Introduction to Digital Health Standards with HL7 FHIR
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This document provides an introduction and overview of digital health standards with a focus on FHIR (Fast Healthcare Interoperability Resources). It discusses why data exchange is needed in healthcare and defines interoperability. It then gives practical examples of FHIR implementation and its use in apps. The document also provides a brief history of other standards like HL7 v2, v3, CDA, IPS and compares them to FHIR. It defines medical terminologies like SNOMED, LOINC and ICD and how they work together with standards.
Introduction to Digital Health Standards with HL7 FHIR
- 1. Introduction to Digital Health Standards with FHIR Janaka Peiris | 2022 May Digital Health Training Series
- 2. Topics ➔ Why learn about digital health ? ➔ Why data exchange is needed ? ➔ What is interoperability syntactic vs semantic ➔ Practical Examples FHIR in action ➔ Brief history and other standards HL7 v2, v3, CDA, IPS, OpenEHR vs FHIR ➔ What are medical terminologies SNOMED, LOINC, ICD
- 3. Why learn about Digital health?
- 4. Why data exchange is needed? Source: https://mobisoftinfotech.com/resources/blog/health-information-exchange-benefits-and-challenges/ Emergency Medical Services
- 5. Popularity of FHIR within US hospitals Source: https://www.healthit.gov/buzz-blog/health-it/the-heat-is-on-us-caught-fhir-in-2019
- 8. Apple Health app uses FHIR to transfer data Source: https://www.apple.com/healthcare/health-records/
- 11. Brief history and other standards: HL7 v2 HL7 v3 (RIM) HL7 CDA OpenEHR FHIR
- 13. History of standards… source: www.medicalbillersandcoders.com : The Evolution of Interoperability in Healthcare
- 14. HL7 V2 examples
- 15. Simple, widely used Not discoverable - main standards around early 2010s - “Push” message model - Ability to customize, but lack of standardization is costly to maintain - True interoperability is lost due to many “undiscoverable” customizations
- 16. Perfect model, but too complex ? - Wanted to achieve “semantic” interoperability - Tried to be a perfect model, to cover “everything” - Tried to eliminate customizations - Model driven (RIM : Reference Information Model) - XML based - Complex tooling - Base for CDA HL7 V3 (RIM)
- 17. Widely used for clinical doc exchange - XML, based on RIM (v3) - Complete clinical documents - Has human readable content
- 19. What is DICOM ? Digital Imaging and Communications in Medicine “Standard for handling, Storing, printing and transmitting information in medical imaging. Both a: - A file structure - Communications protocol” Source: Greg Turner, The Radiology Coach (Picture Archiving and Communication System)
- 20. DICOM (Digital Images & Communications in Medicine) - DICOM is the international standard to communicate and manage medical images and data - high quality of the images is retained - Created in 1985
- 21. IHE-XDS (Cross-Enterprise Document Sharing) - main standards around early 2010s - IHE Integration profiles facilitate patient health record data: - Registration - Distribution - Access - “XDS-SD” for scanned documents - “XDS-I” for imaging XDS https://profiles.ihe.net/ITI/TF/Volume1/ch-20.html
- 22. Source: Herman Oosterwijk of OTec, Inc.
- 23. International Patient Summary (IPS): “Specification that is readily usable by all clinicians for the cross-border, unscheduled care of a patient” Source: IPS Vision
- 24. International Patient Summary (IPS) - A specification - summarized version of the patient’s clinical data - Used in “citizen movements” or “cross-organizational care” paths - Especially for unscheduled or emergency use - Minimal patient-summary - Not just a “discharge document” - Avail in both CDA and FHIR formats
- 26. OpenEHR - An open specification for clinical information model - Focused on data storage (than transfer) - AQL: inbuilt data query language - Has API support - Currently in use
- 27. FHIR is born because… “V2 was at the end of life V3 was too complicated CDA was inherently limited” Needed a “web-based” solution… - Grahame Grieve's Keynote at FHIR India Connectathon, 2020
- 28. Fast, web based, popular - Popular since 2014 - “pull” model, client-server - XML / JSON based - Made for “web” architecture (REST API based) - Ability to customize with “discoverable” customizations - 80% defined, 20% to be extended - Focused on data transfer(than storage) - 140+ entities in model - AWS, Azure, GCP support
- 30. v2 … v3… FHIR Source: http://sil-asia.org : Exploring HL7 Standards
- 32. Popularity of standards source: Exploring HL7 Standards
- 33. Cloud platform support for FHIR:
- 34. Cloud platform support for FHIR:
- 35. Cloud platform support for FHIR:
- 36. FHIR versions: DSTU2, STU3, R4… R5
- 37. FHIR modules:
- 38. Medical Terminologies: Language of medical terms across systems
- 39. SNOMED CT - Global standard for health terms - 350,000+ codes defined (by 2021 July) - 42 member countries
- 40. LOINC - The international standard for identifying health measurements, observations, and documents. - primarily used for laboratory test results - 98,200 concepts defined (by 2022 feb)
- 41. International Classification of Diseases (ICD) - Terminology standard by W.H.O - Codes for : context, causes & consequences - Focus on diseases - 17,000 codes defined (ICD-11) - Latest : ICD-11 (released 2022 Jan)
- 42. Terminology comparison: “If a researcher wants to know how many patients died with a diagnosis of heart attack last year, ICD is enough. If they want more detail, such as what muscle of the heart was involved, they will need SNOMED CT.” SNOMED LOINC ICD-11 350,000+ 98,200+ 17,000 No of codes:
- 43. All standards working together:
- 44. WHO: Digital Documentation for Covid-19 Certificates (DDCC) - FHIR : as implementation standard - IPS: based on this data model - ICD-11: preferred data standard for specifying the disease.
- 46. Q&A