November 12, 2013
IHE Work Item Proposal (Detailed)
1.Proposed Work Item: HL7 FHIR Device Resources (FDR) White Paper
Proposal Editor: Todd Cooper / Center for Medical Interoperability
Work Item Editor: Todd Cooper & Michael Ekaireb
Date: 2013.11.12
Version: 1.0
Domain: Patient Care Devices
Summary
HL7 created the Fast Health Interoperability Resources (FHIR) project to define HL7 V3 implementation technologies that leverage RESTful architecture and greatly simplify the creation of applications. Though FHIR is relatively new on the scene, many have hailed it as the technology that will enable the next generation of HL7 applications based on Version 3 to be created and deployed. Though HL7 v2 will be used for a very long time, HL7 v3 will not only be dominated by CDA information exchange, but FHIR-based integration. Over the last year, a number of device related FHIR resources have been created, enabling clinical applications to discover and exchange device-acquired information.
This white paper will provide a high-level summary of FHIR and a more detailed review of the existing FHIR device resources. It will then examine the challenges of device data integration within the use cases that the FHIR project targets, as well as the differences between FHIR-based application integration and the integration profiles supported by the IHE PCD Technical Framework. Finally, the white paper will examine whether FHIR can be used to provide alternative RESTful implementations for existing PCD profiles, and whether new profiles should be proposed to support FHIR’s unique approach to enterprise application integration.
The intent of the white paper is to identify the best path forward for support of FHIR within the IHE PCD Technical Framework and suggest a path forward.
2.The Problem
In response to the implementation challenges of HL7 version 3, a new RESTful-based implementation specification is under development called “Fast Healthcare Information Resources” (FHIR) that should enable rapid application development. FHIR “resources” hide much of the complexity of HL7 version 3 by encapsulating that detail “under the hood” of each resource.
Historically though providing HL7 v3 support has been on the roadmap, IHE PCD members have not found business need in supporting HL7 v3 messaging; however, with the advent of HL7 FHIR, this is likely to change. Thus supporting FHIR-based transactions will ensure that PCD enabled systems will have the needed transactions to integrate in this ecosystem.
3.Use Cases
Clinical use cases are the same as those currently identified in IHE PCD TF-1.
There is some discussion though that in the case of FHIR resources, more attention should be paid not only to the availability of medical device acquired information, but also its specific clinical use, since these resources are particularly tailored for use by clinical applications.
4.Standards & Systems
HL7 FHIR @
Specific FHIR Device Resources include:
Device
DeviceObservationReport
IHE PCD Profiles that could leverage FHIR implementations, including DEC and ACM.
ISO/IEEE 11073 information model and terminology (IHE PCD TF-3 semantic content) specifications. There many be some new terminology, but in general this should be consistent with the same content in current use for IHE PCD profiles (e.g., DEC and ACM).
5.Technical Approach
This is a white paper, so the purpose is to review the issues around leveraging FHIR resources for use in the PCD technical framework.
New actors
Though no new actors are anticipated at this point, the introduction of new system elements, such as a FHIR resource server, may result in the proposal of additional actors.
Existing actors
To the degree that FHIR resources may be used to provide alternatives to existing profile actors and transactions, all may be leveraged. Alternatively, new profiles could be proposed that create an entire new set of actors and do not need to leverage existing actors.
New transactions (standards used)
New transactions will be proposed to support interactions between FHIR resource servers and clients.
Impact on existing integration profiles
To the degree that usage of FHIR provides alternative implementations for existing IHE PCD profiles (e.g., DEC), then an alternative set of transactions (FHIR-based) and associated profile updates (Volume 1) may be proposed. This could be analogous to ITI’s XDS.a => XDS.b. For example, DEC.a => DEC.b (or DEC.f).
New integration profiles needed
New integration profiles may be proposed to reflect FHIR-based actors and new interactions (transactions).
Breakdown of tasks that need to be accomplished
- Create an overview of currently defined FHIR device resources, the rationale behind their definition and the capabilities they support. Also, a general overview (very high level) and references for FHIR standards.
- Identify areas of medical device interoperability within the scope of the PCD domain to which FHIR technologies may be applied. Include specific clinical scenarios and use cases that involve at least one medical device.
- Examine the differences between the traditional IHE PCD profiles and the types of applications to which FHIR is typically applied.
- Evaluate existing IHE PCD profiles and identify whether FHIR could be used to provide RESTful implementation alternatives. If so, provide proposals for how this might be accomplished.
- Propose new profiles and transactions that are tailored to the FHIR use cases identified above.
- Publish the draft document for review
- Publish final document
6.Risks
The primary risk is coordination with the FHIR program group that will be moving the standard to DSTU status within HL7. Care must be made to ensure the efforts are synchronized and inform the work of the other.
7.Open Issues
None currently identified.
8.Effort Estimates
This will require a project team to be assembled, that will meet every other week in a WebEx session. Assuming that work begins in earnest January 2014, the draft white paper should be ready for review and publication in the May 2014 time frame. Device FHIR resources shall be prototyped and tested at the HL7 FHIR Connectathons in January, May and September of 2014.
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