1. HSCIC – The journey on adopting FHIR
FGM Risk Indication System
presented by Richard Kavanagh, Head of Data Standards

2. HSCIC a brief history
HSCIC is an organisation that subsumed “Connecting for Health” in England
It is responsible for the delivery of national architecture for the NHS in England
It has a scope for both Health and Social Care

3. The current HL7 landscape
National architecture is massively invested in HL7v3 and web services
Very widely deployed
Over 100 “live” messages
Thousands of service end points
Billions of messages flowing
However, it is almost universally disliked by the supplier base in England
The cost of development is reportedly high due to niche skills required for HL7v3

4. Can we have FHIR please?
New projects an opportunity for re-evaluating the HL7 standards used
“Can we use FHIR please?”
Nobody ever asked for HL7v3
Do they know what they are asking for?
Industry are currently seeing FHIR as an obvious way to go (mostly)
though few (if any) of them have any implementation experience yet

5. Introducing FHIR into the National Architecture
FGM Risk System is a new national requirement to be deployed across England
A new messaging capability required to query a national repository
Technical complexity is low and offers an ideal test case for trialling FHIR
Infrastructure, timelines and existing supplier base mandated a “messaging” solution
Internal reluctance to move away from HL7v3

6. Development Team Feedback
Development of FHIR interfaces via technical “proof of concepts” and “demonstrator” systems.
Trialling new “agile” development processes internally within HSCIC
Development team reportedly liked
Open accessibility of the FHIR standard
Simple modular constructs (i.e. the resources)
Managing resource identifiers perceived to be a challenge for the future
Though did not like the absence of “tightened” schemas

7. Creating the “Implementation Guide”
Internally we have decided that we will create “profiles” for all FHIR interfaces. Initially for IG creation then for driving validation.
Furore’s Forge tool is used to create all profiles.
Internal “publication” software used to create the actual implementation guide, published online here evolved from Furore’s DSTU1 open source work in this area.
Initial open source exemplar software to create/consume FHIR messages being produced.
C# version using Ewout’s API being used here
Java version will be added - we intend to use the HAPI API
Early days, but internal effort less than creating HL7v3 RMIMs undertaken by staff with much less training.
Principally a learning exercise, the next one will be easier ….

8. The first national NHS FHIR solution

9. The FGM Solution
A simple query/response pattern

10. The Query Message
Two parameters, a Risk Type and a Patient’s NHS Number
Contains a Bundle of the following

11. The Response Message Contains a Bundle of the following:
No extensions required in the solution

12. The Next Steps for FGM
Use Furore’s new release of Forge to refactor our profiles
Refactor our “publishing” software for changes from DSTU2 and Forge
Get the development team to refactor their software solution
Support the suppliers with their implementations

13. The next steps for FHIR at HSCIC
The use of FHIR is now growing rapidly. Multiple projects now underway
More messaging projects:
Maternity pathways (underway)
Pathology messaging (in evaluation)
Ambulance to Emergency Department interface (in evaluation)
RESTful API projects (all underway) :
APIs for Primary Care systems (i.e. GPs)
Demographics, Scheduling, Medications ….
APIs Integrated Digital Care records (i.e. Secondary / Tertiary care)
Federated development of IGs …
National Appointment Booking/Referral system
FHIR Validation/Assurance (2015 Q4):
National approach & tooling
FHIR for Documents (2016 Q1/Q2):
CDA <> FHIR Conversion based on national profiles

14. Questions @RKavanagh https://uk.linkedin.com/in/richardkavanagh
Any Questions ?
@RKavanagh