Stream: implementers
Topic: Implementation from scratch
Simon Taylor (Jun 05 2017 at 14:44):
Hi all,
After my morning of research, I have found myself here. I couldn’t find any forum/chatroom rules, so I’ll tentatively ask a few questions and hope for some friendly guidance.
I am the developer of an exercise prescription App (Web and Mobile) and would like to take steps towards making our service HL7 and FHIR compliant/compatible. We are seeking integration at a high level instead of chasing around looking to connect with each individual EHR which has proved to be rather difficult unless they have a modern API (Cliniko, DrChrono).
Ultimately, we would like to position ourselves as ‘ready’ to make connections quickly and easily to healthcare systems around the world (think of approaching the NHS and actually being ready to offer a service).
My questions are mainly focussed around where I should take my first steps.
Just starting to look into this where should I go? I see there are services such as https://smarthealthit.org and a number of others that promise connectivity via FHIR. If we can simply use a library such as smarthealthkit then it all looks simple. In fact, too simple!?
In order to be seen as a credible service is there a HL7/FHIR accreditation / certification? I note that the certification (http://www.hl7.org/implement/certification.cfm) seems to be more related to ‘people’ rather than ‘services / apps’.
Consultants: Where can I find a directory of people than could offer consultancy services on levelling up?
By the look of all the questions / streams this is probably the wrong place to ask, however I would rather ask blindly start some courses https://www.pathlms.com/hl7/categories/423/courses.
Many thanks in advance.
Lloyd McKenzie (Jun 05 2017 at 17:17):
The forum/chatroom rules are (here)[http://wiki.hl7.org/index.php?title=Chat.fhir.org_community_expectations]. (You should have seen a link when you signed up?) In any case, these questions are well within the bounds.
We do try to make the libraries simple and easy to use. However, there's always complexity hidden somewhere - whether it's getting people to agree on what to share, how to manage to consent, what code systems to use or how to translate, etc. :)
There is no FHIR accreditation/certification yet. The standard is not yet fully locked down, so certification is a bit premature. That said, there are certainly testing services available. We'll be exploring the notion of certification as parts of the standard become normative (which we believe will start towards the end of 2018)
We don't have a directory of consultants - in part because we're still finalizing the certification process for the people that would allow us to have some degree of confidence that the people on the list could deliver appropriate expertise. Hopefully that'll be in place for the end of this year.
There's a lot of free training materials, blogs and other content available with a simple search. HL7 does offer some good materials (though I'm biased because I teach some of it). Probably the best way to "level up" is to come to a connectathon & WGM. That will surround you with other developers, easy access to the experts, real hands-on experience and a chance to interoperate with (and chat with) other developers. Plus it will give you access to a bunch of tutorials and to the working group sessions where the specification actually evolves so you can get a sense of who the people are and where the standard is at.
Simon Taylor (Jun 05 2017 at 19:40):
Lloyd,
Many thanks for taking the time to write a detailed reply. I guess I had not given enough attention to how immature everything was. I see that there is a session at Salford in two days time, I am going to try and get across to that.
Could you ping me a link to some of your lesson content and direct me to some sandboxing services?
Thanks again
Lloyd McKenzie (Jun 05 2017 at 22:51):
I wouldn't label FHIR as "immature". Much of it is pretty robust and is implemented in production in hundreds, if not thousands of locations. Each resource (and most pages) in the spec have a number indicating their maturity level on a 5-point scale. The core spec and some of the core resources are likely to get locked down in the next release.
You can find a bunch of the training slides in HL7's source control here. If you want the voice walking through them, you'll have to pay for the webinars though. Furore has a ton of videos at both the technical and executive level - many from their FHIR Developer Days conference.
There's actually a link to FHIR test servers directly off the FHIR home page. Scroll down to the bottom and look for "FHIR Public Test Servers" which will take you to the appropriate wiki page. There's a bunch of other material on the FHIR wiki page as well.
Simon Taylor (Jun 06 2017 at 18:26):
@Lloyd McKenzie This is incredible... I didn't think that this was going to be so easy, I must be missing something, hence a few more questions:
What I did:
I got the testing URL http://vonk.furore.com and using postman I was able to perform REST requests such as http://vonk.furore.com/Patient?family=ChalmersNDsluF which returned data as expected - great!
What I expect I can do now:
I will be able to perform all the patient search and CRUD via REST, in addition to adding patient notes - in my case a list of exercises that forms an exercise prescription programme. I plan on doing this via AngularJS $http from the client side, for which I anticipate using SMART.
My one last question:
Some of the largest healthcare organisations in the world are looking to use FHIR, and I could integrate this into my App within an afternoon's work. Aside from the authorization side of things (which I anticipate following this guide for), what am I missing... or can I just crack on and make this a feature and advertise the fact that we are FHIR compatible and ready?
Lloyd McKenzie (Jun 06 2017 at 18:32):
Well, the biggest challenge is data consistency - what codes get used for observations, drugs and allergies? What elements can you expect systems to support when dealing with medication dosage? In the US, the us-core implementation guide provides some of this guidance, but it won't necessarily cover everything you need - at least not yet. Other countries aren't as far ahead.
Simon Taylor (Jun 06 2017 at 19:37):
Yeah, that's interesting and highlights how Dr specific the information codes are on the system. For example, I anticipate that physiotherapists and other wider healthcare practitioners may be using this EHR, which much of the time will be simply inserting written notes on a patient's condition. Therefore many of the fields are unused in the Resource Observation.
In the case of an initial consultation for a Physiotherapist in a hospital may use the following headers / fields.
- Presenting complaint
- Complaint history
- Medical history
- Medication
- Assessment
- Treatment
- Treatment plan
Each of these is likely to be a free textbox.
Lloyd McKenzie (Jun 07 2017 at 01:13):
Right. And some systems might treat all of those as Observation, while others might use MedicationStatement, CarePlan and/or other resources for some of the elements
Last updated: Apr 12 2022 at 19:14 UTC
