New FHIR Milestone Publications

HL7 is is pleased to announce that yesterday, the FHIR team published of a new set of Milestone releases. Included in this release:

FHIR Specification

This release is the Candidate version for the 3rd release of FHIR – technical, STU3. We’ve done much of the reconciliation following the September ballot, and this is in effect, the candidate for STU3 for technical review post ballot. In addition, this publication serves as:

  • The stable base for the upcoming connectathon in San Antonio
  • The stable base for the open ballots on implementation guides (see below)

We’ll take QA and implementation feed back on this version, apply a new round of edits, and publish the final version of release 3 towards the end of February 2017.

Alert readers may note that out original plan was that we’d publish the final Release 3 at the end of this year, but during October it become clear that the cumulative load of ballot (1500 comments) and continuing change proposals from implementers (averaging 3-4/day long term), we could only meet that timeline by sacrificing quality, and – after consultation – the FHIR community preferred for us to hold off till February. But we still needed to publish the candidate release now for the other goals above.

We encourage all the FHIR implementers, current and future, to have a good look at this candidate version, and preferably, prototype systems against it (the change notes may help).Then tell us about any issues that you find. Use gForge (and/or chat.fhir.org), because this content is not open for ballot this cycle. Note, though, that this is transient version that won’t be supported by tools and reference implementations etc going forward, so make sure migration is part of your plan if you implement against this version.

Implementation Guides

This set of publications marks a significant maturation of the US realm FHIR implementation guides. We’ve taken the core content specifications out of DAF (previously known as DAF-Core) and moved them into a new US-Core implementation guide. This is the base implementation guide for all uses of FHIR in the US Realm. It’s presently heavily driven by the Common Clinical Data Set (CCDS) and other Meaningful Use Program requirements, but it’s going to be more than that – it’ll be the one place for all general US Realm rules about how to use FHIR, including:

  • Identifiers and Code Systems
  • Common Patient Demographics
  • Profiles on common clinical content (as now, per Meaningful use)
  • Standard Consent Profiles

On top that, there’ll be a series of domain/solution focused implementation guides. This ballot cycle, we are balloting the following US implementation guides that build on the US-Core:

  • DAF-Research: A specific set of profiles for research access to EHR data, developed in association with the PCORI project and others
  • CCDA: a set of profiles that make it clear how to implement the parts of CCDA not covered by US-Core using FHIR documents. This will be important for sharing the full patient record (not just CCDS)
  • Medications Maturity Project: a draft set of specifications that initiate a project to bring the Medications module in FHIR to maturity at least for US usage (also, many other countries are just launching into the same kind of project)

All these are open for ballot, and you are invited to participate if you’re an HL7 member (also, non-HL7 members can participate in HL7 ballots, for a small fee)

Note that these are all US specific implementation guides. If you’re an HL7 member, but not a US based implementer, you can still participate, but it’s better to do so through gForge directly rather  Other HL7 affiliates are also welcome to publish their content under hl7.org/fhir/[2-letter-country-code] but as yet none have asked to do so.

Summary Report from SNOMED Meeting

Last week, IHTSDO held their main annual business meeting and SNOMED CT Expo in Wellington, New Zealand. I attended, along with a number of other key players from the FHIR terminology community, and we took advantage of the opportunity to hold a joint meeting between the FHIR community and the IHTSDO community.

From the FHIR community’s point of view, this was an important meeting because many of the FHIR stakeholders make extensive use of SNOMED CT and we still have a long way to go before we’ve truly mastered all the issues associated with using SNOMED CT. From IHTSDO’s point of view, FHIR is a very important implementation mechanism by which SNOMED CT content is used in production, and their stake holders have identified working well with FHIR as a priority.

The joint meeting was split into 2 parts – a general exploration of the known issues, and a technical exploration of some of them. During those 2 meetings, we discussed the following issues:

  • Progress since Montreal. In the HL7 working meeting in Montreal (May 2016), the HL7 Vocabulary WG (on behalf of IHTSDO) asked the FHIR project to make several changes around the way the FHIR Publication tools handle SNOMED CT editions, versions, copyright statements, and mappings. These were almost all completed prior to the the Wellington meeting, but we’ve been unable to transition fully to the International Edition for the base FHIR specification because of some specific value sets using US specific content. We agreed that we will change to the International Edition once this content has been promoted to the International Edition.
  • Terminology Service Implementation Guide for SCT. The Terminology service API published as part of FHIR has a very active community, and we’ve been testing the API with SNOMED CT content since we first started using it (it’s already in production in Australia). However our work has primarily focused on the API, and there’s an opportunity for us to improve the service for consumers by being more consistent in how SNOMED CT structures and semantics are exposed through the API. To that end, it was recommended that HL7 and IHTSDO should collaborate on a set of detailed rules about how the SNOMED CT concepts are exposed on the terminology servers. Most of these are things that the server providers have already discussed and agreed on informally, but it would be useful to get formally documented agreement around this. IHTSDO will also look at the feasibility of providing a reference FHIR terminology server.
  • Versioning – IHTSDO is planning to move towards a more continuous release cycle. While the details of this aren’t worked out yet, it may present some issues to the way we use SNOMED CT in FHIR – though FHIR is not special in this regard: all users will have the same challenges and opportunities. We agree that we will have to consider the impact this would have on the FHIR eco-system
  • Cross-Edition support – Presently, the SNOMED CT implementation space is divided by the national release center system – many affiliates have their own edition, with additional concepts, descriptions, relationships, and reference sets. As long as all records come from within the same jurisdiction, this is ok, because you just choose an edition. But if your records cross jurisdictions – which is something that will happen for many systems implementing patient focused record support, then there is currently no specific guidance to support this. IHTSDO agreed that this is something that implementers will need.
  • Value set review – IHTSDO has performed a review of a number of SNOMED CT value sets in the FHIR specification and provided feedback to HL7 on the results. IHTSDO has also developed a reproducible review process that may be applied to other SNOMED CT value sets. It was agreed that the review of SNOMED CT value sets in the FHIR specification should be completed, and that additional SNOMED CT value sets may be identified. IHTSDO has also previously offered to provide HL7 international with a set of SNOMED CT concepts that may be used for free in its international products. Part of the value set review will include looking at opportunities where this might be useful for the FHIR specification.
  • Binding/Mapping progress / Implementation Advice – Linda Bird from IHTSDO has been working on bindings and mappings (both words are used slightly differently across IHTSDO and HL7) between SNOMED CT and FHIR resources, both a simple attribute mapping, and a more complete template binding. So far, we’ve looked at Condition, AllergyIntolerance, Observation, Procedure, Goal and Family Member History. This has identified a number of issues in terms of gaps between the relevant SNOMED CT concepts and the design of the FHIR resources. Some of these may be flaws in the FHIR resources, or in the SNOMED CT content, or they may just be inevitable results of different perspectives – that’s yet to be resolved. We need to work on this jointly, and that might lead to changes to either FHIR or SNOMED CT, or implementation guidance for FHIR implementers that use SNOMED CT, or a formal FHIR Implementation Guide. We’re not sure where that will end up yet.
  • Simplification – we also discussed an idea for providing a framework for sharing additional views on SNOMED CT as a way for helping implementers. We agreed to pursue ideas around making SNOMED CT easier to use for beginning implementers informally for now. The draft SNOMED CT Machine Readable Concept Model (MRCM) currently out for community review (http://snomed.org/mrcm) may allow these simplified views to be created automatically.

A small group of IHTSDO and HL7 participants has been selected to form a joint project group to turn all these ideas into a working project plan. We’d welcome further comment from people who are interested in this area who weren’t at the joint meeting. On the HL7 side, contact me. For the IHTSDO perspective, contact Jane Millar. We’ll be working on this over the next few months.

FHIR report from Baltimore meeting

Last week, HL7 held it’s annual plenary meeting in Baltimore at the Hyatt Regency. As usual, the Hyatt Regency’s odd-ball design generated a few comments, but we were not treated to a repeat of the comic-con the weekend before (provided a colorful backdrop to the last Baltimore meeting). I’m pretty sure I heard that this was HL7’s largest meeting ever. What I can say for sure is – accommodation is increasingly hard to get for HL7 meetings; make sure you get in early for the next one.

For the FHIR project, our main attention was the ballot. Across the core standard, and multiple implementation guides, we received >800 detailed comments as part of the ballot. This represents a slight increase over the last ballot, but there was a clear change in the focus of the comments – there was a significant drop in the number of comments relating to the infrastructure, and much more focus on the domain content, and it’s applicability to real world problems. This is a clear marker of the growing maturity of the standard. We continue to expect that we’ll publish FHIR release 3 at the end of this year.

Most of the meeting was devoted to ballot reconciliation, with a focus on the difficult to resolve items. But we got plenty of other things done as well:

  • The FHIR connectathon was out biggest ever, with more streams, more success, more of everything. Note, that the next meeting, in San Antonio, it’s doubtful we can accomodate that many people, so it’s probably going to be a case of getting in early…
  • The clinicians on FHIR event was also a success – well, what I saw of it. But since we’ve had people asking us about the event, and whether they can run their own, we filmed a documentary about the event – thanks to Kai Heitmann for doing that. We’re not planning to post this publicly; instead, if you’re interested in hosting a clinicians on FHIR event, let me know, and I’ll share it with you when it’s done
  • We (members of the FHIR team) met with several new communities that haven’t previously been part of the FHIR community, and planned how they could get engaged, and share their energy and outputs with us. As always this is a collaborative
    process, and I’ll be making more announcements about this going forward
  • We made some specific decisions to change widely implemented parts of the specifications; consultation with the wider community around these changes is ongoing (see “JSON Comments” and “Logical References“). This is reflective of our process towards normative; some of the next version of FHIR (release 4) will be normative. I’ll be making more announcements about how that’s going to work in the future (when we figure it out).
  • Probably the most significant single decision we made was to take the specification known by the obtuse code word “DAF-core” – that’s the spec based on the Project Argonaut collaboration – and rename it to the US realm Implementation guide, of which it comprise be one section, how to represent the Common Clinical Data Set. Over time, the US realm implementation guide will grow to encompass more than just that. (btw, one decision related to this is that we are working to bring the technical specification from SMART that Argonaut used to HL7 as an appendix to the FHIR specification, named something like the “Application Launch Framework”)
  • Finally, the FHIR foundation continues to take shape as a key part
    of the eco-system to support the implementation process of standards
    (as opposed to the actual development of the standards themselves).
    In particular, it looks like we’ll soon be able to set fhir.registry.org
    live, which is a key piece of the FHIR picture that many people are awaiting.

Overall, the FHIR development team (well, teams – there are many interlaced teams with responsibilities for different parts of the specification, the process, and the community) are happy with a gradual progress. While there is still much to be done across all the specification, the plenary meeting marked our 5th year anniversary, and we are proud of what we’ve achieved in that time.

 

FHIR STU3 Ballot Documentation

FHIR STU3 (Standard for Trial Use) is open for Ballot. For those participating in the ballot (entrance to the ballot is already closed under ANSI rules), here’s a few notes about the ballot process to help focus your attention (note: If you didn’t enrol in the ballot pool, you can still make comments directly on gForge, though they won’t count as ballot formally).

Note, if you’re balloting on FHIR, the STU 3 Ballot Welcome is a useful place to start. In addition, see:

Beyond this, there’s some specific things for balloters to consider when balloting:

  • A significant amount of work has occurred around Workflow in FHIR, with an objective of improving consistency around definition, request and event-related resources, as well as providing guidance around the different mechanisms FHIR supports for managing various styles of workflows. One of the outcomes of this change is that some resources have been revised to align with the workflow patterns and many more resources are expected to undergo this alignment post-ballot. Reviewers are encouraged to consider the potential impact of alignment as part of their ballot feedback.
  • The proposed Vital Signs Profile is created to enable general interoperability between all all vital signs handling systems – particularly with an eye to consumer mediated exchange. If you think that’s a good idea (rather than every system doing vital signs differently) – or you think it’s a bad idea – ballot about it
  • A note about the CQF (Clinical Quality Framework) ballot: during the editorial preparation of the FHIR ballot, the editors integrated the clinical quality framework part of FHIR more directly with the FHIR publication itself. As a result of this, it’s no longer clear what exactly is FHIR, and what is CQIF. However this happened after the FHIR and CQF ballots were announced as separate ballots). We will combine the ballots for FHIR and CQF, and then sort the line items based on the content they address, so that balloters don’t need to worry about the separation between the two. Balloters need only vote against one of the two. We expect that in the future CQF won’t be a separate ballot – it’s just a module in FHIR
  • We’ve introduced a new navigational framework to the ballot, by breaking it up into “modules”. Each module has a page of it’s own that references key content, addresses common implementer use cases, and provides a roadmap for the planned future of the module. These are all a work in progress; comments are welcome

The next time we ballot a maj0r release of FHIR (release 4, perhaps in 12 months or so), we’re planning to bring some of the key foundations of FHIR forward with a Normative status. We don’t yet know exactly what parts (depends partly on how this ballot goes), nor have we worked through the process implications of taking some of the content normative. This may change how you ballot, particularly for artefacts with the higher level maturity levels. (btw, note that MnM is working on clarifying Maturity levels for more kinds of artefacts than just Resources).

Note: we have changed to “STU” from “DSTU” – we’ve dropped the “Draft” part, since FHIR is long past being a draft.

 

FHIR Meeting Report – Montreal, May 2016

Preparation for STU 3

The main focus of the meeting was preparing for the September ballot of release 3, which will be “STU  3” (note that we’re now using the title “STU” – Standard for Trial Use –  rather than “DSTU”  – Draft Standard for Trial Use – to reflect that important parts of the spec are well past the draft stage)

Planned key dates:

  • ballot sign up starts: Jul 27
  • ballot opens: Aug 12
  • ballot closes: Sept 12
  • Baltimore Connectathon / HL7 meeting: Sept 16-23
  • tentative target release date for STU 3: Dec 31

STU 3 is currently planned to include:

  • formats: no change to XML & JSON formats, but we will generate JSON schema. Introduction of RDF, tied to an ontological base
  • RESTful API: no change to existing API, bar some clarifications around transactions. Maybe add Patch?
  • Conformance – split out CodeSystem from Value set and minor changes to other resources, including the use of FluentPath instead of XPath
  • Core Clinical, Administrative & Financial resources – ongoing minor changes in response to trial use and improved quality
  • Continuing improvements to the Clinical Decision Support / Quality Measure framework
  • A new framework for workflow / task management
  • Draft mapping framework and CCDA/FHIR mapping guides

Alongside STU3, we expect to be providing a full tool chain to support implementation guides, covering editing, publishing, validation, and a public registry

Growing Maturity

One clear conclusion from this is that growing importance of the FMM (maturity model) – some areas of the specification are quite stable now, and are being managed accordingly. STU3 will probably be the last version of FHIR that doesn’t include any normative content.

With regard to FMM levels, In the lead up to the Montreal meeting, we surveyed the FHIR use base. From the results of that survey, we were able to make the following list of resources that are a priority for implementers:

Patient Observation Medication Condition
Practitioner DiagnosticReport MedicationOrder AllergyIntolerance
Organization DiagnosticOrder MedicationStatement Immunization
Encounter Bundle MedicationAdministration CarePlan
Person Conformance MedicationDispense Procedure

Specifically, these are resources that the community would most like to see move up through the maturity levels, so the HL7 committees will prioritize these resources when preparing for ballot. Note, though, that it’s mostly up to the community to trial these resources now.

Specification Road map

The FHIR specification is now starting to have real breadth and depth, and we’ve had some comment about growing complexity of the specification. In particular, these areas have attracted comments:

  • RDF / Base Ontology work
  • Fluent Path and the new mapping language
  • Clinical decision support resources
  • CIMI / logical model development

The concern around this work indicates that we need to provide better a better road map to the specification on the main page, and the documentation page, so that people can better understand how these parts of the specification relate to each other, and which parts are relevant for them to implement.

We will be working on this over the next few months.

Acknowledgements

The FHIR community continues to grow in both size and importance. 1000s of implementers have taken part in connectathons, and the number of active contributers – committers, editors, work group co-chairs, facilitators, evangelists – just keeps growing. And not just the number, but the volume and depth of their input.

The FHIR community is our biggest asset – and it’s getting bigger every day.

May 2016 FHIR Release

The FHIR team is pleased to announce that a new stable version has been released, at http://hl7.org/fhir/2016May. This version represents the first stable release of the candidate release #3 for FHIR, and has been released to support the Montreal Connectathon and the CQL on FHIR ballot.

This version includes a number of significant changes and new features:

These are just the highlights – there have been changes to nearly every resource in response to user feedback and new requirements and implementation projects. Note that there’s a few significant breaking changes in this version.

The Montreal Connectathon will be held on May 7 / 8 at the next HL7 WGM. We’re going to have a wide variety of tracks for implementers to participate in, including:

  • Introductory Patient track
  • Clinical Decision Support (CDS Hooks, CQF on FHIR, CDS Enablement Services)
  • Workflow (Lab Orders)
  • Terminology Services, Genomics, Structured Data Capture
  • A special Canadian SMART on FHIR track
  • And yet more…

Some of these are established tracks, while others are new additions. With that much going on, it’s quite likely we’ll run out of space (120 seats), so register early. For full details about the connectathon and the tracks, see the FHIR Wiki.

p.s. This is called the “May 2016 release” even though it’s actually released at the end of March because the connectathon, the ballot, and other feedback from the release will be processed at the May WGM.

Announcing the HL7 FHIR Product Blog

This is the HL7 FHIR Product Blog. It’s used by the FHIR Product Director to make announcements about key events of interest to the FHIR community. These events may include:

  • Balloting and Publishing Plans for the FHIR specification, or for key implementation guides of general interest to the FHIR community
  • Meetings and Connectathons of general interest to the community. Note that HL7 WGM (Working Group Meetings) won’t be announced – you can see their details on the HL7 website
  • Information about the FHIR Foundation and other significant implementation community organizations as it becomes available

The FHIR Product blog will stay focused, and will not carry content related to the details of the ongoing development of the FHIR specification, reference implementations, or implementation communities. If you want information about those things:

 

#FHIR Publishing Plans

At the Orlando meeting, the FHIR Management Group (FMG) made an important decision around the future plans for the FHIR specification.

In March 2015, the FMG decided to publish DSTU2 that covered the base infrastructure, and to plan to release a DSTU 2.1 that left the infrastructure unchanged, and filled out additional details around the Financial and workflow resources, for ballot in the May ballot.

We’ve been following that plan until the meeting in Orlando, but it was evident that we needed to reconsider our plans. There were two reasons why:

  • Resolving the issues around the workflow resources was taking longer than we hoped, and sticking to our plan would mean no connectathon testing of the redesign
  • There was ongoing pressure to make changes to resources that were frozen for DSTU 2.1

After consulting with as many stakeholders as we could, and considering the ramifications of waiting until the September ballot, FMG decided that we will no longer publish a DSTU 2.1 version. We will instead plan to ballot DSTU 3 in September, with a likely publication date late this year.

At this stage, we don’t know all of what is planned for DSTU3. It certainly will include:

  • Significant changes to the financial resources
  • A total redesign of the workflow related resources
  • A set of new resources to support clinical reasoning and decision support

There will be other changes; these will be announced as the process continues.