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Building FHIR Servers on Existing Applications Robert Worden

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Presentation on theme: "Building FHIR Servers on Existing Applications Robert Worden"— Presentation transcript:

1 Building FHIR Servers on Existing Applications Robert Worden

2 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

3 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 physicians discretion

4 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) CDA Patient Search Parameters Candidate Matching Patients Selected Matching Patient Patient Clinical Information (Updates to Clinical Information) Architecture for CDA Match/Compare Few clinical applications support this now.

5 CDA-FHIR Bridge Clinical Application CDA FHIR server adapter for application Search, Match and Display (FHIR client) Patient Resource Clinical Resources Searches on Patient Candidate Patient resources Searches on Clinical Resources Clinical Resources (Updates to Clinical Resources) search data (update) Searches on Clinical Resources FHIR-enabled CDA Match/Compare Three components simplify implementation. FHIR User

6 Building FHIR Servers and Clients from Existing Applications User Interface Business Logic Relational Database FHIR Adapter User Interface Business Logic Relational Database FHIR Adapter Client A Server B

7 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)

8 Three Kinds of Data Transform 1.FHIR Search => Search commands for internal data structures 2.Internal data structures => FHIR resource 3.FHIR resource => Internal data structures All three types of data transform can be generated from one set of declarative mappings. Do you need to write software to do this? No:

9 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)

10 Mappings, Transforms, and FHIR V2 XML Data Structure FHIR class model (EMF Ecore) FHIR Java reference implementation FHIR serialisation (XML or JSON) Relational Database Structure CDA XML Structure M M M B M = mappings B = Bridge Any-to-any transforms can be generated from the mappings. We are interested in Relational Database FHIR

11 Mapping a Relational Database to the FHIR Patient Resource

12 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

13 FHIR Server Farm Architecture Browser Client Application Relational Database 1 FHIR Multi- Server Configuration File Configuration File 3 Relational Database 2 Relational Database 3 Web server (e.g. Tomcat) http jdbc No Database-specific or Resource-specific code!

14 Demo of FHIR Server Farm

15 FHIR and IHE PDQ (HL7 V2.5) FHIR Patient Server Patient Demographics Supplier FHIR SearchQBP^Q22 RSP^K22Patient Resources

16 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)

17 Searching Multiple FHIR Servers

18 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

19 The CDA-FHIR Opportunity Build CDA-FHIR bridges FHIR-enabled applications can easily make Meaningful Use of CDA More applications FHIR-enabled, to make meaningful use of CDA Easier to make meaningful use of CDA More takeup of CDA Virtuous Circle Applications FHIR-enabled for other reasons

20 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

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