FHIR健康信息共享引发的创新

1、FHIR: Sparking Innovation in HealthInformation SharingFHIR: 健康信息共享引发的创新Why Interoperability?为什么要互操作性?Health information sharing is becoming increasingly important - 健康信息共享变得越来越重要Individuals involved in delivering care to consumers now expect the information they require to be available at the point

2、of care - 医护工作者现在希望得到他们所需要的信息Data collected in multiple places - 据采集于多个不同的地方Realistically need to move information around - 实际上，信息是需要被流转的Interfaces are expensive - 接口是昂贵的Especially if not standards based - 特别是哪些非标准的接口Why FHIR为什么要FHIRHL7 defines Interoperability Standards - HL7定义了互操作性标准In 2011, the B

3、oard of HL7 noted: - 在2011、HL7委员会指出：Interoperability requirements are increasing - 互操作性需求正在增加Need for real time access (API) Mobile - 实时访问需要(API) 移动装置Vast increase in the amount, type and source of data - 数据量、数据类型以及数据源在大量增加-e.g. Devices, Genomics - 例如，设备、基因组学Analytics, population health - 分析，人口健康Imp

4、lementer expectations - 实施者的期望Existing standards were lacking, a fresh look was needed现有标准存在不足，重新审视是必要的Scope of FHIR仔细研究FHIRSharing - 共享APISimple query and update (CRUD) - 简单的查询和更新Operations / Services - 业务/服务Documents - 文档Message - 消息Clinical Reasoning - 临床推理Decision Support / Quality definition -

5、决策支持/质量定义Timeline: Where does FHIR fit?时间轴:FHIR所处的位置19801990200020102020CDAFHIRV3V2V21987Start V31995V3 CDA2005Fresh Look2011FHIR Release 32016What is FHIRFHIR是什么Fast Healthcare Interoperability Resources (FHIR) - 快速医疗互操作资源Implementer friendly - 良好的可实施性Simple yet extensible content model - 简单而可扩展的内容

6、模型Pre-defined APIs - 预定义APIOpen source & on line - 开源在线Tooling, examples and libraries supplied - 提供各类工具、示例和资源库Global endorsement - 全球广泛认可Massive supporting community - 大规模的支持社区Benefits of FHIRFHIR效益Clinician - 临床医生Able to get more involved in system design - 能够更多地参与到系统的设计Faster, more timely access

7、to more high quality data - 更快、更及时地获得更高质量的数据Consumer - 消费者Better involvement with health care - 能够得到更好的医疗保健服务Health Care Organization - 卫生保健组织Ability to innovate - 创新的能力Vendor - 供应商Familiar development environment - 熟悉的开发环境App marketplace - 应用程序市场The specification规范/fhir/Freely available online - 免费

8、在线Easy to read - 易于阅读(fully hyperlinked) (丰富的超链接)Lots of examples - 充足的实例English - 语言Resources: For example资源：例如General - 一般 AllergyIntolerance Condition (Problem) Procedure - 手术 ClinicalImpression FamilyMemberHistory RiskAssessment DetectedIssueCare Provision - 服务的提供 CarePlan - 护理计划 CareTeam - 护理队伍

9、Goal ReferralRequest ProcedureRequest NutritionOrder VisionPrescriptionMedication & Immunization -药物与免疫 Medication - 药物治疗 MedicationRequestMedicationAdministration MedicationDispenseMedicationStatement Immunization - 免疫 ImmunizationRecommendationDiagnostics - 诊断 Observation - 观察 DiagnosticReport Pro

10、cedureRequest Specimen - 样品 BodySite ImagingStudy SequenceReferences between resources引用之间的资源PROCEDURE - 手術Patient - 病人Diagnostic report诊断报告Condition - 状态Subject - 主题Report报告Related Item相关条目Encounter - 就诊Performer - 执行者Encounter - 就诊Practitioner - 执业医生Recording a consultation会诊记录12-year-old-boy - 12

11、岁男孩First consultation 首次会诊Complaining of pain in the right ear for 3 days with an elevated temperature. On examination, temperature 38C and an inflamed right eardrum with no perforation. Diagnosis Otitis Media, and prescribed Amoxicillin 250mg 3 times per day for 7 days.右耳疼痛3天并伴随体温升高。检查时，体温38C， 右耳膜发

12、炎，无穿孔。诊断中耳炎， 开药方阿莫西林250mg每日3次，7天。Follow up consultation 随访咨询2 days later returned with an itchy skin rash. No breathing difficulties. On examination, urticarial rash on both arms. No evidence meningitis. Diagnosis of penicillin allergy.Antibiotics changed to Erythromycin 250mg 4 times per day for 10

13、 days.2天后，皮肤发痒的皮疹。无呼吸困难。经检查，荨麻疹双臂。无证据脑膜炎。青霉素过敏反 应，抗生素改为红霉素250mg每天4次，连续10天。Patient 病人Encounter 就诊Condition 状态Observation 观察Medication 药物治疗Allergy Intolerance过敏反应As linked resources作为链接资源Encounter 就诊Pain right ear 3 days右耳疼痛3天Elevated Temperature体温升高Temperature 38 C体温38CInflamed right drum发炎的右耳膜Otitis

14、 Media中耳炎Amoxicillin 250mg阿莫西林 250mgNo breathing difficulties无呼吸困难Urticarial Rash荨麻疹Penicillin Allergy青霉素过敏反应Erythromycin 250mg红霉素250mgEncounter 就诊Itchy skin rash皮肤发痒的皮疹Patient 病人Practitioner从业者Asserter 断言者Performer执行者Asserter 断言者Prescriber 开处方者Performer执行者Performer执行者Performer执行者Asserter断言者Asserter

15、断言者Performer执行者Performer执行者Coded data and Terminology编码数据和术语Structured vs Coded data - 结构化与编码数据Value of coded - 编码的价值Semantic interoperability - 语义互操作性Decision Support - 决策支持Precision Medicine - 精准医疗Secondary use (Analytics, Population Health) - 二次使用(分析、人口健康)Terminologies in use - 术语的使用SNOMED & othe

16、rs - SNOMED及其他FHIR Terminology servers - FHIR术语服务器Adapting FHIR to your needs: Profiling让FHIR适应您的需求：分析Many different ways of delivering healthcare (contexts), but want a single set of Resources 存在许多不同 的医疗提供的方式(关系)，但需要一套统一的资源Need to be able to describe usage statements of FHIR based on context - 需要能够

17、基于上下文描述FHIR的用法声明Allow for these usage statements to: - 使这些用法声明能够:Authored in a structured manner - 以结构化的方式编写Published in a registry & discoverable - 注册并对外发布Used as the basis for validation, code, report and UI generation. - 作为校验、编码、报告和UI生成的基础3 main aspects: - 3个主要方面：Constraining a resource - remove

18、element, change multiplicity fix values - 约束资源 - 删除元素，更改多重修正值Change coded element binding - 更改编码元素绑定Adding a new element (an extension). Must publish definition. - 添加一个新的元素(或扩展元素)。必须发布定义。Profiling adapts FHIR for specific scenarios - 分析FHIR如何去适应具体的业务场景For example例如Limit names to just 1 (insteadof 0.

19、*)Change maritalStatus to another set of codes that extends the onefrom HL7 international改变婚姻状况到另一组码Specify that the identifier uses regional number and is required指定的标识符 使用区域号码 是必需的Dont supportphoto 不支持照 片Add an extension to support new scenario - 添加扩展 支持新场景New Standards and Tooling新标准和工具Security a

20、nd app launch: SMART安全性和应用程序的启动：SMART2 aspects - 2个方面App Launch - 应用程序启动User Authentication - 用户认证Support apps talking to EHRs - 支持 应用程序与EHRs交谈Adaption of OAuth2 - 适应OAuth2App market place - 应用程序市场/External Apps外部应用程序/Invoke Decision Support: CDS Hooks调用决策支持：CDS HooksInteract with Clinical Decision

21、Support services- 临床决策支持服务的互动Triggered by workflow - 触发工作流The hookSeparates user from supplier of CDS services- 将用户从CDS服务供应商区分Tooling: clinFHIR工具: clinFHIRDeveloped as training tool - 培训工具Evolving! - 进化Main components - 主要组件View Patient data - 查看病人资料Scenario Builder - 情景生成器Logical Modeler - 逻辑建模Valu

22、eSet explorer - 资源管理器Implementation Guide viewer - 实施引导Extension Definition editor - 扩展定义编辑clinFHIR.comBuild Profiles: Forge建立配置文件：ForgeOfficial profiling tool - 官方分析 工具Most comprehensive - 最全面的Free version available - 有免费 版本clinFHIR.comStore Profiles online: Simplifier网上商店简介: SimplifierRegistry of

23、profiles - 注册表简介And other artifacts - 和其他 组件clinFHIR.comFHIR GloballyFHIR在全球范围内Whos using FHIR?谁已经在使用FHIR？Systems accessing HAPI server in 20152015年HAPI系统服务器访问Orion and FHIROrion全面支持FHIRIntegration Engine: Rhapsody集成引擎：RhapsodyManage message movement - 管理消息 流向FHIR features - FHIR特征Message mapping -

24、消息映射Interaction with REST servers - 与REST服务器的交互XML / Json integration - XML/Json集成Example HL7 Message to FHIRHL7消息转换FHIR范例Sending System 发送系统Provider Resource StorePatient Resource StoreServer MailboxObservation Resource StoreHL7 messageHL7 ResponseFHIRLook up / Save - 查找/保存Look up / Save - 查找/保存Ref

25、erence - 参照Reference - 参照Data SpacesClinicalPayerConsumerCustomAmadeus: the platform for precision medicineAmadeus: 精准医疗平台Open APIs3rd Party AppsEngageCoordinate / ConsultData Processing PipelineCleansingMappingRoutingSequencingReplayEnrichingData EngineRhapsody3rd Party AnalyticsRaw DataStorePrivac

26、y ServiceClinical PortalNotificationsDocument ExchangeC-CDA ServicesEMPIConsentConsumerEMR / PMSLabEnterprisePCP / GPSystemAnalytics Engine (Option)Patient RegistriesStreaming & Computation PipelineIn Memory Massively Parallel ProcessingPopulation Health ExplorerBulk DownloadReal TimeTerminology Ser

27、vicesAmadeusAmadeus AnalyticsExposing data through FHIR APIs将数据通过FHIR APIAggregate data from different sources - 从不同来源的汇总数据Expose data via FHIR servers -通过FHIR服 务器公开数据OAuth authentication - OAuth认证Developing SMART - 发展SMART接口Looking ahead: enabling the ecosystem展望未来：生态系统FHIR API and Resources FHIR A

28、PI和资源Terminology术语Registry注册Identity身份Repository知识库DS ServicesDS服务Mapping from existing data sources to FHIR- 从现有的数据源映射FHIRStill need to think about security - 还需要考 虑安全性Alignment between different parts of sector -行业不同领域之间的协调Different opinions - 不同的意见Maturity - 成熟度CHALLENGES挑战FHIR Unlocks Innovation In Health Information SharingFHIR解锁创新卫生信息共享FHIR - Evolving, next generation HL7 standard - FHIR发展，下一代的HL7标准Focused on decreasing interoperability costs and unlocking technical innovation in healthcare- 专注于降低互联互通成本以及在医疗卫生领域的创新Profiling can customize FHIR for your organization - 可为各机构个性化定制FHIR标