Møte 32 i FHIR fagforum

  • Dato: 2025-10-22
  • Klokkeslett: 1300-1500
  • 66 personer innom møtet virtuelt (3 i møterom på Helsedirektoratet)

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

Agenda: EHDS on FHIR

  1. Welcome, Thomas og Info from HL7 Norway Øyvind, 10 min
  2. EHDS and Xt-EHR work in Norway, 20 min, Morten Bakken og Kerstin Engelhardt (Helsedirektoratet)
  3. EEHRxF FHIR profiling in the EU, 30 min, Giorgio Cangioli (HL7 Europe)
  4. Profiling of EEHRxF format in Norway, 30 min, Linn Brandt (Helsedirektoratet)
  5. EHDS – 20 år for sent i Norsk helsetjeneste?, 30 min, Eirik Nikolai Arnesen (Legeforeningen)

Presentations

Info from HL7 Norge

  • HL7 Norge og Hackathon - registrere deg nå
  • WGM deltakelse Køln desember

EHDS and Xt-EHR work in Norway

  • EHDS
    • History from 2008- 2027
    • Cross border healthcare directive legal basis for patient mobility.
    • eHDSI infrastructure 2015
    • Commission release the implementing acts.
    • EU4Health primary use of health data XtEHR project
    • Norwegian directorate of healht are appointed as expert organization
      • Participate on behalf of Norway in the XtEHR work.
    • Extended comunication to the stakeholders in Norway
    • Organizing feedback throug stakeholder involvment process.
  • EEHRxF (or The format)
    • Prioritized categories: patient summary, HDR etc.
    • Choice of technical standards for EEHRxF
      • recommend HL7 FHIR as recommended standard for interoperability
    • Use cases in EEHRxF
      • download
      • transmit for portability
      • exhange cross border
      • Harmonized interoperability component
    • Projects for developing the format
    • Logical models vs XtEHR FHIR technical IG’s
      • Guideline level are released from the commission.
      • HL7 Europe draft the implementation profiles
    • EURIDICE - HL7 and IHE profiles

EEHRxF FHIR profiling in the EU

  • Started presenting lab report IG 18 months ago…
  • Focus on the FHIR IG’s developed by HL7 Europe for EHDS
  • The European “Format”
    • Prioritized categories
    • The format will be formally defined by European Commission in the implementing act
    • Based on the artefacts available today how can we defined these artifacts
    • European wide FHIR IG’s
    • EEHRxF as of today, as defined by the FHIR IG’s published.
    • FHIR IG ecosystem
      • FHIR IG for all the prioritized categories
    • Latest releases of the IG’s
  • Content of the guides
    • Extension package
    • common extensions for use in the other IG’s
  • Base og core profiles
    • Base and core profiles of HL7 Europe
      • base loosely defined
    • Core - essential constraints that can be reused across profiles.
    • Align with IPS.
  • Lab report already v1.1
  • Balancing different requirements
    • Balance requirements from many countries
  • Medication Prescription and dispense
    • R4, R5, and pharmacy
    • EHDS logical models input have to be taken into account.
    • Situations adressed
      • multi item prescription
      • indication
      • additional health info
      • etc.
    • Prescription is not documents, but always structured
  • Hospital Discharge report
    • HDR R4 IG
    • Flexible section structure
      • Flat structure as reusable section library
      • Sections can be organized flat or nested
      • Key principles
        • Few required sections
        • open slicing
        • sub sections allowed
      • to achieve
        • local adapt
        • standardized content model
        • consistency
      • Section entry optional
        • strongly recommend to use structured data.
  • Imaging study report
    • informal cooperation effort with HL7 int, IHE Europe and IHE int.
    • Multi version guide both R4 and R5
  • Imaging study
    • Umaging workflow
      • imaging generated
      • result DICOM imaging study
      • Stored in PACS
      • Radiologist reads the Imaging study
      • Typically stored in EHR/PACS
    • Imating manifest information required to access imaging study
    • imaging report - holds the imaging report (data from RIS)
    • Imaging report use the same principles as lab report
      • individual resources, but available as a bundle
    • IHE radiology profile
      • Result of EUDICIE coop
  • Patient summary
    • IPS 2.0 based
  • FHIR IGs overview
  • You can join in the coop effort to make the HL7 Europe IG work.
  • Schedule for bi weekly meetings in HL7 Europe
  • Please contact HL7 europe og europe channel on zulip
  • WGM in Køln in Desember

Profiling of EEHRxF format in Norway

  • EHDS regulation is not specifically on FHIR, what technology and standards to use is decided in the implementing acts.
  • We do know that MyHealth@EU have chosen all new work to be FHIR
  • Joint action work propose FHIR profiles
  • We use FHIR for interoperability in Norway and Europe already
  • EEHRxF will support multiple use-cases
  • National use cases that needs to support the national infrastructure and implementation?
    • National additions to the EU format
    • Will HL7 Norway have a role in developing implementable IG’s for use in Norway
  • Government functions to be established
    • Digital HEalth Authority
      • Rights and obligations to be implemented
      • ensure that exchange is possible
    • Marked surveillance authority
      • supervise EHR vendors to implement according to regulation
  • Directorate of Health
    • Will get some new tasks conceringn DHA and MSA
    • The directorate do not publish fhir Profiles
  • HL7 Norway
    • HL7 Norway publish FHIR profiles
    • official representative in the international standardization of HL7
    • non profit and no employees
  • NHN
    • Do publish some FHIR profiles
    • responsible for NCP in Norway (technical)
  • Other actors like vendors, Health regions etc.
  • Collaboration model for international standards
    • Goverment
  • National vs implemented IGs in Norway
    • no-basis - will it need some alignment in EEHRxF?
      • Should it be
    • Who will maintain the norwegian/EEHRxF framework

Q: coop IHE and HL7 A: Have to consider IHE for testing and alignment.

Q: How to sell products in Norway and europe A:

Q: What level of norwegian profileing should we aim at A: Not really anchored in the healthcre organization - do we need to develop a new way to exchange the data we already do with norwegian messages today.

A: How to transition from what we have today into the future and with the EHDS and XtEHRF implemented.

A: The european level does not define everything relevant to all norwegian use-cases. We do need some norwegian guides.

EHDS – 20 år for sent i Norsk helsetjeneste?

  • Devils advocate high level perspectives from the clinicians in Norway
  • Medical practice is built by the clinicians
  • EHDS will have huge impact on clinicians in Norway
  • Pan-european interoperability idea is not new.
    • The concept is supported by clinicians
    • Will it improve healthcare processes and patient outcomes?
    • Are there any benefits for Norwegian healthcare sector
    • clinicans burden (documentation)
  • Primary use at Myhealth@EU
    • Secondary use
    • WG’s that work on the technical standards and guidelines
  • Work going on in Norway
    • GAP analysis economical and admin consequences
    • GAP analysis and socioeconomical analysis of the EHDS impact
  • The Clinicians in Norway have worked with Helsedirektoratet in EHDS work
    • EHR system is the doctor’s most importan tool
    • Reduce the number of structured data elements
      • They disturb the clinicians way of thinking and working
      • Want avoid componants strictly for secondary use.
  • The EHDS regulation
    • Will be expensive
    • Prescriptions in Norway are mostly electronic total 69 millions prescriptions eacy year
      • Just a little more time pr. prescriptions would lead to a lot of extra work for the clinicians to cater for a few european prescriptions
  • Patient medication list work in progress for 7-8 years
  • In denmark they estimated cost for development to 1 billion euros
  • Lack of personell
  • Digitalization might save time and money if you do it correctly and cater for clinicans needs.
  • Usability of norwegian EHR’s
  • Corrolation between burnout of clinicans and workloads, usability has to be good in the tools the clinicians use the most like EHR’s
  • Clinicians do not need standards that interferes with the clinicians work that makes that work more time consuming.
  • Documentation work is increasing in some cases
  • Interoperability and the EIF
    • EHDS is a lot about technical standards
    • The hard part is practical interoperability, organizational interoperability
      • Is it relevant to try to align the processes in all of europe?
      • Concerned about going directly into technical specification without considering the process differences.

Comment: the eHDS standardization will disrupt some work processess A: Flexibility to different workflows.

Clinicians involvement Two books about medical records and clinical informatics worth reading:

  • Bjørn Bentz on how to write medical records
  • Petter Hurlen about clinical informatics