Enhancing narrative clinical guidance with computer-readable artifacts: Authoring FHIR implementation guides based on WHO recommendations

Shivers, Jennifer; Amlung, Joseph; Ratanaprayul, Natschja; Rhodes, Bryn; Biondich, Paul G.

doi:10.1016/j.jbi.2021.103891

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…Table 1 lists the typical profile definitions and the corresponding FHIR foundational resources discussed in the reviewed articles. As shown, these articles cover a wide range of categories, including genomics [ 10 - 14 ], imaging [ 15 - 17 ], cancer [ 18 - 20 ], diabetes [ 21 , 22 ], COVID-19 [ 23 , 24 ], infections [ 25 ], electrocardiography [ 26 ], screening [ 27 ], and allergy [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review

Nan¹,

Xu²

2023

JMIR Med Inform

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Background With the advent of the digital economy and the aging population, the demand for diversified health care services and innovative care delivery models has been overwhelming. This trend has accelerated the urgency to implement effective and efficient data exchange and service interoperability, which underpins coordinated care services among tiered health care institutions, improves the quality of oversight of regulators, and provides vast and comprehensive data collection to support clinical medicine and health economics research, thus improving the overall service quality and patient satisfaction. To meet this demand and facilitate the interoperability of IT systems of stakeholders, after years of preparation, Health Level 7 formally introduced, in 2014, the Fast Healthcare Interoperability Resources (FHIR) standard. It has since continued to evolve. FHIR depends on the Implementation Guide (IG) to ensure feasibility and consistency while developing an interoperable health care service. The IG defines rules with associated documentation on how FHIR resources are used to tackle a particular problem. However, a gap remains between IGs and the process of building actual services because IGs are rules without specifying concrete methods, procedures, or tools. Thus, stakeholders may feel it nontrivial to participate in the ecosystem, giving rise to the need for a more actionable practice guideline (PG) for promoting FHIR’s fast adoption. Objective This study aimed to propose a general FHIR PG to facilitate stakeholders in the health care ecosystem to understand FHIR and quickly develop interoperable health care services. Methods We selected a collection of FHIR-related papers about the latest studies or use cases on designing and building FHIR-based interoperable health care services and tagged each use case as belonging to 1 of the 3 dominant innovation feature groups that are also associated with practice stages, that is, data standardization, data management, and data integration. Next, we reviewed each group’s detailed process and key techniques to build respective care services and collate a complete FHIR PG. Finally, as an example, we arbitrarily selected a use case outside the scope of the reviewed papers and mapped it back to the FHIR PG to demonstrate the effectiveness and generalizability of the PG. Results The FHIR PG includes 2 core elements: one is a practice design that defines the responsibilities of stakeholders and outlines the complete procedure from data to services, and the other is a development architecture for practice design, which lists the available tools for each practice step and provides direct and actionable recommendations. Conclusions The FHIR PG can bridge the gap between IGs and the process of building actual services by proposing actionable methods, procedures, and tools. It assists stakeholders in identifying participants’ roles, managing the scope of responsibilities, and developing relevant modules, thus helping promote FHIR-based interoperable health care services.

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Section: Resultsmentioning

confidence: 99%

Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review

Nan¹,

Xu²

2023

JMIR Med Inform

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“…Future DAKs could also benefit from a master spreadsheet that standardises data elements repeated across sections, to reduce the time and potential inconsistencies in coding. This would also facilitate the automated creation of FHIR profiles based on the DAK content and codification into machine-readable artefacts in the form of a FHIR Implementation Guide 14…”

Section: Discussionmentioning

confidence: 99%

Experiences in aligning WHO SMART guidelines to classification and terminology standards

Pretty,

Tamrat,

Ratanaprayul

et al. 2023

BMJ Health Care Inform

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ObjectivesDigital adaptation kits (DAKs) distill WHO guidelines for digital use by representing them as workflows, data dictionaries and decision support tables. This paper aims to highlight key lessons learnt in coding data elements of the antenatal care (ANC) and family planning DAKs to standardised classifications and terminologies (CATs).MethodsWe encoded data elements within the ANC and family planning DAKs to standardised CATs from the WHO CATs and other freely available CATs.ResultsThe coding process demonstrated approaches to refine the data dictionaries and enhance alignment between data elements and CATs.DiscussionApplying CATs to WHO clinical and public health guidelines can ensure that recommendations are operationalised in a digital system with appropriate consistency and clarity. This requires a multidisciplinary team and careful review to achieve conceptual equivalence between data elements and standardised terminologies.ConclusionThe systematic translation of guidelines into digital systems provides an opportunity for leveraging CATs; however, this approach needs further exploration into its implementation in country contexts and transition into machine-readable components.

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“…First and most importantly clear and concise documentation of how to implement and provide data using the dataset definition is required. For FHIR-based dataset definitions, so-called implementation guides are used to provide both a narrative overview as well as technical details on the dataset definition [38]. Thus, we have created and published implementation guides for each of the here-developed extension modules.…”

Section: Discussionmentioning

confidence: 99%

“…For FHIR-based dataset definitions, so-called implementation guides are used to provide both a narrative overview as well as technical details on the dataset definition [38]. Thus, we have created and published implementation guides for each of the here-developed extension modules.…”

Section: Discussionmentioning

confidence: 99%

Development of interoperable, domain-specific extensions for the German Corona Consensus (GECCO) COVID-19 research dataset using an interdisciplinary, consensus-based workflow

Lichtner

Haese

Brose

et al. 2022

Preprint

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BackgroundThe COVID-19 pandemic has spurred large-scale, inter-institutional research efforts. To enable these efforts, the German Corona Consensus (GECCO) dataset has been developed previously as a harmonized, interoperable collection of the most relevant data elements for COVID-19-related patient research. As GECCO has been developed as a compact core dataset across all medical fields, the focused research within particular medical domains demanded the definition of extension modules that include those data elements that are most relevant to the research performed in these individual medical specialties.Main bodyWe created GECCO extension modules for the immunization, pediatrics, and cardiology domains with respect to the pandemic requests. The data elements included in each of these modules were selected in a consensus-based process by working groups of medical experts from the respective specialty to ensure that the contents are aligned with the research needs of the specialty. The selected data elements were mapped to international standardized vocabularies and data exchange specifications were created using HL7 FHIR profiles on the appropriate resources. All steps were performed in close interdisciplinary collaboration between medical domain experts, medical information scientists and FHIR developers. The profiles and vocabulary mappings were syntactically and semantically validated in a two-stage process. In that way, we defined dataset specifications for a total number of 23 (immunization), 59 (pediatrics), and 50 (cardiology) data elements that augment the GECCO core dataset. We created and published implementation guides and example implementations as well as dataset annotations for each extension module.ConclusionsWe here present extension modules for the GECCO core dataset that contain data elements most relevant to COVID-19-related patient research in immunization, pediatrics and cardiology. These extension modules were defined in an interdisciplinary, iterative, consensus-based approach that may serve as a blueprint for the development of further dataset definitions and GECCO extension modules. The here developed GECCO extension modules provide a standardized and harmonized definition of specialty-related datasets that can help to enable inter-institutional and cross-country COVID-19 research in these specialties.

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Enhancing narrative clinical guidance with computer-readable artifacts: Authoring FHIR implementation guides based on WHO recommendations

Abstract: Graphical abstract

Cited by 10 publications

References 12 publications

Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review

Designing Interoperable Health Care Services Based on Fast Healthcare Interoperability Resources: Literature Review

Experiences in aligning WHO SMART guidelines to classification and terminology standards

Development of interoperable, domain-specific extensions for the German Corona Consensus (GECCO) COVID-19 research dataset using an interdisciplinary, consensus-based workflow

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