FHIR 的介绍和进展【David Hay】

HL7FHIR:AnupdateforCHIMADr.DavidHay,MBChB,June2015chinc.org.cnAboutMe个人简介•Name:Dr.DavidHay•Role:ProductStrategistatOrionHealth现任OrionHealth医疗产品战略专家•Background–Clinician临床医师–ClinicalApplicationsVendor临床应用供应商–InvolvedinFHIRalmostfrombeginning从一开始就参与FHIR–Co-ChairFHIRManagementGroupFHIR管理协会联合主席–ChairHL7NewZealand新西兰HL7主席–Blog:FHIRBlog.com博客Page2•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnFHIR(FastHealthcareInteroperabilityResources)快速医疗资源互通•DriversforFHIR动机•ThemainpartsofFHIR主要部件–Resources资源–ExchangingFHIR交换核心特征–API应用程序接口–Profiling 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 •ImplementingFHIR实施DesiredoutcomeisthatyouwanttolearnmoreaboutFHIR!理想的结果是，你想更深入的了解FHIR！Page3•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnWhyFHIRchinc.org.cnDrivers动机•Interoperabilityrequirementincreasing互操作性要求的提高–Increasingcollaborativecare–needforco-ordination提高合作医疗–需要协调–ChangingPaymentmodels改变支付模式–ClinicalCaredeliverytoanagingpopulation人口老龄化的临床护理–Decisionsupport决策支持–Involvingthepatient–raisingthebar涉及病人-提高 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 •Needforrealtimeaccess实时访问需要–Mobile手机–Connectedworld与世界接轨•Vastincreaseintheamount&typeofdata数据的数量与类型大量增加–Devices,Mobile移动设备–Genomics基因组学•Analytics,populationhealth分析，人口健康•Implementerexpectations实施者的期望–Expectamodernstandard期待一个现代标准Currentstandardsdon’tcutit-theseledtoFHIR…Page5•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnIssueswithotherstandards与其他标准的问题•HL7version2–Greatformessagingbetweensystems系统间的消息传递–But:•Oldtechnology过时的技术•Hardtocustomizeandextend不容易定制和不容易扩展•HL7version3–Definedcommonmodelforinteroperability定义了通用模型的互操作性–But:•Verylargeinstances实例庞大•Extremelycomplextoimplement实施非常复杂•CDA(version3)–Verysuccessful非常成功–But:•Documentsonly仅限于文档•Difficulttocommunicatecodeddata难以沟通的编码数据Page6•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnBusinessCaseforFHIR–I商业案例•Mobilefriendly支持移动设备–Concise,RESTAPI&JSON•Developerfriendly易于开发–Familiartooling&familiartechnologies–XML/JSON,HTTP,SSL,Oauth通晓的工具和技术–Librariesavailable–HAPI,referenceimplementation方便的标准库•Simpletounderstandandaccesswithexamples!简单的理解和使用的例子•PredefinedResources预定义的资源–Analysisalreadydone已提前分析•Allparadigms,AllArchitectures,AllClients所有的模式，所有的架构，所有客户–Thickclient,browser,mobile,devices胖客户端，浏览器，移动设备Page7•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnBusinessCaseforFHIR–II商业案例•Solvesthecommonproblems–canconcentrateonthetrickystuff解决常见问题–可以专注于棘手的东西–EgAPI/formatsaredefined•Don’tneedtounderstandHealthCaredomaintoimplement不需要了解医疗保健领域的实施–DevelopersorAnalysts开发者或分析师•Largecommunityforsupport支持大型社区•AlreadyinuseInternationally已经在国际上使用–70Organizations,20Countries,allContinents(exceptAntarctica)70组织，20个国家（地区），所有大洲(除了南极洲)–InterestfromProviders,Vendors,Payers,Governments医疗供应者，供应商，保险公司，政府都很有兴趣核心特征Resultsinfaster,cheaperdeploymentsthataremorere-usable结果是更快，更低成本的部署，更可重复使用Page8•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnFHIRTimeline时间轴First1st~2nd~1st~2nd...Draft(草案)DSTUDSTUNorm(标准).Norm(标准).FreshLook2011201220132014201520162017201820192020Page9•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnFHIRManifesto宣言•FocusonImplementers聚焦于实施人员•Targetsupportforcommonscenarios常见 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 的目标支持•Leveragecross-industrywebtechnologies借助跨行业的网络技术•Supporthumanreadabilityasbaselevelofinteroperability以支持人类对数据的阅读作为互操作性的基础•Supportmultipleparadigms&architectures支持多模式与架构•Makecontentfreelyavailable使内容免费•Demonstratebestpracticegovernance展示最佳实践下的管理Page10•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnResources资源chinc.org.cn资源Resources核心特征•“Resources”are:–Smalllogicallydiscreteunitsofexchange小逻辑离散单元的交换–Definedbehaviourandmeaning定义行为和意义–Knownidentity/location已知身份/位置–Smallestunitoftransaction“ofinterest”tohealthcare最小交易单位“利益”的医疗保健–V2:SortoflikeSegments段–V3:SortoflikeCMETs•CanberepresentedinXMLorJSON•Canbeindividualorinbundles–Egmessages,documentsPage12•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnResources资源Page13•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnResourceanatomy资源解剖Metadata元数据Narrative叙述(text)Extensions扩展DefinedStructuredData定义的结构化数据Page14•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnPage15•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnReferencesbetweenresources核心特征引用之间的资源Page16•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnExchangingFHIR交换FHIRchinc.org.cnParadigmsofInteroperability范式的互操作性MessagesDocuments消息文档ServicesREST服务(Operations)FHIRcansupportalloftheseFHIR支持以上所有Page18•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnRegardlessofparadigm,thecontentisthe核心特征same无论范式，内容都是一样的FHIRFHIRMessageRepositoryFHIRDocumentLabSystemNationalExchangeThesameresources同样的资源Page19•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnAPI(ApplicationsProgrammingInterface)应用程序接口chinc.org.cnAPI–REST&Services应用程序接口–REST和服务•Real-timeinteraction实时交互–ApplicationtoApplication应用程序中的应用•Egwithinenterprisesystems在企业系统–PersontoApplication个人应用•EgMobileaccesstodata移动数据访问•Increasinglycommonoutsideofhealthcare在医疗保健之外越来越普及–Twitter,Facebook,WeChat•Oneofthe‘sellingpoints’forFHIR产品的卖点之一–Nootherstandardshasalternatives没有其他标准可以替代Page21•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnRESTfulinteractions-RESTful互动•UsesHTTP–Verbs,Headers,Statuscodes动词，标题，状态码•Singleresourceoperations单一资源的操作–Create新建–Read读取–Update更新–VersionRead版本读取–Delete删除•Search搜索•Transactions事务•VersioningAPIdefined版本API定义Page22•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnOperations操作•AlsousesHTTP•Morecomplexinteractions更为复杂的交互–RPC–RemoteProcedureCall远程程序调用–Definedinputsandoutputs定义输入和输出•Somedefinedinspec一些定义的规格–ValueSetexpansion值集扩展–FetchPatientrecord取病人记录•UserscandefineownOperations用户可以定义自己的操作Page23•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnProfiling分析chinc.org.cn核心特征Profiling分析•Thebasicresourcesarenotenough基本的资源是不够的•Specificimplementationsneedto具体的实施需要–Specifyresourcesneeded指定所需的资源–Extendresources扩展资源–Constrainresources资源约束–Specifycodesets/terminologies指定代码集/术语•FHIRisaplatformspecification平台规范–Profilesadaptittospecificpurposes简介适用于特定用途•ProfilescansupportInternationalization配置文件支持国际化EgChineselanguageinsteadofEnglishPage25•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnProfilingaresource分析资源SpecifythattheidentifierusesaChineseIdentifier–andisrequired使用中文标识指定的标识符(必填)Limitnamestojust1(insteadof0..*)姓名限制LimitmaritalStatustodifferentsetofcodes(ValueSet)限制婚姻状况不同的组代码MultipleBirthindicatoronlyboolean多生日指标Indicatephotonotsupported显示图片不支持Addanextensiontosupport“Ethnicity”添加一个扩展来支持“种族”Note:hardlyanymandatoryelementsinthecorespec!Page26•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnExtensions扩展•Onlymostcommonelementsinbaseresource在基础资源只有最常见的元素–Keepstheresourcessmall保持最简化资源–(Addingeverythingwastheproblemwithversion3)•Extensionsallowotherelementstobedefined允许在扩展中定义其他元素–Samecapabilitiesascoreelements作为核心元素相同的功能•Includingresourcereferencesandterminologybindings包括资源的引用和术语绑定•Extensionsarenormal扩展是正常的–Expectallrealimplementationstouseextensions盼望所有实际实施使用扩展Page27•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnDefiningandusingextensions定义和使用扩展•Extensiondefinitionsaremachinereadable外延定义是机器可读的•It’saresourcelikeanyother它像任何其他的一种资源–Canbequeried/locatedlikeanyotherresource可以查询/定位像任何其他资源•Profileregistrieswillbeestablishedto配置文件注册表将被设立–Storeandsearchfordefinitions存储并且搜索定义ResourceProfileHTTP://server/StructureDefinition/ChineseEthnicitiesExtensionTheextensioninaninstancepointstoitsdefinitionCanbe(andprobablyare)ondifferentservers在一个实例中的扩展所指向的定义可以(和很可能是)在不同的服务器上Page28•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnBindingstoTerminology对术语的捆绑•Someelementsarecoded有些要素被编码–EgCondition.codeorGoal.outcome•Codedelementsare‘bound’toasetofvalues–Canbesimplelistofcodes,oracomplexontology(egSNOMED)可以是编码简单的列表或者复杂本体论•Profilingallowsdifferent‘sets’ofvaluesfordifferentUseCases–UsesValueSetresource1.Resourcehascodedelementfromterminology资源有从术语中获得的编码元素2.Profileindicatesthe1Terminology(orsubset)touse配置文件指示术语(或子集)的使用23.Resource‘claimsconformance’toprofile3资源需要简介的一致性Page29•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnConformanceresource一致性资源•Describeswhataservercando描述服务器可以做什么–Whatresourcesitsupports支持什么样的资源–Whatoperations什么样的操作–Whatprofiles什么样的简介•Machinereadable可机读•Allowsaclientto‘adapt’itselftoaserver允许客户端适应服务器–Egwhatqueryparameterscanbeused什么查询参数可用Page30•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnImplementingFHIR实施chinc.org.cnImplementationsalreadyunderway•AlreadyinuseInternationally已经在国际上使用–70Organizations,20Countries,allContinents(exceptAntarctica)70组织，20个国家（地区），所有大洲(除了南极洲)–InterestfromProviders,Vendors,Payers,Governments医疗供应者，供应商，保险公司，政府都很有兴趣•Lotsofinformationandsupport大量的信息和支持–Specificationonline规范可在线查询–Blogs博客–Skype,email,ListsPage32•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnRhapsodyIntegrationEngine:FHIRandv2conversionRhapsody集成引擎:FHIRandv2转换BlogPostPage33•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnOpenPlatform:FHIRStorage&retrieval存储和检索MigrationofClinicalDatatoBigDataProcessingComponentsPage34•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnWhat’snextforFHIR的下一步•FinalizeDSTU-2–Infrastructureprettysolid基础设施相当坚实•ThinkaboutnextDSTU–Mostlyrefining/addingcontent大规模改进／添加内容•Continuetoworkwithotherorganizations继续与其他组织合作–IHE(MHD,XDS)–CIMI•Profilingisbig分析是繁琐的–Real-worldUseCases现实世界中的用例–InvolveClinicians&Analysts涉及临床医生和分析师–Governancetoconsider要考虑的管理Page35•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnNextStepsforChina中国的下一步•Findoutmore了解更多–Specificationonline(www.hl7.org/fhir/)规范在线查询–TestApplications(clinfhir.com)测试中的应用–TestServers测试服务器•Attendinternationalevents参加国际活动–HL7WorkingGroupMeetings–Connectathons•Holdlocalevents当地活动–Seminars–Connectathons•ProfilesforChina•Supportpilots!试点–FeedbackintothespecificationPage36•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cn核心特征Summarizing总结•FHIRisadisruptivetechnology是一种颠覆性的技术•Asetofresourcesthatcanbeextended一组可扩展资源•Supportsa‘webofresources’支持Web资源•DefinedAPI已定义的API–RESTandOperations•Canbeusedinallparadigms可用于所有的范式•Canbeusedinallarchitectures可用于所有的架构•Designedtobeimplementedquickly&easily,withoutneedingdetailedknowledgeofhealthdomain 设计 领导形象设计圆作业设计ao工艺污水处理厂设计附属工程施工组织设计清扫机器人结构设计 为快速和简易的实施,不需要详细了解医疗保健领域的实施–Andthereforemorecheaply更能减少花费–It’sreadytobeimplementednow!准备现在被实施Thankyouforlistening!Page37•Copyright©2012OrionHealth™groupofcompanies•Allrightsreservedchinc.org.cnwww.orionhealth.comchinc.org.cn