Monthly Archives: October 2015

Clinicians on FHIR

From very early in the FHIR project, we’ve been running Connectathons, where a group of people – mainly developers – gather to test one of a variety of exchange scenarios. The connectathons perform several key functions:

  • Build a community with practical experience using the specification
  • Accelerate the progress of specific functionality towards production
  • Provide detailed QA of the specification

However while these connectathons perform a thorough QA of parts of the specification, there’s others that they don’t check at all. Principally, this is whether the specification offers support for a broad – and realistic – set of clinical use cases. That’s because the developers involved in the technical connectathon pick simple data for the content that is not involved in their exchange concerns.

To balance this, we’ve been running a series of what we initially called ‘clinical connectathons’. Over time, the clinicians who run these – co-chairs of the Patient Care committee (Stephen ChuLaura Heermann Langford, Emma Jones + Russ Leftwich and Viet Nguyen), have found that the ‘connectathon’ approach is not the best way to address the issues, and the event has been renamed to ‘Clinicians on FHIR’.

The attendees to ‘Clinicians on FHIR’ are divided up into groups. Each group is given a series of clinical scenarios, and their task is to create a set of resources that represent the kind of details from the scenario that would be entered in a clinical systems such as an EHR, using a mock-EHR tool maintained at http://clinfhir.com. This tool is maintained by David Hay from Orion Health in NZ to support the Clinicians on FHIR event, but shows real promise as a general teaching/testing tool for FHIR.

The process of creating resources is a great way to help the 3 different types of participants at the event – clinicians, domain experts who control the resources, and technical support who understand the FHIR infrastructure – to understand the process of converting from a set of clinical ideas to a set of resources. It’s also a great way to understand the limits of the existing resource contents – the QA that’s missing from the connectathons.

This meeting, it was my pleasure to provide support to a set of experts working on Medication and Allergy/Intolerance scenarios. In addition to Dr Russ Leftwich, the group included some key contributers to FHIR: the co-chairs of the pharmacy working group (Melva Peters, John Hatem, Marla Albitz, and Scott Robinson).

An aside about this: I often tell people that the single most important part of the FHIR specification is the definitions of the resources, based on a comprehensive understanding of the relevant domain requirements from around the world, and a thorough consensus building approach to their management. This creates the basis for broad buy-in to the use of FHIR, and it’s a gradual slow process that can only be stewarded by experts in the domain who also have the capacity to lead the group to consensus. This typically means, the co-chairs of the relevant committees. They pour their heart and soul into this, and it’s easy for FHIR stakeholders to under-appreciate their work. (see, for example, in the DSTU2 release announcement for DSTU 2, where I mentioned the editors who actually committed content to the specification, but omitted to list the committee co-chairs – who often make a greater contribution).

There’s no simple summary for the outcomes from our group – we worked on several clinical scenarios, found several deficiencies in the resources and in the ClinFhir tool, and created a number of tasks to clarify the specification in the future.

For me, the overall outcome is that the Patient Care co-chairs feel that we’ve found a formula that works for Clinicians on FHIR, and we’re looking at expanding it – both in terms of volume of participants, and in running the event on a more continuous (virtual) basis, which will accelerate our improvement of the specification.