Using FHIR as a Canonical Data Model

Kevin Mayfield
Background (Referral)
• Health and Social Care Bill 2012-2013, The
Scottish Government
• NHS eHealth strategy - must contribute to
care integration and support people with long
term conditions
• Replace shared assessment system with an
Interagency Portal.
• Build upon existing clinical portal
Assessment - Me
• 1996-2009 EMIS (GP Systems)
– 300 baud drug ordering system
– MOD 'GPtoGP' late 90’s
– Defence Medical Information Capability Programme
(DMICP), live streaming of clinical resources to/from
operations in Iraq and Afghanistan
• 2010- NHS & Council roles (SQL)
– Community, Mental Health and Acute.
– 2012 First HL7 interface
Assessment - NHS Team
• Using SCIXML and NHS Scotland Data Standards
• Many bespoke interfaces and multiple integration
• Minimal exposure to HL7 standards.
• Steep learning curve to HL7v3 and CDA.
• RESTful?
• Community care focused around documents
Assessment - Social Services
• 4 councils
• HL7v2 capable (x1)
• NHS (England) ITK and
CDA interfaces. Keen to
use FHIR (x2)
• Bespoke (x1)
• Organisation using a Care
Plan model (x3)
• RESTful
Building The 'Care' Plan
• IHE XDS, BPPC and PIX patterns.
• Mostly UML focused (seen as too technical, flow
charts preferred.)
• Use cases very useful but a tendency to go for
solution early.
• FHIR and RESTful/CRUD used as model for
technical discussions.
• IHE and FHIR proved to be resistant to project
changes (mostly consent and alerts) and change of
• Centralised recording of patients and consent
• Document sharing with central index
• Portal fed data by a variety of methods,
mostly web services (HL7 FHIR preferred).
Activities/Interventions (NHS)
• Document Index using FHIR DocumentReference
– Documents returned from many (NHS) sources using FHIR
– DocumentReference doubled up as a document
notification system.
• Questionnaires and other unstructured data using
FHIR Questionnaires
• Encounters, Care Plan, Orders, Appointments,
Alert/Observation and Condition resources (NHS
• Patient with consent extension and HL7v2 A28/31/40
Progress Notes
• Naturally aligning with IHE profiles
• Too many new things
– FHIR being a major step towards HL7 CDA and IHE profiles
– RESTful interfaces scaled down
– Standard coding (SNOMED) premature
• FHIR 80/20 rule nearly always correct
• Resistance due to DSTU status
– ReferralRequest
– Consent
– Appointments
• Patient identity and consent first
– Information Governance
• Too much IT focus but the information model FHIR uses, especially
the CarePlan resource, showed the way.
• DocumentReference/Binary allowed the adoption of an XDS
pattern and get the metadata correct
– Path to HL7 CDA?
• Questionnaires useful but need to used only when other resource
not available (tended to capture the 20 in the 80/20)
• Only suitable for NHS trusts/social services with EPR systems, PAS
systems could stick with HL7v2
• SCRUM worked! FHIR allows sprints

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