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B uilding FHIR Servers on Existing Applications. Robert Worden rpworden@me.com. Outline. FHIR and CDA Building FHIR Servers and Clients Mapping Application Databases to FHIR FHIR Server Demo FHIR Client for Multiple Servers FHIR and Data Matching CDA-FHIR Bridge.

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Presentation Transcript
outline
Outline
  • FHIR and CDA
  • Building FHIR Servers and Clients
  • Mapping Application Databases to FHIR
  • FHIR Server Demo
  • FHIR Client for Multiple Servers
  • FHIR and Data Matching
  • CDA-FHIR Bridge
more meaningful use of cda
More Meaningful Use of CDA
  • When reading a CDA, a physician is not just a blank slate for new information.
  • Often, he or she knows about the patient already.
  • The physician needs to compare the new information in the CDA with what they already know.
  • Their knowledge of the patient may be stored in an EMR.
  • Comparing requires matching of information from the CDA, with information in the EMR:
    • Match and identify the patient
    • Match clinical data for the patient (e.g. allergies, medications,..)
  • Then (possibly) make updates to the EMR, at the physician’s discretion
architecture for cda match compare
Architecture for CDA Match/Compare

Patient Search

Parameters

  • CDA Handler Module:
  • Extract patient data from CDA
  • Search and match patients
  • User chooses the matching patient
  • Extract clinical information from CDA
  • Compare with clinical information from application
  • (User choice of updates to the application)

Clinical Application

(e.g. EHR)

Candidate Matching

Patients

CDA

Selected Matching

Patient

Patient Clinical

Information

(Updates to Clinical

Information)

Few clinical applications support this now.

fhir enabled cda match compare
FHIR-enabled CDA Match/Compare

User

Searches on

Patient

CDA-FHIR Bridge

Search, Match and Display

(FHIR client)

FHIR server adapter for

application

Clinical Application

Patient

Resource

Candidate

Patient resources

search

CDA

FHIR

data

FHIR

Searches on

Clinical

Resources

Searches on

Clinical Resources

Clinical

Resources

Clinical

Resources

(update)

(Updates to Clinical

Resources)

Three components simplify implementation.

building fhir servers and clients from existing applications
Building FHIR Servers and Clients from Existing Applications

Client A

Server B

User Interface

User Interface

Business

Logic

FHIR

Adapter

FHIR

Adapter

Business

Logic

Relational

Database

Relational

Database

what fhir adapters do
What FHIR Adapters Do
  • (Client) compose a FHIR search request (e.g. for a Patient Resource, with given NHS number).
  • (Client) send the FHIR search request
  • (Server) translate the FHIR search request into search commands for its internal data structures (e.g. SQL)
  • (Server) translate the results of internal searches (e.g. SQL ResultSets) into FHIR resources
  • (Server) send a bundle of FHIR Resources
  • (Client) translate the FHIR resources into its internal data structures (e.g. RDBMS records)
three kinds of data transform
Three Kinds of Data Transform
  • FHIR Search => Search commands for internal data structures
  • Internal data structures => FHIR resource
  • FHIR resource => Internal data structures

Do you need to write software to do this? No:

All three types of data transform can be generated

from one set of declarative mappings.

mapping and transformation toolset
Mapping and Transformation Toolset
  • Define a Logical Model of information to be exchanged (UML, expressed in Eclipse Ecore)
  • Define Mappings of any physical data structure onto the Logical Model
  • Mappings state precisely how the physical data structure represents information in the logical model.
  • Mappings are declarative and easily testable.
  • Open Source tools are used to define, validate, and test the mappings.
  • The same tools generate any-to-any transforms between the data structures (in Java or XSLT)
  • Generated transforms are precise and testable (e.g. round trip tests)
mappings transforms and fhir
Mappings, Transforms, and FHIR

CDA XML Structure

M = mappings

B = Bridge

M

V2 XML Data Structure

FHIR class model

(EMF Ecore)

FHIR Java reference implementation

FHIR serialisation (XML or JSON)

M

B

M

Relational Database Structure

Any-to-any transforms can be generated from the mappings.

We are interested in Relational Database <=> FHIR

fhir server farm
FHIR Server Farm
  • Web service under Tomcat
  • Currently two FHIR servers, created by mapping Relational Databases to FHIR resources:
    • PAS system database
    • ‘Noddy’ patient database (1 table)
  • Jdbc access to the databases
  • Read-only FHIR servers for the Patient resource
  • Support a range of Patient searches
  • Each server is defined entirely by configuration files
  • No database-specific or resource-specific code
fhir server farm architecture
FHIR Server Farm Architecture

Web server (e.g. Tomcat)

Relational

Database 1

Browser

jdbc

http

FHIR

Multi-Server

Relational

Database 2

Client Application

Configuration File

Configuration File

Configuration File 3

Relational

Database 3

No Database-specific or Resource-specific code!

fhir and ihe pdq hl7 v2 5
FHIR and IHE PDQ (HL7 V2.5)

FHIR Search

FHIR

Patient

Server

QBP^Q22

Patient

Demographics

Supplier

Patient

Resources

RSP^K22

fhir and data matching
FHIR and Data Matching
  • As soon as a provider has two or more FHIR servers for the Patient resource, they can compare the Patients across them (in the common FHIR representation).
  • An application can interrogate the different FHIR servers, and compare the results
  • An Open Source Comparative Query Tool can compare across the servers, in terms of the FHIR Patient class model
  • Bulk data matching and de-duplication can be done across databases (proprietary tool)
cda fhir bridge
CDA-FHIR Bridge
  • Enables any incoming CDA as a small FHIR server
  • The CDA ‘server’ supports FHIR searches on common resources (Patient, AllergyIntolerance,...)
  • This is not a full transform from CDA to a FHIR Composition resource; extracting specific FHIR resources is much easier
  • Transforms depend on CDA templates
  • There will be a different bridge for each CDA profile
  • There is no dependence on the EHR application – the bridge is universal for each CDA profile
  • Easy to build
the cda fhir opportunity
The CDA-FHIR Opportunity

Applications FHIR-enabled

for other reasons

Build

CDA-FHIR

bridges

FHIR-enabled

applications can easily make Meaningful

Use of CDA

More applications FHIR-enabled, to make meaningful use of CDA

More

takeup of CDA

Easier to make meaningful use of CDA

Virtuous Circle

fhir mapping tools work in progress
FHIR Mapping Tools: Work In Progress
  • Deployment: currently deploying a FHIR Patient server for an NHS Trust; more are planned
  • Searches: extend capability to more types of search, e.g. date range, alternative values,...
  • Extensions: can hide the extra complexity of FHIR extensions – extensions are identical to core features, in the Ecore class model and in mappings.
  • Write operations: The tools generate the required data transforms, but will always require business logic
  • Documentation of the Open Source Tools: Real soon now
  • FHIR Server Configuration Service: ask rworden@me.com