Implementation Guides

FHIR is a platform specification which implementers use to solve healthcare data interoperability issues. It describes specifications in a generic sense, making them usable in many jurisdictions and in a variety of information architectures and exchange patterns. Based on the nature of the FHIR specifications, multiple solutions can be applied to solve a specific problem. The onus to choose the appropriate solution rests upon implementers. So, it becomes an obligation to implementers to make a consistent set of choices to keep solutions interoperable at different platforms.

To help implementers in understanding how to implement FHIR solutions in a particular context, FHIR Implementation guides (IG) are used. Many IGs fit into one of the following three categories:

  • Jurisdication Base - Describes based rules for using FHIR in a jurisdiction (usually a country specific set of rules)
  • Application Solution - Describes how FHIR is used to solve a particular problem (e.g. EHR App access)
  • Domain Guide - Describes the proper way to represent particular content in FHIR (e.g. how to properly represent the breast cancer diagnostic process)

Note that individual IGs may cross categories or not fall into any of these major categories.

Group Implementation Guide

Argonaut project

This project is a private sector initiative to adopt a uniform set of specifications. Having a uniform set of specifications expedite the development of a first-generation FHIR-based API and Core Data Services. The API and the services enable exchange of electronic health records based on Internet standards and architectural patterns and styles.

References:

https://confluence.hl7.org/display/AP/Argonaut+Project+Home

https://confluence.hl7.org/display/AP/Implemenation+Guides

http://www.fhir.org/guides/argonaut/

Da Vinci project
  • HL7 Da Vinci Project is a collaborative effort of more than 45 industry-leading providers, payers, and technology vendors to accelerate the adoption of HL7 Fast Healthcare Interoperability Resources (HL7 FHIR) as the standard to support and integrate value-based care (VBS) data exchange across communities.
  • The project provides a forum to discuss and solve problems faced by different stakeholders in exchanging the information. It brings in the right subject matter experts to address the problems, and enables them to create draft standards in the form of implementation guides and sample software code.
  • The goal of the Da Vinci Project is to help payers and providers to positively impact clinical, quality, cost, and care management outcomes.

Payers are also required to make a patient’s clinical data, defined as those data the payer maintains that are included in the USCDI version 1, available via the Patient Access API. To facilitate this, we link to the HL7 FHIR® Da Vinci Payer Data Exchange IG

Payer Data Exchange (PDex) IG:

IG URL:

https://hl7.org/fhir/us/davinci-pdex/history.html

Reference implementation:

https://confluence.hl7.org/display/DVP/Member-Match+Reference+Implementation

Plan Coverage and Formularies

Part D Medicare Advantage plans must also make formulary information available via the Patient Access API. And, Medicaid and CHIP FFS and managed care must make preferred drug lists available. To facilitate this, we link to the DaVinci Payer Data Exchange US Drug Formulary IG

IG URL:

http://hl7.org/fhir/us/Davinci-drug-formulary/history.html

HL7 Implementation Guide Proposal:

https://confluence.hl7.org/display/FHIR/Da+Vinci+Pdex-formulary+FHIR+IG+Proposal

Additional Plan Coverage and Formularies resources:

Hosted Reference Implementations

Server:

Home page: https://davinci-drug-formulary-ri.logicahealth.org

Base URL for resources: https://davinci-drug-formulary-ri.logicahealth.org/fhir

For example, to access medications, use the following URL: https://davinci-drug-formulary-ri.logicahealth.org/fhir/MedicationKnowledge

Client: https://davinci-pdex-formulary-client.logicahealth.org

The client reference implementation is an example drug formulary web application that queries and retrieves resources from the FHIR server and presents the data to the consumer. To connect the client with the FHIR formulary server, enter the base server URL for resources into the Base Server URL text field of the client.

Reference Implementation Code

Server: https://github.com/HL7-DaVinci/drug-formulary-ri

Sample Data: https://github.com/HL7-DaVinci/pdex-formulary-sample-data

Client: https://github.com/HL7-DaVinci/pdex-formulary-client

Test Scripts

Touchstone_DaVinci_PDexFormulary_Scripts

References:

https://confluence.hl7.org/display/DVP/Da+Vinci+Welcome

CARIN Alliance Blue Button® Framework and Common Payer Consumer Data Set (CPCDS) IG

CARIN Blue Button Implementation Guide (FHIR IG)

This implementation guide describes the CARIN Blue Button® Framework and Common Payer Consumer Data Set (CPCDS), providing a set of resources that payers can display to consumers via a FHIR API.

Payers are required to make a patient’s claims and encounter data available via the Patient Access API.

Additional resources for the CARIN Blue Button IG:

Hosted Reference Implementations

Server: Not yet available

Client: Not yet available

Reference Implementation Code

Server: https://github.com/carin-alliance/cpcds-server-ri (under development)

Sample Data: Under development

Client: https://github.com/carin-alliance/cpcds-client-ri (under development)

Test scripts

Under development

References:

http://hl7.org/fhir/us/carin-bb/history.html

http://build.fhir.org/ig/HL7/carin-bb/toc.html

https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index

SMART on FHIR

To leverage interoperability of healthcare data, it is required to provide access to third party applications to connect to an electronic healthcare record (EHR) system. The SMART App Launch Framework enables third party applications to launch from inside or outside the user interface of an EHR system.

The Launch Framework supports the four use cases defined for Phase 1 of the Argonaut Project:

  1. Patients apps that launch standalone
  2. Patient apps that launch from a portal
  3. Provider apps that launch standalone
  4. Provider apps that launch from a portal

The framework supports apps for use by clinicians, patients, and others via a PHR or Patient Portal or any FHIR system where a user can give permissions to launch an app. It provides a reliable, secure authorization protocol for a variety of app architectures, including apps that run on an end-user’s device as well as apps that run on a secure server.

References:

http://build.fhir.org/ig/HL7/smart-app-launch/

https://docs.smarthealthit.org/