Møte 16 i FHIR fagforum

  • Dato: 2023-02-08
  • Klokkeslett: 1300-1500
  • 81 personer innom møtet

FHIR fagforum (FFF) er et åpent forum om bruk og implementering av HL7 FHIR i Norge. FFF er åpent for alle.

Nordic projects

  • Intro (5 min)
  • HL7 Norway info (5 min)
  • Mikael Rinnetmäki, Finland (20 min)
    • Nordic IPA, harmonizing the national base profiles of the Nordic countries
    • FHIR Demo, experiences from 2022, info on joint effort for 2023
  • Jens Villadsen, Denmark (30 min)
    • Fælles Udbredelse af Telemedicin (FUT) is a Danish national healthcare platform aimed for telemedicine use that can host 3rd-party apps communicating using HL7 FHIR API
  • Michael Johanson, Denmark (30 min)
    • Transition from legacy to FHIR. EDIfact and XML, you are FHIR’ed!
    • Messaging paradigm partly change for documentsharing and REST-services
  • Emmeli Gross, Sweden (20 min)
    • Swedish base profiles
    • Swedish E-health Agency work on FHIR in the National Swedish Medication List
  • Discussions (10 min)

Presentasjoner

HL7 Norge - Øyvind AAssve, Sykehuspartner

Different norwegian projects

Finland Finnish base profiles

  • Snapshot and SMART implementation guide
  • Based on the most common use-cases in the healthcare sector
  • Most terminology is from existing codesystems
  • Builds on the international IPA specification
  • Take a look on the base profiles in other countries adapt what is being done in other countries
  • Later this spring harmonization of the nordic base profiles

Finnland FHIR demo

  • Finnish demo site in winish FHIR demo
  • Integration using FHIR is documented and tested in connectaton
  • FHIR first strategy of the larges
  • Repeating the FHIR demo HIMSS event in june
  • Interested parties
  • HUS has a FHIR first strategy

Questions/comments

  • Base profile use in finland?
    • Not published yet, but the reason for starting the effort is to prevent the way FHIr is implemented in different projects in implementations
  • Is the government involved in profiling or mandating use of the profiles?
    • Government KELA, THL code setting, Ministry of health (not involved) but the other two are involved
  • [13:21] Jens Kristian Villadsen do they have to be on the nordic market?[13:21] Jens Kristian Villadsenthe solutions?
    • No they do not
  • I have a stealth project of interest :-)
  • FHIR first strategy working out for HUS
    • EPIC installation using the FHIR integration, most recent

Denmark FUT Fælles understøttelse av telemedicin

  • Largest FHIR implementation in Denmark
    • 89 municipalities and all four regions are connectted to FUT
  • Telemedicine solutions on one common infrastructure
    • Confluence site that lists different details on arcitecture, security and 40 different FHIR profiles
    • FUT denmark
  • Main arcitecture is a eHealth infrastructure, the centre of communication between ciizen, service providers and healthcare providers
  • Federation portals, first system of its kind in Denmark communitaion between differnt part of the healthcare system using FHIR
    • First COPD patient yesterday
  • FHIR resources - Patient, AuditEvent Appointment, Communication, Organization
  • FUT and it’s stack API first
    • Not a disease specific platform
    • 13 FHIr services, subset of the FHIR resources, 50 application services running
  • Security model is not SMART, but SMART’ish
    • Federate different identity providers
    • Attributes for roles and assotionations in SAM
    • Access to FHIR resources is federated using role and also what care team you participate in
    • CareTeams if the actual FHIR resources referaence your CareTeam for you to have access to it
    • How do you administrate the care teams efficiently? in cooperation including caregivers from many different organizations
      • No limits to the different administrators, the organizations need to govern this themself
        • One administrator can assign their collegues
      • A true distributed model
    • Tool support for the administrators
      • SAML attribute builder
  • FUT is based on FHIR started R3 converto R4
    • One IG to cover them all
    • Based on HAPI fhir implementation with a large amount of customization

Questions/comments

  • How is the SAML tool integrated with the different adminstration tools in different orgz
  • What is the timeline for use FUT infrastructure
    • Municipality project are on FUT
    • First COPD patient using Questionaire and Observation

Denmark Transisition from legacy

  • EDIFACT, XML, CDA and now try to move to HL7 FHIR, messaging with HL7 FHIR
  • Sundhedsdatanet - Medcom
  • use-case for webservices and webservicees
  • EHMI - with eDelivery
  • Test and certification of systems using standards
  • Stop using danish standards - start using HL7 standards, startu using english as communication language
  • Standard catalog
  • Messging, including refferal hotel
  • Webservice enabled - lab orders, etc
  • Document sharing
    • Patient overview
    • Patient reported outcome
    • pregnancy journal
  • Lessons learned so far
    • Loose coupling
    • Not a 1:1 transition to FHIR, take the use-cases more suitable for REST communication
  • FHIR is recommended, but expensive to implement
    • New functionality added to the FHIR messaging spec
  • New infrastructure for messaging
  • Test and certification
    • more than transport, semantics and standards
  • Technical integration, shared information, dialog with wendors

Danish FHIR core profiles

  • Patient, organization etc.

Channel strategy (communication paradigm)

  • Messaging, document sharing, FHIR services, Linking systems
  • Sustainaility of the modernization project
    • added functionality comes at a cost
  • Deloitte concluded that some messages should be exchanged with FHIR API’s

Questions

  • How have you handled labratory reports that should be witheld from the patient?
    • In the lab result there are consent information
    • National service my consent - certain lab results could be witheld
  • Any thougths of what use-cases are better served by REST than by the messaging paradigm? What makes the use-cases more suitable for RESTFUL API?
  • but expensive to implement what drives the cost? Are FHIR the best model for message based communication? Messaging have low maturity in the FHIr standard itself

Eventuelt og diskusjon

Swedish Base FHIR profiles

  • The details on
  • Work group from regions authorities, system vendors, Inera etc.
  • Focus on profiling swedish concepts decide how the swedish specialites is done in the same way across implementation
  • Problem with org and funding
  • Four profiles and 3 extensions
    • Patient - Typical info from tax-agency for Patient info
    • Practititoer - swedish identifiers, qualification identifiers and some different swedish specific coding for qualification
    • Organization - Swedish
  • Use cases - Swidish medication list is one example

National Swedish medication list

  • Made by swedish health agency
  • Healthcare staff and pharmacists get the same information about the prescriptions
    • External API’s are FHIR based
    • on-boarding in progress
  • Techincal shift from swedish specific SOAP to HL7 FHIR
  • Documentation
    • Simplifier IG in english - with examples
    • Hanbook for FHIR in swedish
    • The HL7 FHIR documentation
  • Advantages of using FHIR
    • Semantics - using FHIr you get a backbone structure and defintion
    • REST is a powerfull and flexible comm paradigm
    • FHIR implementation is quicker using SDK and existing tools
  • The profiles are documented on SIMPLIFIER

Questions

  • Inera have provided some services - but the knowledgable persons have left the organization
  • We have tried to extend the swedish base profiles when working with the industry profiles
    • Tweaking the publication process
  • Swedish strategy is to get the industry to work on profiles
    • Have to find ways to work together

Meldingsliste Profilbilde av Mikael Rinnetmäki. Jens Kristian Villadsen I can tell you… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:26 Jens Kristian Villadsen I can tell you how I’d model that (system changing access rights mid session) with SMART. Offline…

Profilbilde av Reza Baharmand. then who is the admin of administrator team… av Reza Baharmand Reza Baharmand (Ekstern)14:28 then who is the admin of administrator teams?

Profilbilde av Trond André Aag (gjest). Begynn referansen, Jens Kristian Villadsen … av Trond André Aag (gjest) Trond André Aag (gjest)14:28 Mikael Rinnetmäki 08.02.2023 14:26 Jens Kristian Villadsen I can tell you how I’d model that (system changing access rights mid session) with SMART. Offline… Do you have any documentation you can share?

Profilbilde av Jens Kristian Villadsen (gjest). Kobling https://ehealth-dk.atlassian.net/wi… av Jens Kristian Villadsen (gjest) Jens Kristian Villadsen (gjest)14:28 https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/overview

Profilbilde av Mikael Rinnetmäki. Begynn referansen, Do you have any document… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:30 Trond André Aag (gjest) 08.02.2023 14:28 Do you have any documentation you can share? The SMART spec, of course. 😋In addition to that, just some view on how identity providers / authorization servers should work. Short-lived access tokens, etc.

Profilbilde av Camilla Urup Noe Andersson. “careteam” has been a big discussion in the… av Camilla Urup Noe Andersson Camilla Urup Noe Andersson (Ekstern)14:30 “careteam” has been a big discussion in the project, contact me if you want to know more about how the organizations handle their “careteams :) Profilbilde av Jens Kristian Villadsen (gjest). Kobling https://docs.ehealth.sundhed.dk/ av Jens Kristian Villadsen (gjest) Jens Kristian Villadsen (gjest)14:32 https://docs.ehealth.sundhed.dk/

Profilbilde av Sørlien, Ingvar (gjest). What is now the timeline to start using the… av Sørlien, Ingvar (gjest) Sørlien, Ingvar (gjest)14:33 What is now the timeline to start using the FUT infrastructure?

Profilbilde av Mikael Rinnetmäki. Begynn referansen, The SMART spec, of cours… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:33 Mikael Rinnetmäki 08.02.2023 14:30 The SMART spec, of course. 😋In addition to that, just some view on how identity providers / authorization servers should work. Short-lived access tokens, etc. The PractitionerRole is another obvious entry point.

While I remember, please make an entry in y… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:37 While I remember, please make an entry in your calendars for the Radical Health Festival (https://radicalhealthfestival.messukeskus.com/) on June 12-15 in Helsinki. We will probably have some pan Nordic activities connected to the event. Like a workshop for Nordic IPA / harmonizing national base profiles.

Profilbilde av Reza Baharmand. Begynn referansen, While I remember, please… av Reza Baharmand Reza Baharmand (Ekstern)14:44 Mikael Rinnetmäki 08.02.2023 14:37 While I remember, please make an entry in your calendars for the Radical Health Festival (https://radicalhealthfestival.messukeskus.com/) on June 12-15 in Helsinki. We will probably have some pan Nordic activities connected to the event. Like a workshop for Nordic IPA / harmonizing national base pr… Invitation without Discount code? 😆

Profilbilde av Michael Johansen. Core profiling is also pro bono in Denmark,… av Michael Johansen Michael Johansen (Ekstern)14:44 Core profiling is also pro bono in Denmark, as in sweden. Any sponsorship in Norway or Finland?

Profilbilde av Espen Stranger Seland. Good old “dugnad” in Norway. av Espen Stranger Seland Espen Stranger Seland14:45 Good old “dugnad” in Norway.

Profilbilde av Mikael Rinnetmäki. In Finland the base profiling work is funde… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:45 In Finland the base profiling work is funded by HL7 Finland. HL7 Finland gets its funding from members, as both membership and project fees.

Highly recommended model! Wink av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:45 Highly recommended model! 😉

Kobling https://fhir.fi/finnish-base-profil… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:47 https://fhir.fi/finnish-base-profiles/#participate-in-ig-development-and-maintenance

Regarding the Swedish base profiles: In Swe… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:50 Regarding the Swedish base profiles: In Sweden you also have the industry initiative for the base profiles, https://build.fhir.org/ig/SvenskaIndustriProfiler/fhir/. Are the aims of the projects similar or different? Do the projects work together? (Or did they, when the HL7 Sweden project was still running?)

Profilbilde av Pétur Þór Valdimarsson. We have tried to extend the swedish base pr… av Pétur Þór Valdimarsson Pétur Þór Valdimarsson (Ekstern)14:50 We have tried to extend the swedish base profiles when working with the industry profiles.

Profilbilde av Mikael Rinnetmäki. Begynn referansen, Invitation without Disco… av Mikael Rinnetmäki Mikael Rinnetmäki (Ekstern)14:51 Reza Baharmand 08.02.2023 14:44 Invitation without Discount code? 😆 The side events most likely don’t require registration to the event. But do send me a message if you’re interested in a discount code.

Profilbilde av Pétur Þór Valdimarsson. But they are separate projects working inde… av Pétur Þór Valdimarsson Pétur Þór Valdimarsson (Ekstern)14:51 But they are separate projects working independently, even though some individuals are involved in both.

Profilbilde av Petter Wolff. Thankyou all! av Petter Wolff

Petter Wolff15:00 Thankyou all!

Profilbilde av Reza Baharmand. Thank you 🙏 av Reza Baharmand

Reza Baharmand (Ekstern)15:01 Thank you 🙏

IPA is wery Important av Thomas Tveit Rosenlund

Thomas Tveit Rosenlund15:01 IPA is wery Important

Profilbilde av Emmeli Gross (Gäst) (gjest). Thank you! av Emmeli Gross (Gäst) (gjest)

Emmeli Gross (Gäst) (gjest)15:01 Thank you! Profilbilde av Eirik Vegler Broen. thank you. Very interesting! av Eirik Vegler Broen

Eirik Vegler Broen (Ekstern)15:01 thank you. Very interesting!

Profilbilde av Mikael Rinnetmäki. Please remember the Nordics on FHIR calls, … av Mikael Rinnetmäki

Mikael Rinnetmäki (Ekstern)15:03 Please remember the Nordics on FHIR calls, every last Monday of the month, 14-15 CET. https://teams.microsoft.com/l/meetup-join/19%3ameeting_MWM4YzU1NzgtZDMwZi00NDQyLTljYzUtZmIyNzFiZGFmNjQx%40thread.v2/0?context=%7b%22Tid%22%3a%22ca4ef9a8-6017-4d6f-b345-ed904be37123%22%2c%22Oid%22%3a%225f7c049e-16dc-4481-bfb3-ff79b4f28d4e%22%7d

Forhåndsvisning av nettadresse for Join conversation Join conversation teams.microsoft.com Møtet avsluttet: kl. 15:03 etter 2 timer 17 minutter 39 sekunder 15:03 Møtet avsluttet: 2h 17m 39s Deltakelse Profilbilde av Sverre Martin Jensen (gjest). Begynn referansen, IPA is wery Important, T… av Sverre Martin Jensen (gjest)

Sverre Martin Jensen (gjest)15:04 Thomas Tveit Rosenlund 08.02.2023 15:01 IPA is wery Important Yeah, I like beer as well Thomas 😉

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