment

We’ve had a couple of posts recently (well 3) talking about how we can use FHIR resources to represent some common clinical scenarios as a prelude to the clinical connectathon in September. Each of the scenarios exercised a different part of FHIR (and had a slightly different clinical focus):

  • The Chronic Care Scenario has a heavy emphasis on the Care Plan
  • The Acute Care scenario provoked a discussion on how we should be using the Encounter resource – and further highlighted a need to refer form an Observation to an Encounter
  • And finally the scenario dealing with Allergies led us to think about my favourite resource – the List.

(Here’s a bit more detail…)

There’s been a bit of discussion in the HL7 lists recently about the concept of a Clinical Assessment – and how best to represent it in FHIR. As it turns out, one of the scenarios put forward by Patient Care that we won’t be exercising (yet) is the process around making a Nutrition Assessment, and Elaine (one of the Patient Care co-chairs) has asked if I could do a post on this scenario to help stimulate discussion – so here it is.

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Clinical Scenarios in FHIR

July 26, 2014 1 Comment

Well we’ve reviewed all 3 of the posts on the scenarios for the Clinical Connectathon in Chicago in September by the Patient Care Working Group – and there was some good discussion on all of them.

I didn’t keep as good notes as I should have for the Chronic Care scenario – which was a large scenario. A core part of this was the maintenance of the care plan – I had suggested that there should be multiple plans – 1 per Condition, but the consensus of the group was that a singe plan would be sufficient.
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Clinical Scenarios in FHIR: Adverse reaction

July 17, 2014 2 Comments

The final scenario that is a candidate for the clinical connectathon is one that deals with allergies and Intolerance. Here are the details, but at a high level:

  • A patient is prescribed penicillin and 8 days into the course develops symptoms that are diagnosed as an allergy to penicillin, which is recorded in their allergy list, along with details of the nature of the allergy.
  • In addition, the patient (through a patient portal) updates their allergy list – adding an entry that is subsequently updated (or reconciled) by the clinician.

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Clinical Scenarios in FHIR

July 3, 2014 7 Comments

As you know (or should by now!), FHIR has from the outset been an implementer driven standard. The focus has always been on making healthcare interoperability as straightforward as possible, and regular connecathons have been an important part of that process (and we’re up to our 7th now).

However, it has to be admitted that thus far it has been the ‘techies’ – the ‘geeks’ – that are the main attenders at connectathon – and that’s kind of inevitable, given all the base work that’s needed to make FHIR a realistic standard for exchanging health information.

But FHIR is all about exchanging clinical information, and that means that it has to meet the needs of clinicians (which I use in the widest sense) as well as the technical folk. (And patients too – though that is another story).

At the last Working Group Meeting in Phoenix, we decided that it was time to think about a ‘Clinical Connectathon’ – where the emphasis was on meeting the needs of clinicians delivering care rather than the needs of technical people supporting them – can FHIR  do that?

So, at this WGM in September (held in Chicago) we’re going to have our first Clinical Connectathon (as well as the usual one – sigh). The focus of this event is to allow clinicians to focus on the “clinician to clinician connection” rather then the underlying technical resources that support those interactions.
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