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Implementing FHIR Fast Healthcare Interoperability Resources Connecting Michigan for Health 2016 Workshop on FHIR Implementing FHIR Fast Healthcare Interoperability Resources Connecting Michigan for Health 2016 Workshop on FHIR Wayne Kubick, CTO, HL 7 2

Topics for Today My brief overview of FHIR Uses of FHIR The Argonaut Experience Topics for Today My brief overview of FHIR Uses of FHIR The Argonaut Experience The FHIR Community and Connectathons Coming Attractions 3

What Matters Most to HL 7 Vision: A world in which everyone can securely What Matters Most to HL 7 Vision: A world in which everyone can securely access and use the right health data when and where they need it. HL 7 Mission: to empower global health data interoperability by developing the best, right standards and enabling their adoption and implementation. 4

Why FHIR? 5 Source: HIMSS 2016 Why FHIR? 5 Source: HIMSS 2016

Metcalf’s Law: Value of a Network = (Number of users)2 6 Metcalf’s Law: Value of a Network = (Number of users)2 6

HL 7 FHIR: Peak of the Hype Cycle 7 Source: KLAS HL 7 FHIR: Peak of the Hype Cycle 7 Source: KLAS

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In (a) Learning Health System we collect data, feed it through an analytic engine In (a) Learning Health System we collect data, feed it through an analytic engine so it affects (the) next patient. ” -- Tom Sullivan @Sully. HIT 10 10 3/17/20

Some Basics of FHIR A next generation standards framework & platform, built on 30 Some Basics of FHIR A next generation standards framework & platform, built on 30 years’ experience, designed for implementation RESTful Services technology (used by Facebook, Twitter…) Flexible outputs: messages, documents, data, services Based on Resources: essential modular information components easily assembled into working systems. 11

Principles of FHIR • Data resides at the source of truth • APIs access Principles of FHIR • Data resides at the source of truth • APIs access data: pull what you need, instead of only getting what’s pushed • Focus on implementers • Include rigorous semantics • Design for the common 80%; extensions for the rest • Off-the-shelf security and authorization • Speed, scalability, ease of understanding • Everything is human readable and free. 12

May 2016 Survey Results – Priority Resources • Patient • Immunization • Observation • May 2016 Survey Results – Priority Resources • Patient • Immunization • Observation • Medication. Statement • Practitioner • Diagnostic. Order • Medication. Administration • Condition (aka Problem) • Bundle • Allergy. Intolerance • Medication. Dispense • Organization • Care. Plan • Encounter • Procedure • Medication. Order • Conformance • Diagnostic. Report • Person

The international FHIR Maturity Model was envisioned to ensure developers of the value and The international FHIR Maturity Model was envisioned to ensure developers of the value and stability of FHIR 5 4 Tested, published, prototyped 3 2 1 14 International Adoption Passed ballot Connectathon Stable build

JASON Task Force & the Argonauts 15 JASON Task Force & the Argonauts 15

Argonaut Project Origins * JASON Task Force recommendations on market-based interoperability governance and coordination, Argonaut Project Origins * JASON Task Force recommendations on market-based interoperability governance and coordination, and call to action on “public APIs” * Market experience with MU 2 and associated certification *Industry desire to involve private sector and bring market discipline to standards development

Some Argonaut Project Members Accenture athenahealth Beth Israel Deaconess Medical Center Cerner Epic Intermountain Some Argonaut Project Members Accenture athenahealth Beth Israel Deaconess Medical Center Cerner Epic Intermountain Healthcare Mayo Clinic Meditech Mc. Kesson Partners Health. Care System SMART at the Boston Children’s Hospital Surescripts The Advisory Board Company Currently 89 Total Participants

Why Another Standard? 18 Source: Micky Tripathi Why Another Standard? 18 Source: Micky Tripathi

The Argonaut Project • Leverages the work of other initiatives such as the S&I The Argonaut Project • Leverages the work of other initiatives such as the S&I framework and SMART • Accelerates the maturation of FHIR for the industry • Open to all participants • Argonaut is not an organization, competitive or proprietary in nature.

Some Argonaut Tasks • Accelerate the market readiness of the FHIR specification • Support Some Argonaut Tasks • Accelerate the market readiness of the FHIR specification • Support the creation of a community of FHIR implementers • Prioritize and create implementation guides for querying common MU dataset, CCDA, provider directory, security and authorization • Support conformance testing, and publish results • Continuous improvement through frequent sprints. 20

Focus on Common Data Set 21 Focus on Common Data Set 21

Implementation Guides Based on Data Access Framework (DAF) Profiles 22 Implementation Guides Based on Data Access Framework (DAF) Profiles 22

Argonaut Implementation Guides: FHIR Restful APIs & Oauth/OIDC Source: Micky Tripathi Argonaut Implementation Guides: FHIR Restful APIs & Oauth/OIDC Source: Micky Tripathi

Argonaut Implementation Program Argonaut Implementation Program

Some Lessons from Argonaut • Argonaut has proven speed of FHIR development (from several Some Lessons from Argonaut • Argonaut has proven speed of FHIR development (from several months to 2 week sprints) • Competitors are willing to collaborate for interoperability • Foundation is in place, but more needed (search parameters, granularity) • Rapid increase in market demand for Argonaut and FHIR (provider directories, Sync 4 Science, ONC calls for patient apps) • Need to define market ecosystem (terms, IP, safety, contracts) 25 Source: Micky Tripathi

Links to Argonaut Outputs Links to Argonaut Outputs

FHIR Connectathons 27 FHIR Connectathons 27

May 2016 Connectathon Tracks 28 May 2016 Connectathon Tracks 28

Clinicians on FHIR • Periodic workshops where clinicians collaborate with FHIR developers • Goal Clinicians on FHIR • Periodic workshops where clinicians collaborate with FHIR developers • Goal to engage clinicians in evaluating fit for purpose of FHIR resources in use case snippets built around clinical workflows. • Clinicians interact with FHIR developers, using a tool (Clin. FHIR) to build and visualize resource instances and simple profiles. 29

Clinicians Using Clin. Fhir Clinicians Using Clin. Fhir

The HL 7 Partners in Interoperability is a coalition of various stakeholders, including Medical The HL 7 Partners in Interoperability is a coalition of various stakeholders, including Medical Societies, Bio. Pharma, and the Payer community, paving a path toward interoperability Next meeting planned for October 17 -18 2016 31

More than 200 clinical organizations, IT developers, government agencies and healthcare systems worldwide are More than 200 clinical organizations, IT developers, government agencies and healthcare systems worldwide are now committed to developing FHIR applications 32

A 2 -day FHIR Roundtable of implementations and deployed applications will be held at A 2 -day FHIR Roundtable of implementations and deployed applications will be held at Harvard Medical School, Boston on July 27 -28 33

The mission of the newly announced FHIR Foundation is the support of implementers and The mission of the newly announced FHIR Foundation is the support of implementers and implementation* *FHIR. org 34

What’s Next for FHIR? STU 3 ballot: Sign-up July 27 (Resources, Workflow) Baltimore Connectathon What’s Next for FHIR? STU 3 ballot: Sign-up July 27 (Resources, Workflow) Baltimore Connectathon Sept. 17 New product roadmap: • RDF / Base Ontology work • Fluentpath and a new mapping language • Clinical decision support resources • CIMI / logical model development. 35

A Normative version of FHIR is planned for the Spring of 2017 36 A Normative version of FHIR is planned for the Spring of 2017 36

Implementing FHIR Fast Healthcare Interoperability Resources Connecting Michigan for Health 2016 Workshop on FHIR Implementing FHIR Fast Healthcare Interoperability Resources Connecting Michigan for Health 2016 Workshop on FHIR Wayne Kubick, CTO, HL 7 37