Stream: connectathon mgmt
Topic: Federated FHIR
Michael van der Zel (Oct 15 2019 at 11:10):
Suppose there are multiple information sources (ehr in hospital 1, ehr in hospital 2, gp) were data is available for 1 patient.
Suppose there is an index with endpoints per patient.
I am thinking about a solution were there is an index were we can get the Endpoints were data is available for a specific patient.
Is there anybody that can point me to examples or past or future connectathons or specifications for this?
Also interested in SMART-on-FHIR apps that can than present / integrate this data.
Thanks!
Grahame Grieve (Oct 15 2019 at 12:04):
how do you identify the patient?
Grahame Grieve (Oct 15 2019 at 12:05):
how is trust established?
Michael van der Zel (Oct 16 2019 at 15:41):
In the netherlands we have the social security number we can use for identify of the patient. But otherwise we need a PIX of some kind.
Trust could be handled by a federated identity.
Grahame Grieve (Oct 16 2019 at 23:48):
so wouldn't the federated identity solution also solve the end-point issue? And any connectathon track would be secondary to the federated identity? eems like an IHE thing to me?
John Moehrke (Oct 17 2019 at 12:28):
There is a profile from IHE that re-evaluated the PIX use-cases for use with FHIR. So there is a PIXm.
John Moehrke (Oct 17 2019 at 12:29):
However this kind of a solution is not really 'federated', as some central authority must know ALL patients.
John Moehrke (Oct 17 2019 at 12:31):
In your case this central authority might only know the patient.id, the national ID, and the managing organization. Thus limited central exposure. Provided the national ID is always gathered, this should be all that needs to be 'feed' to the central authority, and all that is needed in the PIXm query. Once PIXm returns the set of Patient.id values known, you use .managingOrganization and lookup that organizations endpoint (likely supported by a directory like mCSD)
John Moehrke (Oct 17 2019 at 12:32):
federation would be more like XCA/XCPD. An organizational directory has all endpoints (mCSD), and you query each endpoint (PIXm or PDQm).
Michael van der Zel (Oct 23 2019 at 20:40):
Ok. You have given me some input and I know that I have to work some more on the use-case and I will get back to you.
FHIR is inherently distributed, right? Not all data has to live on 1 FHIR endpoint, or does it? For example, can a Bundle contain resources located on different endpoints? I assume the answer is yes.
Grahame Grieve (Oct 23 2019 at 20:41):
yes
Viktor Jernelöv (Nov 19 2019 at 10:41):
Suppose there are multiple information sources (ehr in hospital 1, ehr in hospital 2, gp) were data is available for 1 patient.
Suppose there is an index with endpoints per patient.
I am thinking about a solution were there is an index were we can get the Endpoints were data is available for a specific patient.
Is there anybody that can point me to examples or past or future connectathons or specifications for this?
Also interested in SMART-on-FHIR apps that can than present / integrate this data.
Thanks!
It sounds like the Netherlands and Sweden have similar problems we need to solve. I'll see if I can find you at Devdays @Michael van der Zel
Rien Wertheim (Nov 19 2019 at 10:51):
The EventMobi app allows you to send messages to other participants. Easiest way to set up a meeting.
Michael van der Zel (Nov 19 2019 at 20:00):
I'll get the EventMobi app and see if we can meet! @Viktor Jernelöv
Michael van der Zel (Nov 21 2019 at 20:56):
I think we should rename this stream to Federated FHIR and at least Sweden and Finland have similar use-cases, but they potentially solve it different with FHIR. We think it is a good idea to work on this and reach a solution that supports our common use-case with the same FHIR usage.
Michael van der Zel (Nov 21 2019 at 20:57):
P.S. Can you rename a stream?
Lloyd McKenzie (Nov 21 2019 at 20:58):
Yes, streams can be renamed, though it shouldn't be done casually as it can break cross-stream links.
Lloyd McKenzie (Nov 21 2019 at 20:58):
(And external links that direct people to the stream)
Josh Mandel (Nov 25 2019 at 14:17):
(it shouldn't break any external links for channels that were created in the last year or so but it could break older ones.)
Abbie Watson (Dec 12 2019 at 04:36):
Ring of FHIR, FhirBlocks, Provider Registry, Longitudinal Timeline. Lots of projects have been tackling this.
We're still waiting on some group to coordinate the registration of standardized test patients across the different EHRs. You can only longitudinally cross-reference the patients between different EHRs if Candace or Jessica or Nancy are registered in each system (and/or have the patient matching piece worked out). I've brought the issue up at Patient Empowerment, Clinicians on FHIR, and elsewhere. We need to create a work product of a patient history that can be baselined and then split up and registered across the different EHRs; that way, when we fetch and merge accordingly, we can validate that the composite is the same as the reference baseline.
Michael van der Zel (Jan 17 2020 at 09:34):
@Viktor Jernelöv will you be at the next WGM so we can talk some more?
Michael van der Zel (Jan 17 2020 at 09:37):
@Abigail Watson Could you send me some links to these project? I am specifically wondering about the architecture and the use of FHIR. Thanks!
Viktor Jernelöv (Jan 22 2020 at 15:37):
Viktor Jernelöv will you be at the next WGM so we can talk some more?
@Michael van der Zel Unfortunately I won't be able to attend.
Let me get back to you once we know how the FHIR work will progress in 2020 (we're doing work in annual cycles).
Julie Maas (Feb 01 2020 at 17:47):
Hello, this work is also taking place with some US-based teams in the Cross Organization Application Access Track which I usually lead. Please see: https://confluence.hl7.org/display/FHIR/2019-09+Cross+Organization+Application+Access, www.udap.org, https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/FAST+Security+Tiger+Team+TLC+Webinar, and https://oncprojectracking.healthit.gov/wiki/display/TechLabSC/FAST+Identity+Tiger+Team+TLC+Webinar for more information and related work.
Unfortunately I will not be at the Sydney meeting, but would be happy to meet up with you another time or discuss on Zulip. cc: @Luis Maas
Last updated: Apr 12 2022 at 19:14 UTC
