FHIR:
Progress and Future
Grahame Grieve
FHIR Product Director for HL7
May 26 2017
Sydney
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Status
R3 published in March
• >2400 change proposals
• Implementation Experience (Trial use is working)
• Alignment with other standards
• Internal Quality Review processes
• Standard for Trial Use
Key Changes
• Added support for Clinical Decision Support and Clinical Quality
Measures
• Broadened functionality to cover key clinical workflows
• Further development of Terminology Services, and support for
Financial Management
• Defined an RDF format, and how FHIR relates to Linked Data
• Incremental improvements and increased maturity of the RESTful API
and conformance framework
5
Plans for Release 4
• Normative
• Graph retrieval
• Data Analytics
• RDF + Patterns
• Services
• Deployment
• FM
• Standard in-process development
Normative
• “Forwards Compatible”
• Implementations that are conformant will continue to be so
• This is aspirational
• Exact meaning: http://hl7.org/fhir/versions.html
Timeline
• Conceived July 2011
• 1st DSTU (Draft Standard for Trial Use) Feb 3rd 2014
• Widespread Community Growth and Adoption
• 2nd DSTU Sept 23rd 2015
• Substantial changes from implementer feedback
• Solid version for US adoption (clinical / event summary)
• 3rd STU Mar 23 2017
• More changes (1000s) – but starting to become stable
• Preparing for normative next time
7
8
Maturity levels
• Intended to indicate level of stability
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FMM1 – Resource is “done”, no build warnings
FMM2 – Tested at approved Connectathon
FMM3 – Passes QA, has passed ballot
FMM4 – Tested across scope, published, prototype implementation
FMM5 – 5 distinct production implementations, multiple countries, 2
• Breaking changes at level 4 and 5 need community discussion
9
Normative FHIR
• For Release 4, some portions will be balloted as ‘Normative’
• Platform, terminology and conformance resources
• Structural resources
• Subset of other resources
• Some resources won’t go normative right away
• Future releases
• Add more resources
• Add profiles on existing resources
• May add elements to resources
• Time line : late 2018
Graph Retrieval
• GraphDefinition (http://hl7.org/fhir/graphdefinition.html)
• GraphQL (http://wiki.hl7.org/index.php?title=FHIR_and_GraphQL)
• demonstration
Data Analytics: Bulk data format
• Required
• Billions of records - efficient encoding
• ETL-able into MPP databases or analytic tools (Apache Drill, Impala, Presto,
Spark, Hive, etc)
• Good array of open source tools
• Preferred
• Self-describing file format (no external schema)
• format is splittable (multiple threads or processes can process)
• Candidates:
• Avro – row based
• Parquet - Column Based
RDF + Patterns
• RDF: http://hl7.org/fhir/rdf.html
• Pattern: http://hl7.org/fhir/request.html
• W5: http://hl7.org/fhir/w5.html
• Goals
• Allow users to process the internal metadata and extract value
• Allow users to share and leverage mappings with other sources of knowledge
Services
Current
• Terminology Service
Future:
• Conformance
• Provider Registry
• Appointment Manager
• Personal Health Data Manager
Deployment Issues
• Move Smart-on-FHIR to be an HL7 standard
• http://hl7.org/fhir/smart
• Prepare cds-hooks for bringing to HL7
• Clarify relationship with UMA/Heart
Financial Management
• Different development process, philosophy and architecture at play
• Differences to be subject of active review
Standard In-Process Development
• Tasks created on gForge after community discussion
• http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&tra
cker_id=677
• http://chat.fhir.org
• 1500 tasks processed for R3 – expect the same scale again
• Plans:
• Migration from gForge to Jira
• Migrate from Subversion on gForge to GitHub
• Build more scalable work flows as the community scales
FHIR Foundation
• Support community development activities
• Implementation Projects like Argonaut
• Provide infrastructure to support Community:
• http://*.fhir.org (support from Google)
• Open for membership soon
• Individual membership ~$250US/year
• Corporate membership … still planning
Certification / Credentials
• HL7 will offer two levels of testing
• Proficiency Certificate – demonstration of your knowledge of the overall
specification
• Professional Credential – deep knowledge of the specification, qualified to
advise on implementation
• Requires ongoing involvement/training
• Testing coming this year
• Heather will talk about education
Questions / Discussion