Fhir basics session 5 on fhir implementation considerations
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This presentation was used for the Final session on FHIR Basics education series which deliberated on FHIR implementation considerations and next steps
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Fhir basics session 5 on fhir implementation considerations
- 1. HL7 FHIR BASICS – SESSION 5 FHIR Implementation Considerations Kumar Satyam https://www.linkedin.com/in/kumarsatyam/ https://twitter.com/kr_satyam 12-June-2021 Presentation by Kumar Satyam
- 2. Acknowledgements & Credits This Presentation borrows from the content of presentations by ➢Grahame Grieve ➢Lloyd McKenzie ➢Ewout Kramer ➢David Hay ➢Michel Rutten ➢ and other members of HL7 FHIR Community. 12-June-2021 Presentation by Kumar Satyam
- 3. Agenda ➢Recap ➢Implementer Considerations ➢Implementing a Servers ➢Next Steps 12-June-2021 Presentation by Kumar Satyam
- 4. FHIR India Community • Open community of HL7 FHIR & Interoperability enthusiasts. • #fhirIndia – social media tag. • https://fhirindia.zulipchat.com/ - Discussion forum • https://www.linkedin.com/groups/13932672/ - LinkedIn Group • https://github.com/HL7India/ - Github 10K by Dec 2021. 12-June-2021 Presentation by Kumar Satyam
- 5. Glimpse of some of the community activities ✓Review and feedback digital healthcare initiatives like NDHB ✓FHIR India Connectathon – July 2020 ✓NDHM FHIR Profiles ✓Concept papers ✓Education & Implementer support ✓FHIR Basics ✓Connect with global community ✓Projects of common interest ✓LOINC Mapping 12-June-2021 Presentation by Kumar Satyam
- 7. Recap 12-June-2021 Presentation by Kumar Satyam
- 8. Fast Healthcare Interoperability Resources 12-June-2021 Presentation by Kumar Satyam R4 - Mixed Normative and STU
- 9. FHIR RESTFul Paradigm ➢Resources (Data) ➢Resource location (URI) ➢ ➢HTTP methods ➢formats ▪XML, JSON, RDF,ND-JSON . 12-June-2021 Presentation by Kumar Satyam
- 10. Instance Level Allows a client to retrieve the current content of a resource, to update the content to a new state, to delete the resource, or to see its modification history Type Level Allows a client to search through the existing resources that already exist, create a new instance of a resource, or get the history of all changes to resource of the type. System Level Allows a client to determine what functionality is provided by the system, perform batches and transactions across multiple resource types, and get the history of all changes to all resources. 12-June-2021 Presentation by Kumar Satyam FHIR Base Services
- 11. Resources in FHIR • “Resources” are: • Small logically discrete units of exchange • Defined behavior and meaning • Known identity / location • Smallest unit of transaction A resource is an entity that: • has a known identity (a URL) by which it can be addressed • identifies itself as one of the types of resource defined in this specification • contains a set of structured data items as described by the definition of the resource type • has an identified version that changes if the contents of the resource change 12-June-2021 Presentation by Kumar Satyam
- 12. Resources 12-June-2021 Presentation by Kumar Satyam
- 13. FHIR Resource Example http://hl7.org/fhir/summary.html#2.17.3 12-June-2021 Presentation by Kumar Satyam
- 14. The FHIR Manifesto • Focus on Implementers. • Target support for common scenarios. • Leverage cross- industry web technologies. • Require human readability as base level of interoperability. • Make content freely available. • Support multiple paradigms & architectures Source : Principles of Health Interoperability_ SNOMED CT, HL7 and FHIR 3rd edition 12-June-2021 Presentation by Kumar Satyam
- 16. Focus on Implementers ❑Open License ❑FHIR maturity model – Focus on adoption ❑Reference implementations & libraries. ❑Public testing servers. ❑Community ❑Connectathons 12-June-2021 Presentation by Kumar Satyam
- 17. Implementers FHIR is a platform standard multiple disparate architectures widely varying purposes • FHIR Implementers are from different backgrounds. • Exposure to previous HL7 standards or other Interoperability standards • Constrained by existing architecture ( mostly ) 12-June-2021 Presentation by Kumar Satyam
- 18. Guiding principles • Test using public servers • Choose a reference implementation – if possible. • Writing client is easy – Server way harder • Code generation from schema – Be aware of limitations • Healthcare is complex – Check implementers safety checklist 12-June-2021 Presentation by Kumar Satyam
- 19. 5-5-5 Rule • 5 secs to find the specification on the web • 5 mins to understand what it is • 5 hours to have some working code • And • 5 years to understand healthcare application development. 12-June-2021 Presentation by Kumar Satyam
- 20. Push or Pull 12-June-2021 Presentation by Kumar Satyam http://hl7.org/fhir/pushpull.html
- 21. FHIR Formats • Systems SHALL declare which format(s) they support in their Capability Statement • Clients and servers can choose what syntax(s) to implement. • In the interests of interoperability, servers SHOULD support both the XML and JSON formats. • Turtle (RDF) & bulk data formats http://hl7.org/fhir/formats.html 12-June-2021 Presentation by Kumar Satyam
- 22. Client & Server • Client & Server - FHIR Restful APIs • Clients • Lightweight applications • Issue crud(e) requests to server • Response & User interface • Servers deal with security, threading, multiple representations, searching and indexing, and persistence. 12-June-2021 Presentation by Kumar Satyam
- 23. Implementing a Server • Choose what services to Offer • Minimally Server must support Conformance Statement Decide what resources to support Read: Get/Search – Should always be provided for resources supported Write: Create/Update ? Delete ? Versioning ? Remember : APIs are external interface ; how they are implemented is internal is irrelevant for exchange 12-June-2021 Presentation by Kumar Satyam
- 24. Implementing a Server • Fresh ground up FHIR server- Speaking FHIR natively – Rare • FHIR usually implemented as bolt-on interface to existing legacy services and data • Generally following strategies are seen • Use of Middleware – Convert FHIR operations & formats like HL7 V2.x • FHIR facades – Convert and expose internal data directly as FHIR • CDR – data from internal system -> a general purpose database -> expose as FHIR • Gradual adoption of FHIR by components • FHIR Create and read – resource may differ. http://hl7.org/fhir/updates.html 12-June-2021 Presentation by Kumar Satyam
- 25. Implementing a Server • Storage Choice • Applications can use the resources defined by FHIR by storing them natively in a database or persistent store http://hl7.org/fhir/storage.html 12-June-2021 Presentation by Kumar Satyam
- 26. Implementer safety Checklist • Conformance Related Safety Checks • E.g. • I've reviewed the Modifier elements • My system checks for modifierExtension elements • my system handles the full Life cycle (status codes, currency issues, and erroneous entry status) • Complete list : https://www.hl7.org/fhir/safety.html#conformance • Security Related Safety Checks • Basic Context : time sync • Communications: encryption • Authentication/Authorization: • Access Control: • Integrity: https://www.hl7.org/fhir/safety.html#security-framework All implementers should run through safety checklist before and after implementation 12-June-2021 Presentation by Kumar Satyam Many more
- 27. Tools for Implementers • Public Test Servers • https://confluence.hl7.org/display/FHIR/Public+Test+Servers • Validation Tools • Java validator • OpenSource reference implementations • HAPI • .Net • Others • FHIR Registry – simplifier.net • Notepad++ plugin Lot of useful links maintained here: https://fhirindia.zulipchat.com/#narrow/stream/270736-general/topic/Useful.20Links 12-June-2021 Presentation by Kumar Satyam
- 28. Security 12-June-2021 Presentation by Kumar Satyam
- 29. SMART on FHIR 12-June-2021 Presentation by Kumar Satyam Smart on FHIR open specifications. Adds to FHIR to integrate with existing health systems : • A set of scopes and permissions agreed between client and server that are specific to the app context. • Login & authorization • Oauth2 & OIDC • Consistent UI integration between client and server. • Interactive decision support between user, server, and decision support systems. “Substitutable Medical Apps, Reusable Technology”
- 30. Next Steps 12-June-2021 Presentation by Kumar Satyam
- 31. What Next • Participate in connectathons • Tryout some fhir starter projects • Map requirements to FHIR – Clinfhir • Tryout the tools • Join the implementer community Try- learn- implement – share 12-June-2021 Presentation by Kumar Satyam