FHIR and the NHS APIs

So in addition to providing clinical resources to define clinical contect in a message/ document etc. FHIR also aims to provides administrative resources to do things such as discover and create appointments.

If I understand correctly, the Code4Health Interoperability community also intends to define such APIs. Of course it will also need to define authentication specifications or is this out of scope?

How do we ensure that we don’t re-invent what FHIR is trying to do by making NHS specific APIs.

Can someone shed some light?

Have use cases been created (and published) for these API’s?

FHIR came from app and hospital(/trust) developers wanting simple standard API to systems. It really doesn’t need much modification to be useful (we do need central points defining England and UK uri’s - I’ve been using these http://www.mayfield-is.co.uk/#/news).
Code4Health Interoperability may have different requirements such as mandatory one NHS Number which isn’t practical on app/trust level, it’s not REST friendly or compatible across the UK.

For authorisation and authentication I think many app and trust developers would settle on OAuth2 with possible extensions to support SMART in the future. [But type of OAuth2 grant will vary across the board and might not be possible as it fits with REST]

Also on security, a NHS wide API will have restrictions on using REST. Url’s can reveal confidential information and requests may have to be packaged up as SOAP requests.

Adopting FHIR is no-brainer as far as I’m concerned, as long as it stays license free.

Malcolm Newbury
Malcolm.Newbury@gmail.com

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I believe it will remain so and totally agree it’s a no brainer.

My main concern is we’re trying to adopt it top down rather than bottom up (you can read my last post as those concerns). I know the NHS likes to work top down but will that work?

Have already heard one (large UK) supplier stating they had no interest about FHIR from NHS trusts - the irony was they were standing in front of a screen showing customer (i.e. NHS trusts) requested api’s they’ve done and ones NHS/HSCIC was requesting as FHIR api’s.

Guess which one was core FHIR api’s?

(it wasn’t Cerner - the customer API’s were roughly http://fhir.cerner.com/may2015/ with the NHS ones being are here http://developer.nhs.uk/library/interoperability/gpsoc-im2/fhir-api/ and http://developer.nhs.uk/library/interoperability/fhir-dms-for-fgm/)

If bottom up is desirable, how do we encourage it, sites like this and hackdays?

And not EPIC https://open.epic.com/Interface/FHIR

Sadly most NHS trust don’t know what FHIR is. It also promises much but it
is still early days.

Also we need to recognise that it is still in draft standard. And as you
said the NHS number need to get somewhere.

I think that there are certain things that the centre should mandate. The
railtracks to ensure that everyone is adhering to the same rule book where
appropriate.

It’s lost is draft status a few months ago.

NHS Number is a difficult one. They need to tell us to refer to NHS Number (England) as

urn:fhir.nhs.uk:id/NHSNumber

But not go OTT on the rules such as making it mandatory - that’s a business/NHS England desirability and technical difficulty. [NHS number only exists in Wales/England, Scottish CHI, Scottish NHS Number and NI HSCN shouldn’t be excluded - they all aid patient identification. Patients can have all 4 (5-6 if you change sex)]

There is a series of engagements planned between NHS England and suppliers in the next couple of weeks on the issue of APIs and FHIR profiles in particular.
I am 90% confident that FHIR profiles will be accepted as the default “GO TO” standard for interoperability for granular transactional data exchange in the next 2 weeks.
Further, I am 75% confident that these will be the standard resources from the US modified only where necessary to cope with UK (95% the same).
All of GP records have been modelled now as FHIR profiles. A draft set will be published on some web sites this week.
In addition the extension elements of FHIR are capable of incorporating structured data derived for example from archetypes so I am confident FHIR will easily adapt to be able to use the clinical data models coming from the openEHR design community.

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Thanks David,

That is very encouraging. If we can line up the profiling work you have done with the archetyping being done by PRSB/HSCIC for the Transfer of Care Summary.

e.g.
AoMRC Discharge summary (meds only), Draft Template [Internet]. Health and Social Care Information Centre, UK, HSCIC CKM Clinical Knowledge Manager [cited: 2016-03-14]. Available from: http://ckm.hscic.gov.uk/ckm/#showTemplate_1143.96.3

then we might just have a rational and efficient means of getting clinical people to express their requirements and then get those rapidly implemented within systems (openEHR or otherwise) and between systems via FHIR/ CDA.

If we continue to present the various vendors with needless, multiple representations of the same clinical ideas (when all the hard work of alignment has already been done), we can hardly expect enthusiastic adoption and implementation.

Ian

Hi kevin - just perusing mayfield-is uk code systems and I notice the use of the old URN format for HSCIC resources . Just to note that all HSCIC specified resources e.g. identifier systems and value sets identifiers now use the URL syntax and NOT URN e.g. ODS-Organization-Code is now: http://fhir.nhs.net/Id/ods-organization-code.

thanks
Simon

Thanks.

Have they published a list yet? I’ve noticed a few inconsistencies, Dunmail noted a similar problem in GPSoc API’s.
https://www.openhealthhub.org/c/fhir-implementation

The HSCIC FHIR URI Registry was available via NHS Dev Net, but I cant find it now. I will chase up. Can you provide detail on GPSoc inconsistencies?

It was this one

If you can supply a link to the English URI’s I’ll match alter my web page (or remove them).

Not looking forward to standardising my use of them though … :slight_smile: Might move to STU3 first

Is there a definitive source for what the FHIR URIs should be for NHS?
Specifically I am looking for a URI/URN to use for HRG codes.
http://content.digital.nhs.uk/hrg
Thanks!

They are on the NHS and HL7 UK FHIR Reference servers.

NHS - https://fhir.nhs.uk/

HL7 UK - https://fhir.hl7.org.uk/ (this doesn’t have data at the moment but the test version is here https://fhir-test.hl7.org.uk/)

I’ve not come across hrg though.