1. @JoshCMandel @SMARTHealthIT Harvard Medical School
Slides at bit.ly/smart-fhir-2016
SMART on FHIR
Harvard Medical School

2. } { SMART's Core Focus Clinicians Researchers Consumers (et al.)
Slides at bit.ly/smart-fhir-2016
SMART's Core Focus } {
Clinicians Researchers Consumers
(et al.)

3. } { SMART's Core Focus Clinicians Researchers Consumers (et al.)
Slides at bit.ly/smart-fhir-2016
SMART's Core Focus } {
Clinicians Researchers Consumers
(et al.)
Healthcare IT Systems
>1200 Certified EHRs
& Portals & Data warehouses

4. } { SMART's Core Focus Healthcare IT Systems
Slides at bit.ly/smart-fhir-2016
SMART's Core Focus } {
Healthcare IT Systems

5. } { SMART's Core Focus clinical data authorization authentication UX
Slides at bit.ly/smart-fhir-2016
SMART's Core Focus } {
clinical data authorization authentication UX
Healthcare IT Systems

6. Motivation: Let people with ideas...
Slides at bit.ly/smart-fhir-2016
Motivation: Let people with ideas...

7. … do better than publishing PDFs!
Slides at bit.ly/smart-fhir-2016
… do better than publishing PDFs!

8. Substitutability = choice
Slides at bit.ly/smart-fhir-2016
Substitutability = choice
Apps

9. Substitutability = re-use
Slides at bit.ly/smart-fhir-2016
Substitutability = re-use

10. … SMART's assessment from 2010-2013 Focused on document exchange
Slides at bit.ly/smart-fhir-2016
SMART's assessment from …
Focused on document exchange
Not open or free
Not adequately expressive
Not unambiguous
Not easy to learn
Summation: Not developer-friendly

11. … SMART's assessment from 2010-2013 @JoshCMandel @SMARTHealthIT
Slides at bit.ly/smart-fhir-2016
SMART's assessment from …

12. @JoshCMandel @SMARTHealthIT
Slides at bit.ly/smart-fhir-2016
SMART's assessment from …
<observation classCode="OBS" moodCode="EVN">
<templateId root=" “ … />
<templateId root=" " … />
<templateId root=" " … />
<id root="107c2dc0-67a5-11db-bd c9a66" />
<code code=" " codeSystem=" " displayName="HGB" />
<statusCode code="completed" />
<effectiveTime value=" " />
<value xsi:type="PQ" value="13.2" unit="g/dl" />
<interpretationCode
<referenceRange>
<observationRange>
<text>M g/dl; F g/dl</text>
</observationRange>
</referenceRange>
</observation>
code="N" codeSystem=" " />

13. First Take: SMART "Classic"
Slides at bit.ly/smart-fhir-2016
First Take: SMART "Classic"
RDF Data models (now deprecated)
Relations everywhere (data == graph) Natural use of vocabularies (terms == URIs) Readily extensible (just add triples)
Docs example: demographics

14. First Take: SMART "Classic"
Slides at bit.ly/smart-fhir-2016
First Take: SMART "Classic"
"Apparently the layout of the Demographic RDF in the developer’s documentation is a logical representation and not a physical one."
"Had the payload been a typical XML document where the data relationships are expressed in its structure, the cognitive overhead would have been non existent."

15. First Take: SMART "Classic"
Slides at bit.ly/smart-fhir-2016
First Take: SMART "Classic"
Attempted solutions to "developer experience" woes
Education (tutorials, sample code, discussion group)
Libraries (JS, Java, Python, …)
JSON-LD (including "frames" to shape data)

16. Take Two: SMART on FHIR FHIR is a draft standard from HL7 Open
Slides at bit.ly/smart-fhir-2016
Take Two: SMART on FHIR
FHIR is a draft standard from HL7
Open
Clinical models REST API
Community
CC0 License
Resources in "plain" JSON/XML Expressive queries Connectathons, Skype, list

17. What is FHIR? Resources
~100 "atomic" structures 17

18. Building an app platform with FHIR
Slides at bit.ly/smart-fhir-2016
Building an app platform with FHIR
FHIR is a tool, not an out-of-the-box solution SMART got involved in 2013
clinical data authorization authentication UX
FHIR + profiles OAuth OpenID Connect
Open-source "glue"

19. +launch
+launch
+embed
+authz
+authn
+data

20. Quick demo of FHIR and SMART
Slides at bit.ly/smart-fhir-2016
Quick demo of FHIR and SMART
FHIR REST API
/Patient/380133
/Patient?name=amy
/Observation?name=
SMART App Gallery

21. SMART Lessons We can live without most features
Slides at bit.ly/smart-fhir-2016
SMART Lessons
We can live without most features
(e.g. inter-app communication, complex ordering)
Developer experience > theoretical elegance
Community is key!

22. SMART on FHIR: Community
Slides at bit.ly/smart-fhir-2016
SMART on FHIR: Community
+ standards development (HL7)
+ vendors (Argonaut)
+ care providers (HCA, HSPC, Intermountain)
+ data networks (SureScripts)
+ content & app dev (Polyglot, British Medical Journal)
+ pharma (Eli Lilly)
Growing list of partners:

23. & Questions Discussion @JoshCMandel @SMARTHealthIT
Slides at bit.ly/smart-fhir-2016
Questions Discussion
&

25. Use-Case-o-matic Pick one from each row!
User Start from Access Duration
Architecture
clinician, patient, none EHR, portal, none patient, population brief, long-term confidential, public

26. OAuth 2 shines at "access delegation"
User*
Authorize
Data Holder
EHR, Hospital, Clinic, HIE,
Lab, Insurer, etc.
App
Decision support, visualization, eRx, pop health, etc.
GET /ehr/data (etc.)

33. What is FHIR? Resources
50+ "atomic" structures

34. What is FHIR? Datatypes (Common structures for core meaning)

35. What is FHIR? Profiles ("Meta" models used to describe resources)