In this post I document further observations on the FHIR resources, made during the transcription of the DSTU4 FHIR resources to the BMM format used in openEHR, as described here. This post examines the definition of process state in FHIR resources.
FHIR contains a number of resources that represent workflow actions in healthcare, including ServiceRequest, MedicationRequest, MedicationDispense, Appointment and so on. All of these contain a ‘status’ attribute which is coded with a local code-set representing possible lifecycle states of the action. Here is ServiceRequest:
This post continues the review presented in the previous post, where I looked at the Administrative resources of FHIR. Here I take a look at the formalism used in FHIR, i.e. how the resources (and profiles) are formally expressed. FHIR resources are described in terms of a custom formalism expressed as hierarchical tables. The appearance of a resource, along with the elements of the ‘language’ is shown above.
It has to be said in passing that the FHIR website and various visualisations, linking etc is a masterpiece of content-driven presentation.
We have been making steady progress on the openEHR Task Planning specification and visual modelling language (TP-VML) for clinical workflow. One of the differentiators of Task Planning, is that, like YAWL, it is designed as a formalism for developing fully executable process plans. This means that all the semantics of a TP Plan are formally defined and executable in a TP engine. It also means that the accompanying visual language, TP-VML, consists of visual elements formally related to the TP model. This is in contrast with BPMN, which is defined as a diagramming language with some formal elements mixed in, and other formal requirements expressed separately in the specification. Nonetheless, we are carefully studying the semantics of OMG’s BPMN2 / CMMN / DMN specifications to make sure we cover the necessary requirements, and use the same conceptual terminology as far as possible.
The NHS has around one million employees and serves most people in England and Wales. We could easily imagine a slightly larger organisation serving the whole UK, although for historical reasons Scotland and Northern Ireland are separate. Another large public healthcare organisation is the Veteran’s Administration, which manages around 160 veterans hospitals and countless clinics in the US. Brazil has an organisation called SUS – the universal healthcare system – which provides public sector care for 160m people not on private care. Smaller countries have similar, generally large, organisations, at least by the standards of each country. Large private organisations such as Kaiser Permanente and Partners Healthcare are in the same position, with the same needs.
There has been an endless search by such organisations over the 25 years I have been involved in e-health for the silver bullet to solve their IT challenge.