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.