Improving Process State Representation in FHIR

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:

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FHIR versus the EHR

This image has an empty alt attribute; its file name is fhir_v_the_ehr.png

One of the many things the FHIR silver bullet hype claims FHIR will solve is the EHR, along with Clinical Decision Support (CDS), Care Pathways, and who knows, paving driveways and launching spacecraft. I have made various arguments against silver bullet psychology, which I will not repeat here, but do want to look (again) at the FHIR v EHR question (a previous post on FHIR v openEHR looked at some aspects, and a second at further technical details).

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A FHIR Experience – the formalism

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.

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A FHIR experience: models or just definitions?

This is a second instalment of a technical review of the HL7 FHIR resources. As described in the previous post, this review is the result of an element-by-element transcription of the FHIR DSTU4 resources to the openEHR BMM (Basic-meta Model) format for the purpose of model analysis and archetyping. Here I look at the Administrative domain. Continue reading

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A FHIR experience: consistently inconsistent

In recent work I am involved in, the HL7 FHIR DSTU4 resources were converted to the openEHR formalism known as Basic Meta-Model (BMM), which is published as an open specification. BMM is an object-oriented formalism, conceptually similar to UML (minus the diagramming), with a fully formal definition. It has been in use since 2009 within the openEHR ADL Workbench, since about 2011 in HL7 CIMI, and since about 2016 in openEHR Archie (ADL2/BMM libraries and tools) and commercial tools including Marand ADL-designer and Veratech LinkEHR.

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openEHR Task Planning – a visual model of clinical workflow

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.

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Why the NHS needs its own health-tech university

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.

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