1. FHIR Server Design Review Brian Postlethwaite HEALTHCONNEX October 2015

2. Telstra Unrestricted Solution Architectures Generic FHIR Server Publish/Sync Façade Cache Database Structures Blob Store (XML or json) Atomised Data (Full ER Model) View (Façade-ish) Hybrid Presentation Title | Presenter Name | DatePage 2

3. Telstra Unrestricted Server is pure FHIR Not intended to handle other formats No requirements from legacy systems Do not require content conversions Storage options very flexible Can optimise storage Can optimise indexing Security considerations Presentation Title | Presenter Name | DatePage 3 Generic FHIR Server

4. Telstra Unrestricted Utilize a separate FHIR server Content extraction Content conversion Storage/indexing/searching FHIR server problem Synchronization timing and scope 2 way changes? Security? Presentation Title | Presenter Name | DatePage 4 Publish Sync

5. Telstra Unrestricted Expose a FHIR interface to existing system Content conversion on the fly as required Complexities of conversion of queries onto existing structures Security applied by source If using views, updates can be challenging All server load is directly applied to the source services/tables How to handle history? Presentation Title | Presenter Name | DatePage 5 Facade

6. Telstra Unrestricted Basically a Façade and a generic FHIR in one Cache the content that was returned Content required can be returned quickly Security applied by source Indexes can be: in replicated content views on the source data Synchronized from source data Load an be minimized from the source data to the cache content History can remain in the cache Presentation Title | Presenter Name | DatePage 6 Cache

7. Telstra Unrestricted Database Design Presentation Title | Presenter Name | DatePage 7

8. Telstra Unrestricted Native content format (xml/json) Extensions stored in place No need to assemble May require object model conversion between formats Indexing considerations dedicated index tables outside data Sync or async updating? XML content indexes? Consider how meta updates should be done Presentation Title | Presenter Name | DatePage 8 blob store xml/json

9. Telstra Unrestricted Traditional database design model All entities have their own tables and full ER model Needs to be formatted for output Challenges with extensions Ensure model supports history Just façade existing schema with extensions? Presentation Title | Presenter Name | DatePage 9 Atomised data

10. Telstra Unrestricted Legacy database Extensions for additional columns How to handle updates How to handle incoming data Extensions? History? Searching? Presentation Title | Presenter Name | DatePage 10 View (Façade)

11. Telstra Unrestricted Depends on storage model Timing - Synch/Async Flexibility for new indexes Simple Index on table Dedicated index tables (common for blob style) Data types in index - generic table/atomized Effect on availability in search Impact on applying security Presentation Title | Presenter Name | DatePage 11 Indexing for Search

12. Telstra Unrestricted Blob store – fhir format Internal replication from relational store Extensions may only live in fhir store FHIR store covers history Indexing from either location Presentation Title | Presenter Name | DatePage 12 Hybrid

13. Thank you