Møte 23 i FHIR fagforum

  • Dato: 2024-04-17
  • Klokkeslett: 1300-1500
  • 62 personer innom møtet virtuelt og 4 tilstede i møterommet.

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

Agenda: HL7 FHIR in Europe

  1. Info from HL7 Norway and welcome, Thomas og Øyvind 10 min
  2. General intro about HL7 Europe and international, Line A Sæle (FHI) 10 min
  3. European laboratory report IG, Giorgio Cangioli (HL7 Europe) 30 min
  4. Hospitals on FHIR med Luc Chatty (Fyrstian) 30 min
  5. Standardization activities in Europe and international, Mari Svardal og Kerstin Engelhardt (The Norwegian directorate of Health) 25 min
  6. Q&A, 15 min

Presentasjoner

HL7 Norge

1 million kroner til HL7 Norway.

  • Is a part of Helseteknologiordningen.

Workshop for AuditEvent base profile. Domain profiles for vital signs before this summer.
WGM Dallas 19-24 mai.
Vitalis in may - base profiles - Gothenburg.
Please propose topic for FHIR seminars and courses.

HL7 Europe

HL7 Europe collaboration.
Share the HL7 International Vision for sharing healthcare data.
Non profit foundation - collaboration with all the HL7 affiliates in Europe.

Projects

  • Patient Summary
  • Lab results and reports
  • Medical imaging studies and reports
  • Hospital discarge reports.
  • European Electronic Health Record Exchange Format - EEHRxF
  • XpanDH and Xshare - project use this format

Implementing the standard.

Questions

Q: IPS - FHIR implementation guide - HL7 Europe was involved in the work

  • European IPS draft as a supporting action for IPS implementation.

Q: European implementation guide for medicinal product master data developed by the European medicinal product organization. Description and identification of medicinal product. Legemiddel grunndata.

  • There is a lot of profiles across Europe, what HL7 Europe is more directly involved in

European Lab report IG

  • Giorgia Cangioli - Co-facilitator of HL7 Europe lab report.
  • Published the HL7 Europe Lab report FHIR IG this year.
    • Common rules for facilitate harmonization of information model.
    • Support the developmnt of EEHRxF.
  • Specify only the Content of the lab report/result - not how to search for it or exchange it.
  • Timeline - Ballot october 23 - Connectatons.
  • How to participate in the work?
    • Webinars - with Hospitals on FHIR.
    • Provide feedback on Jira/Ballot
    • Connectatons
    • Join the project meetings.
  • Feedback types
    • Balloting feedback through HL7 voting members.
    • Specification feedback on Jira.

The IG

  • HL7 FHIR Logical models - ehalth network dataset from EU.
  • Profiles for mapping.

  • HL7 FHIR profiles.

  • Obligations are informative in thes version of the IG - Functional constraints

Work on the IG is a balancing act:

  • Some lab results are signed documents others are REST resources that can be searched.
  • European lab reports are DiagnosticReport always refers a Composition.
    • The composition defines the report structure
    • Composition defines the bundle (of type document)
    • REST perspective and document perspective

Complex and multiform scenario for cross border exchange of lab reports.

  • Layers of standards
    • International
    • EU common and EU x-border
    • National

Bi weekly call on semantic an functional requirements.

Questions

Prescription of the medicinal products, are you working with the national competent authorities. Basing information on medicinal products?

  • Engagement of several authorities.
  • For prescription you don’t necessarily need all the details from medicinal products, what is enough information about prescription/dispense information.
  • Myhealth@EU - you can describe package and form - look also on the definition resources.
  • Important to provide information exchangeable between countries
  • Prescription is juristicion dependant.
  • Need to agree on a common vocabolary.

Luc Chatty on Hospitals on FHIR

Hospital on FHIR is:

  • Community for adpotion of FHIr standards involving hospitals/healthcareproviders and solution providers.
  • Help to adopt the standard

  • Goal: Reduce cost and effort for FHIr implementation

  • Grades and maturity model defined by the initiative.
  • What hospitals are using FHIR today?

  • Missing primary care in Europe (they have not implemented FHiR)

  • Methods - Facade but more are setting up FHIR repos
  • Examples - some Hospitals are working together on FHIR solutions
  • Participate by sendin questions to info@hostpitalsonfhir.
  • website
    • Local initatives webinars etc, but no comprehensive overview of the initiatives.
    • Local ambassadors

Questions

Q: Should you really even try set everything on FHIR ? Is that a realistic goal since FHIR has some major pain-points of its own ?

  • Should always use FHIR for its main purpose and play to it’s strength
  • Some experience in Norway for using Fhir in national services involving hospitals.
  • As long as hospitals are involved.
  • Hospitals on FHIr has focus on projects where hospitals are involved and should/is implementing some solutions.

Helsedirektoratet - dept of standardization on International standardization

Primary use of health data and e-health specifications.

  • EHDS - regulatory agreement reached this year - Norway are obliged to implement.
  • Goals of EHDS.

IG-s developed in innovation initiatives shoudl deliver specificaitons that can be included the EHDS regulations.

  • Norway is involved in Xt-EHR project and other projects
  • Participate anc contribute to the european standardizaiton work
  • Drive national standardization and interoperability in Norway.

Combining what happens in EU with what’s happening in Norway HelseNIM - information models for different use-cases

  • Model that is used in many other countries.

  • High level information model
  • Prepare information models for various areas
  • Predictable framework for innovation and implementation

Semantics are the main point

  • Definitions and codes.

HelseNIM should take into account many areas of use

  • What information is common in all use-cases
  • Which standards and regulation come into play in the different use-cases for this information.

Base standard on foil is different for different use-cases.

  • HelseNIM is a translation vessel from international standards and local/national implementations.
  • Use international standards implementable for vendors.

Questions

Q: Logical model norwegian - what is different from the German/French etc. model. Should we have an european model? Could it actually add complexity?

  • Structure of the logical models in differnt countries are most usually the same. In some elements international code systems can be easily adopted that are international consensus about.
  • Some regulatory issues can be handled in the national information model.
  • Aim to align our existing logical models towards european standards.

Q: Logical model - the shit hits the fan when you start to use this model, exchange is the most important use-case and should probably be implemented using FHIR. A good help for the implementers would be FHIR serialization/IG, to provide further implementation guideance. To prevent serialization/implementations are different.

  • Important discussion for this information models. Should be different from the actual implementations.
  • Actual implementation is currently out of scope for the Helse NIM.
  • Open process, in what way.

Q: The implemented information model - moving towards models to represent artifacts on different levels logical/implemented. Logical level must express the code system requirements and definition.

  • The code systems of choice - some codes are business rules to follow, not part of the technical specification. Use of ICD-10 is a regulatory requirement for example.

Q: Open process?

  • Monthly demo - ongoing work is demonstrated.
  • Primary target group is the healthcare workers so how to be open about this to reach the correct stakeholders.
  • Workgroup organization
  • Publication platform in development, models only available as PDF.
  • Nasjonale informasjonsmodeller for helse (Helse-NIM) - ehelse

Q: Codesystems - on the medicinal products from DMP 200 different codesystems from norway and international.

  • Critical information working throug IPS spec chapter by chapter and using codesystems from national and international standards.
  • Try to avoid mapping.

Q: Format for logical model could use FHIR logical model tools - it’s quite neat for development, publishing etc.

  • Good tip