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Dr. David Hay | Orion Health Product Strategist | Chair Emeritus HL7 NZ
Building a Scenario using clinFHIR
Devdays| November2017
Plan for the sessions
‣ Today
‣ Review overall process
‣ Review key FHIR elements
‣ ‘Clinical’ Models
‣ Information, Resources, References
‣ Tomorrow
‣ Structured and Coded data
‣ Create/View FHIR artifacts
‣ Extension Definition
‣ ValueSet
‣ Profile
‣ Implementation Guide
The road to FHIR (aka the process)
Clinical
Problem
Information
Model
Resources
Model
References
Graph
Clinician / Business Analyst
FHIR Expert / Terminology
FHIR
artifacts
Review basics of FHIR
Resources
General
AllergyIntolerance
Condition (Problem)
Procedure
ClinicalImpression
FamilyMemberHistory
RiskAssessment
DetectedIssue
Care Provision
CarePlan
CareTeam
Goal
ReferralRequest
ProcedureRequest
NutritionOrder
VisionPrescription
Medication & Immunization
Medication
MedicationRequest
MedicationAdministration
MedicationDispense
MedicationStatement
Immunization
ImmunizationRecommendation
Diagnostics
Observation
DiagnosticReport
ProcedureRequest
Specimen
BodySite
ImagingStudy
Sequence
Resource instance example
Resource Identity &
Metadata
Human Readable
Summary
Extension with URL to
definition
Structured Data:
• MRN
• Name
• Gender
• Birth Date
• Provider
XML and JSON
<valueString value=“jedi”/>
FHIR datatypes (for Information model)
‣ What is a Data Type
‣ Most useful ones (for now)
‣ String
‣ Date
‣ Quantity
‣ CodeableConcept
‣ Coded data, eg SNOMED
References between resources
Coded Properties
type
bodySuite
indication
performer.role
complication
relatedItem.type
Other Properties
identifier (Identifier)
outcome (String)
PROCEDURE
Patient
Diagnostic reportCondition
Subject
ReportRelated Item
Encounter Performer
Encounter Practitioner
Recording a consultation
12-year-old-boy
First consultation
Complaining of pain in the right ear for 3 days with an
elevated temperature. On examination, temperature
38°C and an inflamed right eardrum with no
perforation. Diagnosis Otitis Media, and prescribed
Amoxicillin 250mg 3 times per day for 7 days.
Follow up consultation
2 days later returned with an itchy skin rash. No
breathing difficulties. On examination, urticarial rash
on both arms. No evidence meningitis. Diagnosis of
penicillin allergy. Antibiotics changes to Erythromycin
250mg 4 times per day for 10 days.
Patient
Encounter
Condition
Observation
Medication
Allergy Intolerance
As linked resources…
Encounter
Pain right ear 3 days
Elevated Temperature
Temperature 38° C
Inflamed right drum
Otitis Media
Amoxicillin 250mg
No breathing difficulties
Urticarial Rash
Penicillin Allergy
Erythromycin 250mg
Encounter
Itchy skin rash
Patient
Practitioner
Asserter
Performer
Performer
Performer
Asserter
Prescriber
Performer
Performer
Performer
Asserter
Asserter
Not all references shown
Exchange Paradigms
REST Documents
Messages Services (Operations)
The clinical problem
Electronic Discharge Summary
‣ A summary of a Hospitalization
‣ Document paradigm
‣ Part of the clinical record
‣ CDA equivalent
‣ Header
‣ Patient, Author, Admission details
‣ Sections
‣ The clinical information
Data Flow
Shared Data
Storage Database
Discharge
Summary
Information (Logical) Model
Information / Logical Model
‣ What is an Information model
‣ It’s the information being shared in ‘clinician speak’
‣ A form of Logical Model
‣ Different ways to represent
‣ FHIR
‣ openEHR
‣ CIMI
clinFHIR
‣ Developed as development /
training tool
‣ Evolving!
‣ What does clinFHIR do
- View Patient data
- Logical Modeler
- Scenario Builder
- ValueSet explorer
- Extension Definition editor
- Implementation Guide viewer
Clinfhir.com
clinFHIR: Server roles
‣ Specific FHIR server roles
- Data/patient – patient related (clinical)
and ‘reference’ (Practitioner,
Organization)
- Conformance – profile, extension
definition, NamingSystem
- Terminology – ValueSet & Terminology
operations
clinFHIR
Patient
and Data
Profiles
(Conformance)
Terminology
Demo
‣ Clinfhir.com
‣ Login
‣ Email, password
‣ Set the servers
‣ HAPI R3
‣ Describe each module, & what it is for
‣ Show Logical Modeler
‣ Show Information Model
Using the Logical Modeler
Resources Model &
References Graph
Resources Model
‣ Link between Information
Model and FHIR artifacts
‣ Also use Logical Model to
show Resources
‣ Need FHIR knowledge to
build
Demo: Create a Resources Model from an Information model
‣ Show resources model of EDS
References Graph
‣ Shows relationships between
resource instances graphically
‣ Uses ‘Instances’ of resource types
‣ Scenario Builder tool
‣ Don’t need detailed FHIR
knowledge
‣ but do need Resources Model
or to be able to choose the
correct resource types
‣ Can also add data to instances
Demo: Scenario Builder
‣ Show relationship between resources
graphically
‣ Build examples of resources
‣ Base on Resources model
Document paradigm
‣ Summary at a point in time
‣ Part of record
‣ Very common
‣ Discharge Summary
‣ Referral letter
‣ Progress Note
‣ CDA
- CDA on FHIR
Bundle Resource
Bundles
‣ Container resource
‣ Types of Bundle
- Searchset
- Transaction
- Document
- Message
- …
Patient Resource
List Resource
Condition Resource
Documents - are bundles
Patient
Practitioner
Observation
Resource
Device
List
Condition
Composition
• Subject
• Author
• Section 1
• Section 2
List
Condition
Note: Most resources have a reference to Patient
Bundle
Documents
Encounter
Pain right ear 3 days
Elevated Temperature
Temperature 38° C
Inflamed right drum
Otitis Media
Amoxicillin 250mg
No breathing difficulties
Urticarial Rash
Penicillin Allergy
Erythromycin 250mg
Encounter
Itchy skin rash
Patient
Practitioner
Asserter
Performer
Performer
Performer
Asserter
Prescriber
Performer
Performer
Performer
Asserter
Asserter
Composition
Pain right ear 3 days
Elevated Temperature
Otitis Media
Temperature 38° C
Inflamed right drum
Amoxicillin 250mg
Patient
Practitioner
Encounter
Demo
‣ Creating a Document
Exercises
1. Document requirements
2. Build Information Model
3. Build Resources Model
4. Create Resources Graph
5. Convert to Document
• Getting started
• Set servers (hapi-3)
• Create user account
• Use initials for model name
• Remember to save models
Notes Process
That’s it!
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Building a Scenario using clinFHIR

  • 1. Dr. David Hay | Orion Health Product Strategist | Chair Emeritus HL7 NZ Building a Scenario using clinFHIR Devdays| November2017
  • 2. Plan for the sessions ‣ Today ‣ Review overall process ‣ Review key FHIR elements ‣ ‘Clinical’ Models ‣ Information, Resources, References ‣ Tomorrow ‣ Structured and Coded data ‣ Create/View FHIR artifacts ‣ Extension Definition ‣ ValueSet ‣ Profile ‣ Implementation Guide
  • 3. The road to FHIR (aka the process) Clinical Problem Information Model Resources Model References Graph Clinician / Business Analyst FHIR Expert / Terminology FHIR artifacts
  • 5. Resources General AllergyIntolerance Condition (Problem) Procedure ClinicalImpression FamilyMemberHistory RiskAssessment DetectedIssue Care Provision CarePlan CareTeam Goal ReferralRequest ProcedureRequest NutritionOrder VisionPrescription Medication & Immunization Medication MedicationRequest MedicationAdministration MedicationDispense MedicationStatement Immunization ImmunizationRecommendation Diagnostics Observation DiagnosticReport ProcedureRequest Specimen BodySite ImagingStudy Sequence
  • 6. Resource instance example Resource Identity & Metadata Human Readable Summary Extension with URL to definition Structured Data: • MRN • Name • Gender • Birth Date • Provider XML and JSON <valueString value=“jedi”/>
  • 7. FHIR datatypes (for Information model) ‣ What is a Data Type ‣ Most useful ones (for now) ‣ String ‣ Date ‣ Quantity ‣ CodeableConcept ‣ Coded data, eg SNOMED
  • 8. References between resources Coded Properties type bodySuite indication performer.role complication relatedItem.type Other Properties identifier (Identifier) outcome (String) PROCEDURE Patient Diagnostic reportCondition Subject ReportRelated Item Encounter Performer Encounter Practitioner
  • 9. Recording a consultation 12-year-old-boy First consultation Complaining of pain in the right ear for 3 days with an elevated temperature. On examination, temperature 38°C and an inflamed right eardrum with no perforation. Diagnosis Otitis Media, and prescribed Amoxicillin 250mg 3 times per day for 7 days. Follow up consultation 2 days later returned with an itchy skin rash. No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy. Antibiotics changes to Erythromycin 250mg 4 times per day for 10 days. Patient Encounter Condition Observation Medication Allergy Intolerance
  • 10. As linked resources… Encounter Pain right ear 3 days Elevated Temperature Temperature 38° C Inflamed right drum Otitis Media Amoxicillin 250mg No breathing difficulties Urticarial Rash Penicillin Allergy Erythromycin 250mg Encounter Itchy skin rash Patient Practitioner Asserter Performer Performer Performer Asserter Prescriber Performer Performer Performer Asserter Asserter Not all references shown
  • 13. Electronic Discharge Summary ‣ A summary of a Hospitalization ‣ Document paradigm ‣ Part of the clinical record ‣ CDA equivalent ‣ Header ‣ Patient, Author, Admission details ‣ Sections ‣ The clinical information
  • 14. Data Flow Shared Data Storage Database Discharge Summary
  • 16. Information / Logical Model ‣ What is an Information model ‣ It’s the information being shared in ‘clinician speak’ ‣ A form of Logical Model ‣ Different ways to represent ‣ FHIR ‣ openEHR ‣ CIMI
  • 17. clinFHIR ‣ Developed as development / training tool ‣ Evolving! ‣ What does clinFHIR do - View Patient data - Logical Modeler - Scenario Builder - ValueSet explorer - Extension Definition editor - Implementation Guide viewer Clinfhir.com
  • 18. clinFHIR: Server roles ‣ Specific FHIR server roles - Data/patient – patient related (clinical) and ‘reference’ (Practitioner, Organization) - Conformance – profile, extension definition, NamingSystem - Terminology – ValueSet & Terminology operations clinFHIR Patient and Data Profiles (Conformance) Terminology
  • 19. Demo ‣ Clinfhir.com ‣ Login ‣ Email, password ‣ Set the servers ‣ HAPI R3 ‣ Describe each module, & what it is for ‣ Show Logical Modeler ‣ Show Information Model Using the Logical Modeler
  • 21. Resources Model ‣ Link between Information Model and FHIR artifacts ‣ Also use Logical Model to show Resources ‣ Need FHIR knowledge to build
  • 22. Demo: Create a Resources Model from an Information model ‣ Show resources model of EDS
  • 23. References Graph ‣ Shows relationships between resource instances graphically ‣ Uses ‘Instances’ of resource types ‣ Scenario Builder tool ‣ Don’t need detailed FHIR knowledge ‣ but do need Resources Model or to be able to choose the correct resource types ‣ Can also add data to instances
  • 24. Demo: Scenario Builder ‣ Show relationship between resources graphically ‣ Build examples of resources ‣ Base on Resources model
  • 25. Document paradigm ‣ Summary at a point in time ‣ Part of record ‣ Very common ‣ Discharge Summary ‣ Referral letter ‣ Progress Note ‣ CDA - CDA on FHIR
  • 26. Bundle Resource Bundles ‣ Container resource ‣ Types of Bundle - Searchset - Transaction - Document - Message - … Patient Resource List Resource Condition Resource
  • 27. Documents - are bundles Patient Practitioner Observation Resource Device List Condition Composition • Subject • Author • Section 1 • Section 2 List Condition Note: Most resources have a reference to Patient Bundle
  • 28. Documents Encounter Pain right ear 3 days Elevated Temperature Temperature 38° C Inflamed right drum Otitis Media Amoxicillin 250mg No breathing difficulties Urticarial Rash Penicillin Allergy Erythromycin 250mg Encounter Itchy skin rash Patient Practitioner Asserter Performer Performer Performer Asserter Prescriber Performer Performer Performer Asserter Asserter Composition Pain right ear 3 days Elevated Temperature Otitis Media Temperature 38° C Inflamed right drum Amoxicillin 250mg Patient Practitioner Encounter
  • 30. Exercises 1. Document requirements 2. Build Information Model 3. Build Resources Model 4. Create Resources Graph 5. Convert to Document • Getting started • Set servers (hapi-3) • Create user account • Use initials for model name • Remember to save models Notes Process

Editor's Notes

  • #4: Work through a clinical scenario You understand the drivers for FHIR, and the benefits You can describe it to others You know where to find out more information You are familiar with clinFHIR You can engage with the community
  • #5: Not this linear in practice Clinical safety / terminology Mention Implementation guide at end
  • #7: Talk about Maturity model
  • #8: Explain what XML & Json are – eg different language
  • #10: Names are element names ? Keep names…. ?? Introducte before scenario builder
  • #15: Logical model – independent of underlying storage (in that case Resource)
  • #18: Logical model – independent of underlying storage (in that case Resource)
  • #20: What is a conformance server…
  • #21: Add screen shot arrows to servers
  • #24: Nodes to represent resources Child nodes as needed elements (can do details)
  • #26: Problem list Show Lis mutli referece Reminder of docs
  • #31: 77532 – eve betterhalf – documents Georgia taylor