HL7 FHIR Update

Bob Milius, PhD Principal Research Scientist, CIBMTR IT Co-chair, HL7 Clinical Genomics Work Group

There are no conflicts of interest to disclose. Health Level 7 International • Non-profit, ANSI-accredited healthcare Standards Developing Organization (SDO)

• “HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients”

2 HL7 asked a question...

What would healthcare exchange look like if we started from scratch using modern approaches?

3 HL7® FHIR®

4 • Newest standard • Active Testing • FREE! – Three Connectathons a year – 17th in Jan 2018 (over 5 yrs) • History • Immense interest – 2011 Proposed – Argonaut – 2012 First version • Vendor initiated project – 2017 Standard for Trial Use 3 • Epic, Cerner, Intermountain, Mayo, – 2018 Next release MEDITECH, Athena, McKesson, Partners, etc • Normative – ONC • Aligns with REST services • Sync For Science • Sync For Genes – XML, JSON – ASCO workshops

5 Resources • “Resources” are: – The "R" in "FHIR" – Small logically discrete units of exchange – Defined behaviour and meaning – Known identity / location – Smallest unit of transaction – “of interest” to healthcare

6 Profiles • Constraints and extensions on one or more resources for a use case

• May also define new extensions search terms, new messaging events, etc.

7 Resources + Profiles = Solution 80% 20% 100%

8 CIBMTR work in progress... Work in progress... • HLA – FHIR resources and profiles representing HLA genotyping report with allele assignment and the sequence data supporting the interpretation

• Reporting to CIBMTR: AGNIS – Adopt, adapt, validate and implement a HL7 FHIR-based electronic exchange infrastructure as a foundation of AGNIS

– Develop, validate and implement HL7 FHIR based electronic reporting of Patient data by a Transplant Center EMR to the CIBMTR

• New FHIR Resource – BiologicallyDerivedProduct

10 Work in progress... • HLA – FHIR resources and profiles representing HLA genotyping report with allele assignment and the sequence data supporting the interpretation

• Reporting to CIBMTR: future of AGNIS – Adopt, adapt, validate and implement a HL7 FHIR-based electronic exchange infrastructure as a future foundation of AGNIS

– Develop, validate and implement HL7 FHIR based electronic reporting of Patient data by a Transplant Center EMR to the CIBMTR

• New FHIR Resource – BiologicallyDerivedProduct

11 Transplant Transplant Admin Etc. Center Center DB Reporting to UI(s) External Labs

Physician Internal CIBMTR CTMS EMR Labs

FormsNet UI Collaborative 1. Build 2 Research infrastructure Data Transplant AGNIS AGNIS On FHIR Groups Manager Center Client Client e.g., BMT CTN 2. Patient demographic data

FormsNet AGNIS AGNIS Translator Service DB 1

Current systems Research 2 AGNIS ETL New AGNIS On FHIR Service Research Database

Research CIBMTR Extracts

12 OpenEpic & FHIR • Founding member of Argonaut Project

• Integral FHIR Server in all current installations

• https://open.epic.com/Interface/FHIR

13 OpenEpic & FHIR

Resources available: • Patient • Provider • AllergyIntolerance • Medication • MedicationList • MedicationStatement • Condition • Observation • FamilyMemberHistory • DiagnosticReport • Immunization • CarePlan • Goal • Procedure • Device • DocumentReference • https://open.epic.com/Interface/FHIR • Binary

14 Epic App Orchard • Identify mappings of CIBMTR patient data to FHIR resource

• Using these mappings, develop a free Epic App for transplant centers to collect Patient demographic data to report to CIBMTR

• Mappings are public, and may be applied to other EMRs

• https://apporchard.epic.com/

15 HL7 FHIR is used by... Project Argonaut

“The purpose of the Argonaut Project is to rapidly develop a first generation FHIR-based API and Core Data Services specification to enable expanded information sharing for electronic health records and other health information technology based on Internet standards and architectural patterns and styles.”

http://www.healthcareitnews.com/news/epic-cerner-others-join-hl7-project

16 Argonaut Implementation Guide

Implementation Guides

• set of rules to solve a particular problem

• composed of a set of Profiles, each describing a different aspect of the problem

http://www.fhir.org/guides/argonaut/r2/ 17 18 Developing the FHIR infrastructure • Client • Mapping – Java, AngularJS – FHIR Mapping Language • Server • CRID assignment – Java open source, • Data flow HAPI FHIR – integration into • Security CIBMTR research – SMART on FHIR ecosystem • Implementation Guide – Set of profiles for reporting to CIBMTR

19 Work in progress... • HLA – FHIR resources and profiles representing HLA genotyping report with allele assignment and the sequence data supporting the interpretation

• Reporting to CIBMTR: AGNIS – Adopt, adapt, validate and implement a HL7 FHIR-based electronic exchange infrastructure as a foundation of AGNIS

– Develop, validate and implement HL7 FHIR based electronic reporting of Patient data by a Transplant Center EMR to the CIBMTR

• New FHIR Resource – BiologicallyDerivedProduct

20 21 Work to do... • Labs – HLA

Transplant Transplant Admin Etc. • EMR – GVHD Center Center DB UI(s) External Labs • BMT CTN - Emmes Physician Internal CTMS EMR Labs

FormsNet UI Collaborative Research Data Transplant AGNIS AGNIS On FHIR Groups Manager Center Client Client e.g., BMT CTN

FormsNet AGNIS AGNIS DB Translator Service

Current systems Research AGNIS ETL New AGNIS On FHIR Service Research Database

Research CIBMTR Extracts

23 Links to information and tools • HL7 FHIR – Home • http://hl7.org/fhir – Current Build • http://build.fhir.org – Chat • http://chat.fhir.org – Wiki • http://wiki.hl7.org/index.php?title=FHIR

24 Tutorials/Webinar slides found in...

• https://github.com/nmdp-bioinformatics/dash/tree/master/fhir – Introduction to FHIR – FHIR for Executives 1 – FHIR for Executives 2 – FHIR for Architects – FHIR for Developers

25 People Leadership Architects/Analysts/Developers • Doug Rizzo • Bob Milius • Dennis Confer • Jane Pollack • Martin Maiers • Robinette Renner • Matt Prestegaard • Kirt Schaper • Erik Bergman • Bridget Wakaruk • Joel Schneider Project Management • Andrew Brown • Tom Wiegand • Jason Brelsford • Pradeep Bashyal • Enoch Kan • others...

26 Thank you! Questions?

Contact Bob Milius, PhD [email protected]