#CM4H16 #FHIR Workshop with eJeff Eastman of MiHIN

Working on FHIR – tutorial on connecting to a sandbox and working with FHIR with simple examples attendees can try
Dr. Jeff Eastman, Senior Directory Architect, MiHIN

MiHIN Patient Generator

19 Personas + 4,081 simulated Patients and Physicians

Based on 130 Statistical models

How MiHIN got into FHIR

Health Provider Directory (HPD) – Providers, Organizations etc.

State Consumer Directory (SCD) – Consumers (aka Patients)

Active Care Relationships (ACR)
This is a matching of HPD and SCD.

HPD -FHIR Memberships (aka Affiliations)

Implemented as FHIR Basic Extensions

Using FHIR Basic Resource to create a new resource for Affiliatins

MiHIN has created HPD-FHIR Electronic Services as a Basic Extension.

This creates FHIR as a Router.

SCD – FHIR Active Care Relationships

Created as a Basic Extension.

Next release of FHIR will release CareTeams that is close but not a complete match.

#CM4H16 #FHIR Workshop with eJeff Eastman of MiHIN

Working on FHIR – tutorial on connecting to a sandbox and working with FHIR with simple examples attendees can try
Dr. Jeff Eastman, Senior Directory Architect, MiHIN

MiHIN Patient Generator

19 Personas + 4,081 simulated Patients and Physicians

Based on 130 Statistical models

How MiHIN got into FHIR

Health Provider Directory (HPD) – Providers, Organizations etc.

State Consumer Directory (SCD) – Consumers (aka Patients)

Active Care Relationships (ACR)
This is a matching of HPD and SCD.

HPD -FHIR Memberships (aka Affiliations)

Implemented as FHIR Basic Extensions

Using FHIR Basic Resource to create a new resource for Affiliatins

MiHIN has created HPD-FHIR Electronic Services as a Basic Extension.

This creates FHIR as a Router.

SCD – FHIR Active Care Relationships

Created as a Basic Extension.

Next release of FHIR will release CareTeams that is close but not a complete match.

#CM4H16 #FHIR Workshop with eJeff Eastman of MiHIN

Working on FHIR – tutorial on connecting to a sandbox and working with FHIR with simple examples attendees can try
Dr. Jeff Eastman, Senior Directory Architect, MiHIN

MiHIN Patient Generator

19 Personas + 4,081 simulated Patients and Physicians

Based on 130 Statistical models

How MiHIN got into FHIR

Health Provider Directory (HPD) – Providers, Organizations etc.

State Consumer Directory (SCD) – Consumers (aka Patients)

Active Care Relationships (ACR)
This is a matching of HPD and SCD.

HPD -FHIR Memberships (aka Affiliations)

Implemented as FHIR Basic Extensions

Using FHIR Basic Resource to create a new resource for Affiliatins

MiHIN has created HPD-FHIR Electronic Services as a Basic Extension.

This creates FHIR as a Router.

SCD – FHIR Active Care Relationships

Created as a Basic Extension.

Next release of FHIR will release CareTeams that is close but not a complete match.

#CM4H16 Patient Matching with @AdamCulby

Patient Matching on FHIR

Adam Culbertson, Innovator in Residence on Patient Matching, HIMSS

Patient matching: Comparing data from multiple sources using attributes to identify common records. ie. John Smith is the same John Smith.

Patient Matching in probabilistic matching creates a confidence score.

Data + Algorithms = Linked Data.

email is increasingly used.

Metrics for Algorithm Performance

Lack of transparency in how matching algorithms perform

Varied claims

Need beter transparency

Need reporting on Match rates

There are good metrics.

Precision / Recall

  • Are two things the same thing?

Possibilities are:
True Positive
True Negative

False Negative
False Positive

Blocking is the process of selecting matches on a particular field before a more detailed comparison is done on the full record.

FHIR is a great solution for Structure

FHIR Enabled Matching

FHIR can be used to create Synthetic data that can be tuned to specific use cases.

FHIR Search Parameters can be used to Create matching queries.

Potential to create a FHIR Extension.

Creating a Test Harness offers opportunities to build a tool to assess best matching tool for a particular use case.

#CM4H16 Working on FHIR – Synthetic Patients with eJeff of #MIHIN and Mark Braunstein of GA Tech

Lunch and Learn: FHIR Resources for Testing PatientGen
Dr. Jeff Eastman, Senior Directory Architect, MiHIN
Using PatientGen FHIR Resources for Research and Educational Purposes
Mark Braunstein, Professor of the Practice, College of Computing, Georgia Institute of Technology

Patient Gen

It is hard to create synthetic Patient data.

Purpose is to create credible test data

  • Randomly assigns

  • Patients can be aged and go through life changes

  • 130 Conditions

PatientGen can create:
– ADTs
– FHIR
– ACRS

and much more

Available to anyone

http://52.72.172.54:8080/fhir/home

Mark Braunstein, CA Inst. of Tech.

Runs CS 6440 Introduction to Health Informatics

Nine years old.
Evolved with rapidly changing HIT landscape

Offered as part of OMSCS (On Line Masters of Science in Computer Science)
Heavily project based.

Offered as a MOOC. 10 weeks long.

Projects:

Teams of 4-6
Multi-disciplinary

Emory/VA/CDC lecture on their domains.

Students then work on real projects.

CDC – App Suite for Community-wide Obesity program (4 Projects)

GT built FHIR Server on top of OMOP

Students have access to:

  • 10,000 Chronic disease patients

#CM4H16 – Consent on #FHIR and Patient Choice

Consent on FHIR and Patient Choice

Carol Robinson, Principal, CedarBridge Group

Kathleen Connor, President, Baycliffe Strategies

Privacy on FHIR

Behavioral Health data sharing has been limited by Technology and policy.

The culture will be changing.
Patients will have moe granular options for sharing.

Michigan E-Consent Management System (eCMS)

Use Case Principles:
– Patients should be able to determine when and with whom their sensiive health data is shared.
– Behavioral Health Providers should be able to fully participate in HIE
– MI Regional HIEs should be able to efficiently manage patient consent determinations via a federated model.

Two components:

  • Statewide consent form
  • eCMS

Technical Overview

Standard Consent Directives separate the content from the management:
– ONC Patient Choice
– HL7 v2, v3 and CDA Consent Directive standards
– IHE BPPC and APPC Consents
IHE tracks CD content in XD* Metadata

Metadata reflects whether a consent directive is active

Metadata is included in CON Segment of the ADT. eg. ADT Access Control Restrictions

ONC Data Segmentation for Privacy (DS4P)

  • DS4P Security Labeling
  • Consent Directive Content
  • Consent Tracking Metadata
  • Authentication
  • Exchange Paradigms
  • Access Control/Audit

ONC DS4P Standards

The Stack:
– Content Tagging (CDA R2 Header(
– Content Structure (Consolidated CDA)
– Manifest Metadata ((XDS Metadata)
– User Context
– Push or Query/Retrieve Transport Mechanism
– Foundational Security

Patient Choice:

Three levels of rules:

    1. HIPAA Runs in background
    1. Basic Choice
    1. Granular Choice

Basic Choice: Organizations/States can define Opt-in or Opt-out

FHIR Consent Tracker Resource

Capture Consent Directive Metadata (for workflow)

Standard method for consumer consent information to be stored and managed.

Metadata includes:
– Consent Directive Provenance (author, signer, custodian)
– Consent Directive prescribed DS4P Security Labels for Confidentiality and Security Controls for downstream controtl
– Consent Domain Authority

FHIR Consent Directive Profile

http://hl7-fhir.github.io/consent.html

Different states and organizations have differing requirements on what is a signature.

eg. Minnesota requires a “wet signature” i.e. signed in ink on paper.

Consent Directive examples for FHIR:
http://hl7-fhir.github.io/consent-examples.html

#CM4H16 Lenel James – BCBSA – Payers on #FHIR

http://connectingmichigan.net/wp-content/uploads/2016/06/MiHIN-Connecting-Michigan-For-Health-2016-Agenda-for-Release-final-06-07-16.pdf

Payers on FHIR

Lenel James, Business Lead – Health Information Exchange & Innovation, Blue Cross Blue Shield Association

A value-based care perspective

Why is FHIR different

Document-based exchange doesn’t let you delve into the context of the data received.

FHIR fits in to real-time operations
FHIR fits Payer workflows.

Value-based care

Local patient-center programs that meet national quality and affordability criteria to drive unparalleled value
– Measured Value
– Integrated Care
– Customer Flexibility

Provider Empowerment
eg. ACTIONABLE Analytics

Industry Vantage Point

Use technology to improve collaboration. Death to the Fax!

FHIR Use cases

FHIR for information Exchange
– Basic Patient management
– Structured Data Capture
– Patient Scheduling
– Financial Resources

Mapping Claim 837 to FHIR is underway.

FHIR Use Cases – Patient:
– Care Gaps
– Risk Adjustment
– EOB delivery
– Patient Demograph

Lenel Makes a shout-out to #BlueButton on #FHIR work at CMS

FHIR Uses Cases: Practice:

  • Value-based contract performance
  • HEDIS/ Care gap measures
  • Provider Attestations.

Looking at HEDIS on FHIR
– Matching with FHIR DAF profiles.

Value-based Care Use Case:

  • Colorectal Cancer Screening Member Requests.
    NantHealth built demo in 4 weeks using FHIR.

IBX saved $0.5M by shifting their New Health Portal to use FHIR.

The Big Picture

FHIR coexists.

Trust: Must be a collaborative process.

Patient interaction supports better care.

What you can do

Learn FHIR now so you can support Pilots.

  • Look at where you do Clinical Data Exchange
  • Look at FHIR use cases
  • Review FhIR Education and Background links
  • Plan to attend the September Connectathon
  • Get on the list of news from ONC.
    -Check out ONC Proving Ground

#CM4H16 Argonaut: Vendors on FHIR – Wayne Kubick

Argonaut: Vendors on FHIR

Wayne Kubick, Chief Technology Officer, Health Level Seven International

http://connectingmichigan.net/wp-content/uploads/2016/06/MiHIN-Connecting-Michigan-For-Health-2016-Agenda-for-Release-final-06-07-16.pdf

What matters most to HL7

Vision: A world where people have the information they need, securely, where and when they need it.

Mission: To empower global health data interoperability by developing the best and most appropriate standards.

A standard becomes useful because people use it. It benefits from the power of the network effect.

Just be aware that we are at the peak of expectations in the Gartner Hype Cycle.

ONC is supporting FHIR for consumer-facing applications

MIH and ONC Launch Sync for Science (S4S) Pilot. Enabling Individual Health Data Access and donation.

FHIR is Resources that are essentially modular information components easily assembled into working systems.

FHIR is DESIGNED FOR IMPLEMENTATION.

Principles of FHIR

  • Data resides at the single source of truth
  • API Access data: Pull what you need, instead of only getting what’s pushed
  • Focus on implementors
  • Include rigorous semantics
  • Design for common 80%, extensions for the rest
  • Off the shelf security and authorization
  • Speed, scalability a, ease of understanding
  • Everything is human readable and free.

Maturity Model

  1. Draft for comment
  2. Stable Build
  3. Connect-a-thon
  4. Passed Ballot
  5. Tested, Published, Prototyped
  6. International Adoption

JASON Task Force and the Argonauts

JASON Task Force made a call to action on “public APIs”

Based on Market experience with MU2 and associated certification

Industry desire to involve private sector and bring market discipline to standards development.

Currently 89 Participants in Argonaut.

Argonaut leverages work of S&I Framework and SMART workgroups.
Accelerates maturation of FHIR
Open to all. Free to participate.

Prioritize and create implementation guides
Supporting conformance testing and publish results.
Continuous improvement through frequent sprints

Common MUDataset, CCDA, Provider Directory, Security and Authorization.

Argonaut uses 2-week sprints. Accelerating the speed of development.

Need to define market ecosystem (Terms, IP, safety, contracts)

Clinicians on FHIR Workshops

Interact with developers using ClinFHIR tool to build and vizualize resource instances and profiles.

http://clinfhir.com

HL7 Partners in Interoperability

policy, planning and change management

FHIR applications Roundtable

Implementations and deployed applications

July 27-28 – Harvard Medical School, Boston

FHIR Foundation

501.c.3 charitable non-profit

Support for implementers and implementation.

Development of a FHIR Registry to keep track of profiles.

http://FHIR.org

What’s Next:

STU3 (System for Trial Use) Sign up July 27.
Baltimore Connect-a-thon – September 17-18
New Product Roadmap:

  • RDF / Base Ontology work
  • Fluentpath and a new mapping language
  • Clinical decision support resources
  • CIMI / Logical model development

A normative version of FHIR is planned for Spring 2017.

HL7 Payers on FHIR – Partners in interoperability, Chicago July 7 11-12
HL7 Virtual Connectathon for Payers (Skype) Jul7 13 11am-5pm ET