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Building Bridges: Mapping HL7 V2 to FHIRSimone Heckmann, Gefyra GmbH / HL7 GermanyBoston, 19-21 June @HL7 @FirelyTeam #fhirdevdays18 www.fhirdevdays.comHL7 , FHIR and the flame Design mark are the registered trademarks of Health Level Seven International and are used with per mission.
Who we are„gefyra“ is the Greek word for „bridge“We offer FHIR training,consultancy for FHIR projectsprofessional toolingintegration services (j/w Health-Comm,based on INfOR Cloverleaf )We have been involved with FHIR since2014,have tested our V2 mappings on 7Connectathons,and have them running in productionenvironments
FHIR-ServerIntegration EngineV2-based EHR?ADT-MessagesFHIR-Clients
FHIR als Daten-HubIntegration Engine4
Scenario Mapping a V2 ADT A01 messagehttp://wiki.hl7.org/index.php?title Version 2- FHIR Mapping Scenarios
MSH \& LegacyEHR SPARK 20150502090000 ADT A01 00000002 P 2.5EVN A01 20150502090000 PID 1 345345412312345 10 NHS NH 456756756745 TCPAS MR Gefyra Alpha F Ms L 19280524 F Bridge Street 22 Bridgetown 12345 P 277543 PRN U NK1 1 Gefyra Beta FTH 44 201 12345678 PV1 I INT 0001 02 GENHOS 0100 ANDERSON,CARL 0148 ADDISON,JAMES SUR 0148 ANDERSON,CARL S 234637 GENHOS A GENHOS 20150502090000 AL1 1 DA 1605 acetaminophen L MO Muscle Pain hair lossAL1 2 DA 1558 Oxycodone L MO Muscle Pain hair lossAL1 3 MA 2221 Peanuts L SV Anaphylactic Shock
MSH \& LegacyEHR SPARK 20150502090000 ADT A01 00000002 P 2.5EVN A01 20150502090000 PID 1 345345412312345 10 NHS NH 456756756745 TCPAS MR Gefyra Alpha F Ms L 19280524 F Bridge Street 22 Bridgetown 12345 P 277543 PRN U NK1 1 Gefyra Beta FTH 44 201 12345678 PV1 I INT 0001 02 GENHOS 0100 ANDERSON,CARL 0148 ADDISON,JAMES SUR 0148 ANDERSON,CARL S 234637 GENHOS A GENHOS 20150502090000 AL1 1 DA 1605 acetaminophen L MO Muscle Pain hair lossAL1 2 DA 1558 Oxycodone L MO Muscle Pain hair lossAL1 3 MA 2221 Peanuts L SV Anaphylactic Shock
so, it‘s a Bundle of Resources! Yes. But there are multiple typesof Bundles.Is it a message, a batch, atransaction or a document ?http://build.fhir.org/bundle.html
A message, obviously! True, but which event? Whichstructure? What‘s the logicassociated with the event? Doesthe server know all this? Do we really want to re-implementV2 messaging with FHIR?http://build.fhir.org/messagedefinition.html
So what do we do? We (the integration engine) knowwhat the events mean and whichactions we expect the server toperform. So we can tell the serverwhat to do. Let‘s try Transactions!
whathow
MSH \& LegacyEHR SPARK 20150502090000 ADT A01 00000002 P 2.5EVN A01 20150502090000 PID 1 345345412312345 10 NHS NH 456756756745 TCPAS MR Gefyra Alpha F Ms L 19280524 F Bridge Street 22 Bridgetown 12345 P 277543 PRN U NK1 1 Gefyra Beta FTH 44 201 12345678 PV1 I INT 0001 02 GENHOS 0100 ANDERSON,CARL 0148 ADDISON,JAMES SUR 0148 ANDERSON,CARL S 234637 GENHOS A GENHOS 20150502090000 AL1 1 DA 1605 acetaminophen L MO Muscle Pain hair lossAL1 2 DA 1558 Oxycodone L MO Muscle Pain hair lossAL1 3 MA 2221 Peanuts L SV Anaphylactic ShockPatient - create/update?Encounter - createAllergyIntolerance(s) - purge/create
Now, let‘s REST-ify that!
How do I update/create? We need to check if the Patientalready exists. If it does, we wantto PUT, if it doesn‘t we want toPOST. Enter the „Conditional 0.2
So what‘s the criteria? The Conditional UPDATE will fail ifit matches multiple resources, soour criteria must identify thePatient uniquely. Sounds like „identifier“, right?http://build.fhir.org/search.html#token
PID 1 345345412312345 10 NHS NH 456756756745 TCPAS MR g/identifiers
How do I purge/create? First, we need to DELETE allpreviously submittedAllergyIntolerances, then POST thenew ones. But wait! We need tomake sure, we only delete theones we (the integration engine)created! Enter the „Conditional 2.1
So what‘s the criteria? Somehow we need to be able torecognize the AllergyIntoleranceswe submitted.This can be achieved by either adding tags to the resourcemetadata (simple) or using Provenance resources (notso simple, but more ttp://build.fhir.org/provenance.html
So, if we use tags, our criteria is:DELETE [base]/AllergyIntolerance?patient.identifier [?]& tag [?]„chained search“„token parameter“
These are our resources!That‘s us!
So, in our case:GET [base]/AllergyIntolerance?patient.identifier [?]& has:Provenance:agent:device [?]We also need to create a Device resource!Advantage: the Provenance Resource also gives us an chance to store the original message for traceability as anAttachment. ( yes, we need to create that resource, too )
Now: the field mapping! Check the „mapping“ tab at thetop of each resource There‘s no „one-size-fits-all“ – V2structures and FHIR serverrequirements will vary! look at the FHIR mappinglanguage and StructureMapresource! look at ConceptMap resourceand the d.fhir.org/terminology-service.html#4.6.8
How do I reference a resource that doesn‘t have a url(yet)? Assign a UUID to everyBundle.entry.fullUrlThen reference the associatedresource by this uri.The server must replace UUIDswith the actual urls whenprocessing the ences
But what if I don‘t want to touch the resource I need toreference? Conditional Update will update thematching resource,Conditional Create will create anew resource if none matches.Both can get us into trouble, if wedon‘t have permission tocreate/update specific resources. Solution: Use ConditionalReferences es
Limitations! V2 Source will overwrite all changesand additions to Resources on theServer (- Patch) There is no „trigger“ to invokeadditional actions on the server (- Message/Operations) „Merge“ is tricky (- Operations) Doesn‘t work in the absence of RESTProtocol (- Message) Is it PV1 actually an Encounter orrather an EpisodeOfCare?
What if the server doesn‘t support Transactions? Basically, the Transaction Bundleconstitutes a list of individual, atomicREST interactions. We can run themthrough „post processing“ and splitthem up. But remember: we have to handle thereplacing of the UUIDs with the actualURLs ourselves! We can even split the Conditionalinteractions up into a GET andPUT/POST/DELETE interaction,But then we have to deal with the errorson our side.
You can move complexity around,but you can‘t make it go away(Grahame Grieve)
ClientClientServerServerComplexityTransactionPlain RESTComplexityMessage
FHIR-ServerIntegration EngineV2-based EHRTransaction-BundlesADT-MessagesFHIR-Clients
FHIR-ServerIntegration EngineV2-based EHR?/Observation/ historyORU-MessagesSearchset BundleFHIR-Clients
history reliability simple to implement repeatable (if something wentwrong)- not selective/high traffic- delay- second interaction for includesSubscription realtime selective low bandwidth- no queueing- no trigger if a resource drops outof your selection
What next? Join the hands on session at the„Building Bridges“ table. Try the excercises atwww.gefyra.de/devdays2018 Give feedback and ask questionsin the 20FHIR
.speaking of „translations“
Get your Kling-on at www.qhul.org!
we make fhir work
integration services (j/w Health-Comm, based on INfOR Cloverleaf ) We have been involved with FHIR since 201
