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

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

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

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

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

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

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 http://data.developer.nhs.uk/fhir/fgm/ 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 https://github.com/im2admin/FGM_CSHARP 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 ….

The first national NHS FHIR solution

The FGM Solution A simple query/response pattern

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

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

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

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

Questions @RKavanagh https://uk.linkedin.com/in/richardkavanagh Any Questions ? @RKavanagh https://uk.linkedin.com/in/richardkavanagh richard.kavanagh@hscic.gov.uk