Stream: fhir-messages
Topic: Messaging IGs
Kevin Mayfield (Nov 04 2020 at 22:20):
I'm aware of Da Vinci alerts. http://build.fhir.org/ig/HL7/davinci-alerts/
UK has ePrescribing in progress. https://simplifier.net/guide/DigitalMedicines/EPSMessagingRequirements
Denmark seems to have one covering ADT and documents, some others are mentioned in devdays 2020 on ePrescribing. Any links?
Lloyd McKenzie (Nov 05 2020 at 02:55):
Canada has had PrescribeIT in production for about 4 years now (though it wasn't originally called that). It's not national, but it is used in several jurisdictions. https://specs.prescribeit.ca/R3.0/erx/erx.html
Lloyd McKenzie (Nov 05 2020 at 02:56):
We also have some messaging based eReferral stuff. (@Tim Berezny )
Kevin Mayfield (Nov 05 2020 at 06:58):
Thanks @Lloyd McKenzie This page https://specs.prescribeit.ca/R3.0/erx/erx.html#10.1 has many similarities to https://simplifier.net/guide/DigitalMedicines/EPSMessagingRequirements
How we send to EPS is similar and how receiver collects is also very similar. (This part isn't public in the IG yet)
John Moehrke (Nov 05 2020 at 12:43):
IHE used Messaging in the Patient Master Identity Registry (PMIR) implementation guide - a guide for greenfields looking to have a multi-community master patient (golden). It is using Messaging rather similar to ADT, but only on Patient resource changes, and to manage a master identity that might be linked to local identities. https://healthcaresecprivacy.blogspot.com/2020/11/patient-master-identity-registry.html
Craig Newman (Nov 05 2020 at 13:26):
If you're looking for other messaging IG, several Public Health ones use it.
The CDC's MedMorph project is based on messaging (https://build.fhir.org/ig/HL7/fhir-medmorph/index.html) as is the bidirectional services eReferral IG (http://hl7.org/fhir/us/bser/)
Electronic case reporting (eCR) allows for messaging but does discuss other workflows (http://hl7.org/fhir/us/ecr/STU1/index.html)
Kevin Mayfield (Nov 07 2020 at 06:16):
Thanks. Interesting to see the link to ADT. I've been wondering if FHIR Messages should related to HL7v2, so the Patient, Encounter and DocumentReference focused messages should have similar structure to v2 equivalents.
It would make transform easier and so adoption.
Not seeing this as negative, as for example our national v2 Patient messages (A28/31) already focused on Patient (PID) changing. In our patient encounter management , it's mostly the Encounter (PV1) that changes and support for other resources is variable.
Lloyd McKenzie (Nov 07 2020 at 07:27):
In general, you're better converting the v2 to regular REST actions where you can. The only reason to replicate the simple ADT functions in FHIR messaging is if you needed both asynchronous and routed change.
Kevin Mayfield (Nov 07 2020 at 08:03):
I don't think we can force restful adoption and would expect resistance to making intermediaries and endpoints use rest. It's too many requests going across domains, within a domain REST is fine.
The source (as triggers) and destinations can handle as FHIR RESTful but many will expect to this to remain HL7v2 (or HL7v3).
E.g. for ADT_A01 replacement. We could change this to POST /Encounter making heavy use of reference identifiers but I would expect most suppliers to still want a Patient resource i.e. FHIR Message with Encounter and Patient mandatory.
Long term, POST /Encounter is desired but it's not practical at the moment.
Jens Villadsen (Nov 07 2020 at 12:43):
@Kevin Mayfield Denmark is about to release its first IG within 2 months period covering a small initial subset of messages in the https://build.fhir.org/ig/hl7dk/dk-medcom/ and its sibling IG's. You can reach out to @MedCom FHIR Team or @Irene Zuschlag / @Ole Vilstrup / @Michael Johansen in order to get more details
Kevin Mayfield (Nov 07 2020 at 14:40):
Thanks very useful. Seems similar to our thoughts, we seem to be the only ones going for MessageDefintion per event Coding and one UKcore messageHeader profile.
Have also subdivided the encounter eventcode via reasonCodes (admit, discharge, etc)
Lloyd McKenzie (Nov 07 2020 at 20:28):
Messaging depends on site-site negotiation and tends to be use-case specific. You can't run SMART or CDS Hooks or similar solutions on top of messaging. Messaging is necessary for certain limited cases and may also be necessary as a transition strategy for a broader set of use-cases. However, if you really want to get full mileage out of FHIR, you should be looking to avoid messaging when you can. Replicating a v2 environment and just changing syntax isn't going to buy you much.
Kevin Mayfield (Nov 08 2020 at 11:12):
Possibly mixing up contexts here. Using messaging between organisations does not prevent the receiver from transforming it to FHIR RESTful.
It makes message handling a lot simpler, an intermediary doesn't have to wait for all the RESTful requests to arrive before it can be passed on (some of the internal endpoints will probably want all resources before processing can begin).
The rough plan is: if one resource is being exchanged use FHIR RESTful for others use FHIR Messaging. So for MDM_T01 this becomes POST /DocumentReference, and for MDM_T02 this is a FHIR Message.
Michael Johansen (Nov 08 2020 at 20:34):
@Kevin Mayfield The Danish profiling of messages is for the part of integrations we dont substitute with datasharing instead of messaging. Not all old legacy messaging should migrate to FHIR messaging, but some do. We use a common messageheader (a medcom core, not DK core), with a value-set for eventcoding for the two messagetypes (and more to come). Since focus is not the same in our messages, we have a separate messageheader for each messagetype. Comments will be appreciated
Kevin Mayfield (Nov 08 2020 at 21:25):
Is this being covered on the danish devdays talk?
Jens Villadsen (Nov 10 2020 at 08:40):
@Michael Johansen
Michael Johansen (Nov 10 2020 at 15:23):
@Kevin Mayfield We will show the two profiles and what ressources we have used, Since the talks are only 10 minuts, I have not included details for the question regarding MessageHeader in each profile or a unique MessageHeader at MedCom core level (all messagetypes). The talk is pre-recorded, so I cant address this issue in the presentation, but feel free to ask during the 10 minuts Q&A
Kevin Mayfield (Nov 10 2020 at 16:53):
@Kevin Sprague @Dave Barnet This is the conversation I mentioned about messaging.
Last updated: Apr 12 2022 at 19:14 UTC
