Latest Posts

• 14-Feb-23: Modernising the MyHR?

  On Friday last week, an article by Wendy John was published by Wild Health, in which I’m quoted as saying, regarding the My Health Record and the Strengthening Medicare Taskforce report:

• 28-Feb-22: Soliciting Feedback concerning the roadmap for #FHIR R5

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• 25-Nov-21: HL7 Australia Webinar: Playing with #FHIR

  

• 05-Nov-21: Smart Health Cards at the HL7 Australia Connectathon Nov 2021 (#FHIR)

  HL7 Australia is running a virtual connectathon 23-24 November 2021. See https://www.eventbrite.com.au/e/inaugural-hl7-fhir-trans-tasman-connectathon-registration-193185943357 for registration (free!).

• 30-Oct-21: Under the hood: Australian International Covid Certificate

  I’ve just spent a day looking under the hood at the Australian international covid certificates, and I thought I’d post a few observations here.

• 13-Oct-21: Security Vulnerabilities in FHIR implementations

  There’s a new report out that finds lots of security vulnerabilities in FHIR implementations, both client and server. This is useful work from Alissa Knight - thanks.

• 22-Sep-21: HL7 Australia Webinar: Smart Health Cards

  SMART HEALTH CARE CARDS WEBINAR - 5 OCTOBER 2021

• 30-Oct-20: #FHIR DevDays & LMICS Discounts

  FHIR DevDays Amsterdam/Europe edition is coming up soon: November 17-20.

• 08-Oct-20: Digital Health in Australia

  For the interest of my readers:

• 08-Sep-20: An alternative approach for resolving the Secure Messaging dilemma in Australia

  Earlier this year, just as Covid-19 was getting going, I was talking to Nathan Pinskier about the many challenges fixing GPs at this time. Nathan asked me whether there was an alternative approach to solving the secure messaging problem – which is a consistent pain point for medical practitioners, especially this year.

• 07-Sep-20: #FHIR Distribution Map 2020

  This is a map we produce annually or so that shows all a geo-location resolution of all the hits on http://hapi.fhir.org (thanks James Agnew).

• 29-Jul-20: Representation of Common Australian Identifiers in v2 and CDA

  This is a wrap up of presentations made last week in the Australian HL7 meeting, along with some additional late breaking information: Medicare OIDs have been finalised.

• 29-Jul-20: Indian Covid-19 Telehealth Application (based on #FHIR)

  A couple of weekends ago, HL7 India held the inaugural FHIR Connectathon for India. I was honoured to be ask to attend, and so I joined the main zoom channel several times. (Zooming into India is a poor substitute for actually meeting the people and getting good curry breakfast, lunch and dinner, but we make do with what we have).

• 04-Jun-20: #FHIR DevDays: Collaboration in the time of the virus

  The Covid-19 pandemic has brought sweeping changes to our lives. I’m pretty sure that everyone in the world has been affected now. All the changes relate to our ability to meet together - to work, eat, play, and love, and these changes are gradually impacting the quality of lives more and more - or just killing us. I’m particularly concerned that the impact on our lives and the economy is exponential, just like the virus directly. Over time, the gradual degrading of our interactions starts to create network effects, and these are gradually building now. It seems that we are already seeing second order effects.

• 05-May-20: Question: #FHIR and Video support

  Question:

• 06-Apr-20: Question: URL for #FHIR Version

  Question:

• 01-Apr-20: COVID-19 Related Codes

  This subject came up on a call I was on so here’s all the codes that I know about in various code systems that are related to COVID-19.

• 01-Apr-20: ClinicArrivals - helping Australian GPs with Covid-19

  A couple of weeks ago, Nathan Pinskier reached out to me on behalf of the RACGP expressing concern about the impact of COvid-19 on Australian GPs.

• 28-Mar-20: #FHIR and Appointments during the COVID-19 Epidemic

  In a number of contexts, people are using FHIR in production to make or report on patient appointments. It’s a natural question, then, how the COVID-19 epidemic impacts on this.

• 27-Mar-20: Privacy Policy

  Under some circumstances, private health information and personal identifying data may pass through software and/or services provided by Health Intersections Pty Ltd.

• 20-Mar-20: HL7, #FHIR, and Covid-19

  A few people have asked me what HL7 is doing about the Covid-19 pandemic.

• 29-Nov-19: On the safety of EHRs

  The subject of EHR safety is back in the news - probably driven by the AMIA meeting last week:

• 16-Sep-19: Patient Innovators at #FHIR DevDays - follow up

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• 30-Aug-19: Patient Innovator Track at #FHIR DevDays

  A new phenomenon at DevDays is the Patient Innovator Track. This track shows that patients are the ultimate beneficiaries of FHIR. The Patient Innovator Track provides a stage to patients who have taking control of their health by using the data of their disease and their treatment, or app developers who enabled patients to do so.

• 19-Jun-19: Future of Secure Messaging in Australia

  The Australian Digital Health Agency is working hard on a secure messaging project. This is a project to build out a working eco-system so that any clinician can send documents and messages to any other clinician in a secure fashion.

• 14-Jun-19: #FHIR DevDays: Smart Scopes

  One of the subjects we discussed at DevDays in Redmond Seattle (2019) was starting to plan what changes to make for scopes in v2 of the Smart App Launch specification.

• 22-May-19: Spreadsheets for #FHIR Resources

  One of the ubiquitous uses of Excel (or spreadsheets more generally) is for mapping purposes. 

• 21-May-19: Hard #FHIR Safety Problem: Synchronization

  It’s a common thing for implementers to want to do with FHIR: connect to a FHIR server, and make a local copy of the information provided by the server, and then check back occasionally with the server for updates - that is, new resources, or changes to existing resources. (In fact, it might be argued that this is **the **thing that FHIR is for, based on actual usage).

• 17-May-19: Gender Participation in the #FHIR Community

  This is post #3 in my series about why to participate in the FHIR standards process.

• 13-May-19: Security Appliances and FHIR Servers

  The FHIR Standard doesn’t say much about security. Given the critical importance of security for healthcare data, readers are sometimes surprised by this. There are, however, many different valid approaches to making a server secure, so the FHIR standard delegates making rules about security to other specifications such as the Smart App Launch Specification.

• 05-Apr-19: Open Source is the worst

  Last week I spoke at the CSIRO e-Health consortium. During my presentation, I said:

• 29-Mar-19: Clinical Messaging in Australia

  The Australian Digital Health Agency is working hard on replacing faxing with secure messaging. Peter MacIsaac discusses one of the ancillary challenges this causes in Pulse IT today:

• 06-Mar-19: The 3 Legs of the Health Informatics Standards Process

  Lately, I’ve been describing the standards process that we’re engaged in - making a difference to people’s health through defining healthcare IT standards - as a process that has 3 legs. Kind of like this:

• 09-Feb-19: #FHIR Events at HIMSS

  A couple of FHIR community members asked me about what specific FHIR related events are happening at HIMSS 2019. Here’s the list of things I know about:

• 29-Jan-19: Using Must-Support

  FHIR defines a Must-Support attribute as a piece of metadata on every element. About this, the specification says:

• 25-Jan-19: When is now NOW? (#FHIR Question)

  [Guest post from Jean Duteau]

• 20-Jan-19: #FHIR R5 Roadmap

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• 22-Nov-18: MyHR: CDA or PDF?

  Quoting from the story Sue Dunlevy wrote about John Halamka after his visit to Australia for Wild Health this week (paywalled):

• 21-Nov-18: Courage

  Yesterday, I spoke at the Wild Health Summit, along with John Halamka, Eyal Oren from Google, and other Australian Health IT leaders.

• 21-Nov-18: Clarifications about the FHIR Trademark

  HL7 owns the “FHIR” ®  trademark (along with the FHIR flame icon). While the specification itself is licensed under Creative Commons Public Domain, and can be used in anyway possible, the Trademark is not public domain; HL7 defends the trademark carefully.

• 10-Oct-18: #FHIR and Cancer Patient Empowerment - Mikes story

  I’m very honoured to make a guest today from Mike Morris, who I met at the HL7 FHIR Applications Round Table in Washington DC a couple of weeks ago. Mike is a cancer patient who is using FHIR improve his own treatment.

• 05-Oct-18: #FHIR Baltimore Report

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• 01-Oct-18: #FHIR on the Hype curve: Follow up

  My recent blog post from Wes Rishel (thanks) got Steve Posnack thinking, and he’s responded with some statistics around adoption of FHIR in USA:

• 24-Sep-18: Vision for a federated digital Health eco-system in Australia

  A reader asked me to describe what I think a federated system for digital health in Australia would look like. So here’s a vision for the system, from 3 different perspectives: services, governance, and user experience.

• 22-Sep-18: Follow up to Senate Submission + Future Health Index

  My last blog entry published my senate submission (which is formally found here) and testimony about the Australian My Health Record.

• 15-Sep-18: Submission to the Senate inquiry on My Health Record

  This is the submission I made to the Australian Senate with regard to it’s inquiry into the My Health Record. 

• 04-Sep-18: #FHIR and the Gartner Hype Cycle

  On a forum for FHIR Foundation members, I raised the subject of where FHIR is on the Gartner Hype Cycle (see Gartner write up, or Wikipedia). FHIR Foundation member Wes Rishel (@wrishel), who’s a FHIR user, and also was a Gartner Analyst before he retired, graciously made this contribution that I could post here.

• 27-Jul-18: Question: v2 network device information

  Question:

• 18-Jul-18: #FHIR Medication.Request message data structure analysis

  Here’s a contribution from a FHIR Implementer who says:

• 17-Jul-18: Active Questionnaires in #FHIR

  FHIR defines a Questionnaire resource that specifies a set of questions for a user, along with a QuestionnaireResponse resource to capture their response. Forms/Questionnaires like this are ubiquitious in healthcare, so this has had a lot of attention.

• 29-Jun-18: Principios de interoperabilidad en salud y estándares

  Diego kaminker asked me to draw my readers attention to this:

• 06-Jun-18: #FHIR JSON format questions

  There’s a thread running on chat.fhir.org about the FHIR JSON format. This thread needs some background, so here goes…

• 04-Jun-18: Determining the #FHIR version

  We’ve now published 3 FHIR milestone releases, and we’re working towards the 4th. We still haven’t clearly documented how you determine what version of FHIR is in use.

• 01-Jun-18: #FHIR: Extensible bindings and stating the value set for a code

  FHIR defines an extension to use to state the the value set a Coding was taken from:

• 25-Apr-18: Question: #FHIR Terminology services

  Question:

• 24-Apr-18: #FHIR DevDays comes to Boston

  It’s less than 2 months to FHIR DevDays USA. It’s our first visit to the US, and it will be held from June 19 to 21 in Boston, MA.

• 13-Apr-18: Understanding #FHIR Patterns

  The FHIR R4 ballot is out (see announcement), and I’d like to draw attention to one part of FHIR that we’ve been working hard on during the preparation of R4: Patterns.

• 06-Apr-18: Question: Wheres the Fax Number?

  Question:

• 09-Mar-18: Blockchain in Heathcare - are standards needed?

  Last weekend, in the lead in to HIMSS in Las Vegas, several of the FHIR team met with a number of block chain specialists, most particularly including David Huseby from the Hyperledger project at the Linux Foundation. We discussed various use cases for use of blockchain, with the intent of understanding what - if anything - HL7 should do to support blockchain adoption through the standards process. During an open and wide-ranging discussion, several of us came to the following consensus about the use of blockchain in healthcare (and we thank David greatly for his assistance).

• 04-Mar-18: Should you use #FHIR resources as your storage format?

  In discussions with implementers, one question that has come up quite a lot recently is whether you should store FHIR resources natively in your database or not.

• 08-Jan-18: Australian Digital Health Strategy Question

  On the subject of replatforming the MyHR, the Australian Digital Health Strategy has this to say:

• 22-Dec-17: Re-platforming the MyHR

  A couple of months ago I made a post proposing that the MyHR could be reworked to use the Argonaut interface. This change could open up the MyHR infrastructure so that providers and vendors could collaborate to build innovative local solutions without being bound to national political concerns about what is possible or not.

• 21-Dec-17: #FHIR R4 Ballot & Community Consultation

  See my post over on the FHIR product directors blog.

• 21-Dec-17: #FHIR Paradigms

  Many of the FHIR tutorials show this diagram:

• 10-Dec-17: Question: LOINC code for smoking start date

  Question:

• 02-Nov-17: Sharing Information with a Patient Case Manager

  Sharing Information with a Patient Case Manager

• 27-Oct-17: #FHIR and R (Stats / graphing language)

  I’ve spent the last 2 days at the 2017 Australian R Unconference working on an R client for FHIR.

• 24-Oct-17: Question: HL7 v2 referrals in Australia

  Question:

• 22-Oct-17: #FHIR and Bulk Data Access Proposal

  ONC have asked the FHIR community to add new capabilities to the FHIR specification to increase support for API-based access and push of data for large number of patients in support of provider-based exchange, analytics and other value-based services.

• 20-Oct-17: Question: #FHIR Training

  Question

• 17-Oct-17: Argonaut in Australia, and the MyHR

  Project Argonaut is coming to Australia. That is, at least one major US EHR vendor is planning to make their SMART-on-FHIR EHR extension interface available in Australia during 2018 (discussion about this at Cerner Health Conference where I was last week). HL7 Australia will work with them (and any other vendor) to describe what the Argonaut interface looks like in Australia (short answer: not much different: some different patient extensions, a few terminology changes (not RxNorm), maybe a couple of extensions on prescriptions for Reg24 & CTG). Also, HL7 Australia will be planning to engage with Australian customers of the US EHR vendors to help build a community that can leverage the capabilities of the SMART on FHIR interface.

• 04-Oct-17: Observation of Titers in HL7 Content

  Several important diagnostic measures take the form of a Titer. Quoting from Wikipedia:

• 04-Oct-17: Cultural Factors affecting Interoperability

  One of the under-appreciated factors that affects how successful you’ll be at ‘interoperability’ (for all the various things that it might mean) is your underlying culture of working with other people - your and their underlying expectations about whether and when you’ll compromise with other people in order to pursue a shared goal.

• 21-Sep-17: Why participate in the #FHIR Community? (Individuals & Standards)

  This blog is the first of series I’m going to run in the lead up to the HL7 San Diego meeting looking at the question of why to participate in the FHIR community. For this first blog, I’m going to look at the question of why to get involved in standards at all at the individual level. (subsequent entries in the series: The vendor engagement matrix, Gender Balance and Participation, …)

• 21-Sep-17: #FHIR Product Directors Report from San Diego meeting

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• 12-Sep-17: Question: #FHIR Documents and Composition

  Question

• 08-Sep-17: Question: Extending systems to deal with non-#FHIR type content

  Question

• 07-Sep-17: The Vendor Engagement Matrix

  This is post 2 in my series on why to participate in the standards process: a reason why Vendors should engage with standards

• 29-Aug-17: Question: #FHIR API to update resource metadata?

  Question:

• 21-Jul-17: Question: Validity of AllergyIntolerance extension in #FHIR

  Question:

• 15-Jun-17: Report from joint #openEHR / #FHIR meeting

  Last month, the openEHR and FHIR communities met for a day in Norway. From the openEHR community, Ian McNicoll and Silje Ljosland Bakke were present, and from the FHIR community, Ewout Kramer and myself were present, along with a group of Norwegians who are involved in FHIR and/or openEHR. My thanks to HL7 Norway, DIPS (en) and the Direktoratet for e-helse for collaborating to bring the meeting together.

• 12-Jun-17: Interconversion between #FHIR and HL7 v2

  Question

• 19-May-17: #FHIR Report from Madrid Working Group Meeting

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• 08-May-17: Woody Beeler has passed away

  Today, Woody Beeler passed away after battling cancer for a few years. Woody was a friend, an inspiration, and my mentor in health care standards, and I’m going to miss him.

• 08-May-17: Lloyd McKenzie on Woody Beeler

  Guest post: My close friend Lloyd wanted to share his thoughts on hearing the news about Woody.

• 04-May-17: FHIR Product Priorities for Release 4

  Now that we’ve published Release 3 of FHIR, it’s time for us to consider our main priorities for the next FHIR release. This is my draft list of product priorities that we’ll be discussing - and trying to execute - at the Madrid meeting next week:

• 20-Apr-17: Proposal for #FHIR JSON format change: @manifest

  There’s a long running discussion in the FHIR community about the way the JSON format handles extensions, and operation invocations (“Parameters”) resource.  Various implementers keep proposing format changes to the JSON format around extensions, but the last time we made an attempt to change this, it was roundly quashed at ballot.

• 20-Apr-17: #FHIR Testing is Coming

  The FHIR Team has been working with the HL7 Education Work Group to introduce FHIR certification testing so that members of the FHIR community can demonstrate their knowledge of the specification. There’s going to be 2 levels of certification test.

• 22-Mar-17: #FHIR Release 3 Published

  See the official FHIR Product Director Blog.

• 06-Mar-17: Question: CCDA and milliseconds in timestamp

  Question:

• 07-Feb-17: #FHIR, CDS-Hooks, and Clinical Decision Support

  This is a guest post written by Kevin Shekleton from Cerner, and first posted to the HL7 CDS email list. Reproduced here for wider availability by agreement with Kevin

• 20-Jan-17: #FHIR Product Roadmap - January 2017

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• 16-Jan-17: Opportunities Vacant in the #FHIR project

  The FHIR team is continuing to grow, and has plenty of opportunities for more people to contribute.  Here are some of those opportunities:

• 11-Dec-16: #FHIR and Alt-health

  Unless you’ve been living under a rock, you’ve probably heard the terms ‘alt-right’ and ‘fake news’ by now. According to Wikipedia: “the alt-right (short for “alternative right”) is a loose group of people with far right ideologies who reject mainstream conservatism in the United States.” and “Fake news websites (also referred to online as hoax news) deliberately publish hoaxes, propaganda, and disinformation to drive web traffic inflamed by social media. Note: I’m well aware that Fake news websites aren’t confined to just the alt-right, but there’s a strong link between alt-right and fake news. It’s become clear, as time as progressed, that this is just another security risk in the eco-system that is the internet. Viruses, phishing, and now fake news. Something for Google and Facebook to work on - here’s some thoughts about that.

• 08-Dec-16: About

  Health Intersections is the consulting company of Grahame Grieve. I consult to national programs, vendor consortiums, individual vendors, and standards bodies about healthcare data exchange

• 07-Dec-16: New #FHIR Milestone Publications

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• 03-Nov-16: #FHIR and SNOMED Support

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• 29-Oct-16: Verhoeff Algorithm in Delphi

  I needed an implementation of the Verhoeff check digit algorithm in Delphi, and couldn’t find one. So reproduced here for ease of use by anyone else who needs it:

• 28-Sep-16: Support for Testing in the #FHIR Specification

  On the last day of the baltimore meeting, a small group of us met to talk about the future of testing in the FHIR specification. In particular, the participants included both Aegis and Mitre, who develop Touchstone and Crucible respectively. Out small group made 3 decisions:

• 27-Sep-16: #FHIR: Baltimore meeting report

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• 27-Sep-16: #FHIR - Adding Identifier to Reference

  One of the more controversial sessions at the Baltimore meeting was where we discussed task 10659:  Reference should support logical references

• 26-Sep-16: #FHIR DevDays event is coming up

  I’m finally on the way home from the HL7 Baltimore meeting. That means that the next main event for the FHIR community is the DevDays meeting in Amsterdam, organised by Furore. This just gets better every year.

• 22-Sep-16: #FHIR: Comments in JSON

  We use XML comments extensively in FHIR for the examples in the specification:

• 20-Sep-16: Notes on #FHIR trademark usage

  The FHIR trademark system is operational. There are 2 kinds of license to apply for:

• 20-Sep-16: #FHIR Video Contest

  We work hard to ensure that the FHIR specification is as easy to understand as possible. For example, we have several ‘getting started’ guides for different audiences. But never-the-less, getting orientated with the specification, and/or the FHIR connectathon process can still be a challenge. So today, HL7 is announcing a competition.

• 18-Sep-16: Call for comments: Logical references

  Two tasks have been created from the current FHIR Ballot: 10354, and 10659. Both propose the same basic idea: to allow a reference to refer to an item by it’s logical identifier rather than a direct URL. This is a pretty significant change, so we’re calling for comments from the FHIR Implementer community.

• 24-Aug-16: #FHIR STU3 Ballot Documentation

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• 23-Aug-16: #FHIR and Character encoding in URLs

  One issue that is causing confusion for FHIR implementers is the question of what characters need to be escaped in an http: URL. The general shape of an http: url is

• 11-Aug-16: #FHIR is 5 years old today

  Unofficial FHIR project historian Rene Sponk has pointed out that it’s exactly 5 years to the day since I posted the very first draft of what became FHIR:

• 07-Jul-16: Principles of Health Interoperability SNOMED CT, HL7 and #FHIR (Edition 3)

  I’m pleased to announce that the 3rd edition of “Principles of Health Interoperability” is now available. Tim Benson wrote the first 2 editions, with coverage of V2, V3, CDA, and SNOMED CT, and he asked me to join with him for the 3rd edition, and provide a section on FHIR.  I’m really glad to say that it’s finally come to fruition, and the book is now available.

• 28-Jun-16: Furore DevDays: Premiere #FHIR meeting in Europe

  I’ve just booked my flights for DevDays:

• 26-Jun-16: Question: Apple CareKit and #FHIR

  Question:

• 21-Jun-16: Question: Binding choices

  Question:

• 02-Jun-16: Question: How do profiles fit into the overall conformance picture

  Question:

• 02-Jun-16: #FHIR in China

  For the last few days, I’ve been in China for the China Health Information Network Conference 2016. I’d like to thank HL7 China and Professor Li (Chair, HL7 China) for inviting me - I really enjoyed the trip.

• 30-May-16: Question: where did the v2 messages and events go in FHIR?

  Question:

• 20-May-16: #FHIR Meeting Report – Montreal, May 2016

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• 17-May-16: #FHIR and the Gartner Hype Cycle

  As FHIR product director, I get plenty of comments about the hype associated with FHIR. And there is plenty of hype. Here’s the Gartner hype curve:

• 14-May-16: BlockChain is the new XML

  There’s an amazing amount of noise running around the healthcare about Blockchain.

• 19-Apr-16: Question: Searching by extensions in #FHIR

  Question:

• 18-Apr-16: Mapping between CCDA and FHIR

  Across the board, many FHIR implementers have the same challenge: mapping between some other format, and a set of FHIR resources. Right now, the pressing issue is mapping between CCDA and FHIR (in both directions). At the HL7 Orlando meeting in January 2016, we held a Birds of a Feather session about mapping. At this meeting, there was general consensus that we - the FHIR community - would like to have a mapping framework that

• 31-Mar-16: New #FHIR Vital Signs Profile

  Over on the official FHR product blog, I just announced a new release. I wanted to expand on one of the features in the new version here

• 15-Mar-16: (When) Will #FHIR replace HL7 v2 messaging?

  Question:

• 15-Mar-16: Using #FHIR Observations for User fitness data

  In a question on stack overflow, an implementer asks about using Observation for user -gathered fitness data:

• 05-Mar-16: Announcement: #FHIR Code-a-thon Washington DC April 1/2

  An announcement from CMS/HHS Entrepreneur-in-Residence and FHIR community member Mark Scrimshire:

• 24-Feb-16: Question: Locating the #FHIR end-point

  Question:

• 17-Feb-16: Question: #FHIR conformance requirements

  Question:

• 14-Feb-16: IEEE Event: Health Informatics on #FHIR

  Health Informatics on FHIR: Opportunities in the New Age of Interoperability

• 13-Feb-16: Possible alternative syntaxes for #FHIR extensions

  At the last few HL7 working meetings, the FHIR core team has gathered on Thursday evening for a deep technical session. In Orlando, we talked about various open issues to do with profiling (and then we all went to Howl at the Moon). In Atlanta, we explored alternative syntaxes for extensions, which led to a proposal that we put to a fairly large committee meeting (~50 people), a combined cross-section of FHIR stakeholders in Orlando. That proposal died immediately - it got a very hostile reception, actually. A couple of the participants at the meeting thought that this was a reflection of insider bias, and asked me to present the proposal on my blog so that it gets a wider set of eyes looking at it. So here it is.

• 13-Feb-16: Patient Matching on #FHIR Event at HIMSS

  In a couple of weeks I’m off to HIMSS at Los Vegas. I’m certainly going to be busy while I’m there (If you’re hoping to talk to me, it would be best to email me to set up a time). Before HIMSS, there’s several satellite events:

• 10-Feb-16: Question: #FHIR Common Search Parameters

  Question:

• 10-Feb-16: Example Batch Requests for Patient Summary (#FHIR)

  Andy G from Mitre submitted this gForge task:

• 03-Feb-16: Right-To-Left scripts in #FHIR

  Today, I’m at Linux Conference Australia. I watched a hysterically funny and very interesting presentation by Moriel Schottlender on using Right-To-Left scripts, such as Hebrew, Arabic, Farsi, etc:

• 02-Feb-16: Question: #FHIR _format parameter

  Question:

• 02-Feb-16: Question: Entering the #FHIR Bandwagon

  Question:

• 02-Feb-16: #FHIR Product Director Blog is go

  Just to let all my readers know that there’s now an official FHIR Product blog at http://onfhir.hl7.org/.

• 01-Feb-16: Question: HL7 v2 message processing rules

  Question

• 31-Jan-16: #FHIR and HTTP Patch

  At the last connectathon, we had a stream testing support for PATCH using JSON patch. A number of us participated in the stream, and some of us got JSON patch working fine.

• 27-Jan-16: Question: #CDA - how to handle Observation Component code

  Question:

• 16-Jan-16: #FHIR Product Director

  While in Orlando last week, HL7 appointed me The “FHIR Product Director”. This is a new position that has been created by HL7 in accordance with the HL7 BAM (“Business Architecture Model” – can you tell that HL7 likes acronyms and ‘models’?). For HL7, appointing me to FHIR Product Director role achieves two important goals:

• 16-Jan-16: Announcement: #FHIR publishing plans

  At the Orlando meeting, the FHIR Management Group (FMG) made an important decision around the future plans for the FHIR specification.

• 11-Jan-16: Use of CDA Observation.value

  CDA has an all important element Observation.value:

• 06-Jan-16: #FHIR Implementers Safety Checklist

  One topic that comes up fairly often when I talk procurers and users of interoperability is ‘clinical safety’. Everyone knows why it’s important, but it’s much harder to pin down what it is, and how to measure it, or how to ‘be safe’. With this in mind, the FHIR specification includes an implementer safety checklist. All developers implementing FHIR should run through the content of this safety checklist before and after the implementation process. But the lack of feedback I get about it suggests to me that not many people read it.

• 22-Dec-15: Improved Documentation of the $closure operation for #FHIR Connectathon 11

  One of the stated goals of FHIR Connectathon 11 in Orlando in a few weeks time is for the terminology services stream participants to test out the $closure operation.

• 10-Dec-15: #FHIR and mapping approaches

  Across the board, many FHIR implementers have the same challenge: mapping between some other format, and a set of FHIR resources. The other format might be a CIMI model, an openEHR model, a CCDA document, or a series of other things. At the HL7 Orlando meeting in the second week of January 2016, we’ll be holding a BOF (Birds of a Feather) on Tuesday evening. In this meeting, we’ll be:

• 08-Dec-15: Terminology Services Connectathon in Australia

  This is out today:

• 08-Dec-15: #FHIR and Postels Robustness Principle

  An important principle in interoperability is Postel’s Robustness Principle:

• 01-Dec-15: A Path expression language for #FHIR

  Since the beginning of working with FHIR, we’ve had a number of contexts in the specification where we’ve need to refer to a particular element within a resource, or make rules on the properties of the elements in a resource. Over time, that list has grown, and within the specification we now have the following places for this:

• 24-Nov-15: FHIR Notepad++ Plug-in: Tools for #FHIR developers

  I’m pleased to announce that the FHIR Plug-in for Notepad++ that was distributed and tested at the DevDays in Amsterdam last week is now ready for general release.

• 04-Nov-15: Language Localization in #FHIR

  Several people have asked about the degree of language localization in FHIR, and what language customizations are available.

• 04-Nov-15: #FHIR DevDays Amsterdam 2015

  In two weeks time - Nov 18 2015 - I will be joining Ewout Kramer from Furore in Amsterdam - along with other core team members James Agnew, Josh Mandel, Lloyd Mckenzie - for the Furore #FHIR DevDays 2015. I’m really looking forward to this - it’s the peak European FHIR event, and we’ve got a great program lined up:

• 15-Oct-15: Clinicians on FHIR

  From very early in the FHIR project, we’ve been running Connectathons, where a group of people – mainly developers – gather to test one of a variety of exchange scenarios. The connectathons perform several key functions:

• 22-Sep-15: FHIR DSTU2 is published

  The FHIR team is pleased to announce that FHIR DSTU is now published at http://hl7.org/fhir. The 2nd DSTU is an extensive rewrite of all parts of the specification. Some of the highlights this version accomplishes:

• 23-Aug-15: What is the state of CDA R3?

  Question

• 10-Aug-15: Question: #FHIR and patient generated data

  Question:

• 15-Jun-15: Question: Solutions for synchronization between multiple HL7-repositories?

  Question:

• 09-Jun-15: Profiles and Exceptions to the Rules

  One of the key constructs in FHIR is a “profile”. A profile is a statement of how FHIR resources are used for a particular solution - or, how they should be used. The FHIR resources are a general purpose construct, and you can do kind of general purpose things with them, such as store the data in a PHR, and do generally useful display of a clinical record etc.

• 18-May-15: #FHIR Report from the Paris Working Meeting

  I’m on the way home from HL7’s 2015 May Working Group Meeting. This meeting was held in Paris. Well, not quite Paris – at the Hyatt Regency at Charles De Gaulle Airport.

• 17-May-15: Question: PRD segment in ORM and ORU messages?

  Question:

• 11-Apr-15: #FHIR, RDF, and JSON-LD

  FHIR doesn’t use JSON-LD. Some people are pretty critical of that:

• 23-Mar-15: #FHIR DSTU ballots this year

  Last week, the FHIR Management Group (FMG - the committee that has operational authority over the development of the FHIR standard) made a significant decision with regard to the future of the FHIR specification.

• 18-Mar-15: Canadian FHIR Connectathon

  FHIR® North

• 10-Mar-15: Guest Post: Breaking a lance for #FHIR

  A guest post about FHIR adoption from Andreas Billig, Fraunhofer FOKUS. I asked Andreas to write about his experience using FHIR to implement a terminology service.

• 10-Mar-15: Establishing Interoperability by Legislative Fiat

  h/t to Roger Maduro for the notification about the Rep Burgess Bill:

• 27-Feb-15: #FHIR Terminology Services Connectathon

  This week I was in Washington DC for the inaugural FHIR terminology services connectathon. This was the first of its kind: a connectathon focused on the terminology services portion of the FHIR specification.

• 27-Jan-15: A JSON representation for HL7 v2?

  Several weeks ago, I was in Amsterdam for the Furore FHIR DevDays. While there, Nikolay from Health Samurai showed off a neat javascript based framework for sharing scripts that convert from HL7 v2 to FHIR.

• 09-Jan-15: #FHIR for Laboratory Integration

  As the FHIR project has progressed, many organizations are starting to face the difficult question: when should we think about using FHIR for our production interfaces?

• 01-Jan-15: Question about storing/processing Coded values in CDA document

  Question

• 19-Dec-14: Question: Using FHIR for systems integration

  Question:

• 12-Dec-14: #FHIR Updates

  A round of links and news about progess with FHIR

• 03-Dec-14: FHIR and Healthcare Informatics Education

  One of the interesting things about FHIR is how it offers new prospects for real practical hands-on education.

• 02-Dec-14: Question: Clinical Documents in FHIR

  Question:

• 21-Nov-14: Question: glasses prescription in FHIR

  Question

• 05-Nov-14: Question: Delphi Client for #FHIR

  Question:

• 01-Nov-14: Mapping to the FHIR Allergy/Intolerance Resource

  I’ve just posted an updated Allergy/Intolerance resource for the candidate FHIR DSTU2. This is closely very based on the shared FHIR/openEHR achetype, though the resource has been renamed. As part of preparing it, a few of us surveyed existing systems, and it seems useful to post the details of these here. Here’s a variety of allergy/intolerance data entry screens from around the interwebs (only one betrays it’s original directly). Each of them is marked with a set of numbers that identify the fields in the Allergy/Intolerance resource:

• 27-Oct-14: Preparing for the Australia #FHIR Connectathon

  It’s 10 days or sp until the Australian FHIR Connectathon, which is Friday. This post is to help people who are preparing for that connectathon. There’s 3 tracks at the Australian Connectathon:

• 24-Oct-14: #FHIR Updates

  Several FHIR related updates:

• 16-Oct-14: Health Interoperability Webinar

  David Booth, who’s working with the FHIR team on RDF format, asked me to post this to alert my readers to this:

• 08-Oct-14: If Hospitals ran like Restaurants

  Yesterday, I gave a lecture about Healthcare Interoperability - and the lessons learned from FHIR - to a group of master’s students at Melbourne University HaBIC. In passing, I mentioned the danger of using bad metaphors to describe healthcare interoperability, and compared this to the danger of the whole “healthcare should be like the airlines”… and then today, I saw this (h/t HISTalk)

• 07-Oct-14: Question: Using #FHIR Medication Resources

  **Question: **

• 01-Oct-14: New #FHIR Open License

  Today, HL7 released an updated version of the FHIR™ Draft Standard, which is now covered under a Creative Commons License: No Rights Reserved. This marks the formal adoption of a recognized open license for the FHIR specification, and one that is truly open: this is an unencumbered license. Under the terms of the Creative Commons license, HL7:

• 29-Sep-14: #FHIR DSTU2: Changing the Composition Resource

  While in Chicago, one of the decisions that we made was to refactor the Composition resource. Here’s the design in DSTU #1:

• 27-Sep-14: #FHIR Report from the Chicago meeting

  Here’s a FHIR progress report from the HL7 working meeting in Chicago held the week before last.

• 23-Sep-14: HL7 Australia #FHIR Forum and Connectathon

  On Thursday & Friday 6-7 November 2014 Hl7 Australia is holding a FHIR Forum and Connectathon in Melbourne.

• 11-Sep-14: Question: FHIR release schedule

  Question:

• 09-Sep-14: 20 Questions #6: Optionality vs Extensiblity

  In the 6th question of the 20 Questions series,  Greg Meyer, asks:

• 08-Sep-14: #FHIR: Testing a new search mechanism

  The FHIR search mechanism is based on the HTTP parameter mechanism - a series of named parameters with values. This works quite well for simple cases, but we’ve pushed it pretty far, and there’s a few cases for which we’ve had to invent some pretty tricky hacks to get things done (modifiers!). Here’s an example of a moderately simple search: find all the observations for patient with a name including “peter” that have a LOINC code 1234-5:

• 02-Sep-14: 20 Questions for Health IT

  “20 Questions for Health IT” is a project being run by Chad Johnson from HL7Standards.com:

• 20-Aug-14: Caption Contest

  I don’t get humorous stuff on this blog often enough. However, my attention has just been drawn to this picture of one the followers of this blog posing with a projection of the RIM:

• 14-Aug-14: Question: Using Medication resources in FHIR

  Question:

• 11-Aug-14: Question: sending PDFs via HL7 v2

  This question is a follow up to one asked on Stack Overflow

• 01-Aug-14: #FHIR CDA Position Statement & Roadmap: Joint Statement with Lantana

  Lantana Consulting Group invited me to take part in the Spring CDA Academy after the HL7 Working meeting in Phoenix in May, which I enjoyed greatly. While I was there, we spent some time discussing the relationship between CDA and FHIR, both where things are today, and where we think they should be.

• 22-Jul-14: Question: NEHTA CDA & GP referrals

  Question

• 19-Jul-14: #FHIR Connectathon 7, Chicago Sept 13-14

  We will be holding the next FHIR connectathon in Chicago on Sept 13/14 associated with the HL7 Plenary Meeting. Once again, anyone interested in implementing FHIR is welcome to attend.

• 17-Jul-14: License Restrictions on Terminologies

  One of the things that we can do in FHIR that can make a significant contribution to interoperability in FHIR is to describe how to use common terminologies in a common fashion. Interoperability is a waste of time if the way one organization uses a code system is different to way another one does. And I’ve learnt, through my implementation experience, that it’s not just enough to say “use this code system”, or “this is the namespace for the code system”. There’s a lot more to say, about what valid  codes are, how versions should be identified consistently, how to exchange information about subsets - which relates heavily to agreeing how to use the code system, etc.

• 11-Jul-14: Joint openEHR/FHIR review of Allergy/Intolerance

  I previously announced that:

• 04-Jul-14: FHIR: Useability vs Reusability

  I regularly get requests to look at a RESTful API for healthcare data from some company out there. Generally, people ask me one of 3 questions:

• 04-Jul-14: Explaining the v3 II Type again

  Several conversations in varying places make me think that it’s worth explaining the v3 II type again, since there’s some important subtleties about how it works that are often missed (though by now the essence of it is well understood by many implementers). The II data type is “An identifier that uniquely identifies a thing or object”, and it has 2 important properties:

• 04-Jul-14: Exchanging Codes with Translations in practice

  All the mainstream clinical coding data types across HL7 (v2, v3, FHIR) and elsewhere (openEHR, IHE, DICOM to a lesser degree) allow for a translations of codes. These are provided because institutions are often not able to get consistency over which terminologies are in use. On the other hand, actually exchanging translations of codes is not that common in my experience. I’ve seen it in the following cases:

• 20-Jun-14: #FHIR + Open ID Connect

  I’ve upgraded my FHIR server to support OpenID Connect tokens as part of it’s OAuth based login. This is part of implementing IHE’s IUA profile, though I’m not yet sure whether I’m going to finish that off - I’m still discussing the way that works with the IHE authors.

• 18-Jun-14: Question: v2 Referrals

  Question:

• 17-Jun-14: Error in R2 Datatypes

  Today, Rick Geimer and Austin Kreisler discovered a rather egregious error in the Data Types R2 specifications. The ISO data types say:

• 04-Jun-14: Question: CDA as a canonical data model

  Question:

• 03-Jun-14: Joint OpenEHR / FHIR review of Allergy-related Resources

  I’m really pleased to announce a new initiative as part of the ongoing development: we’re going to do a joint review of the FHIR resources for Allergy/Intolerance (AllergyIntolerance and AdverseReaction), and the openEHR archetype for the equivalent content (openEHR-EHR-EVALUATION.adverse_reaction.v1). The review is going to be done on the openEHR CKM, on a newly prepared archetype that shows the essential content models of the existing archetypes and resources (they’re quite different)

• 03-Jun-14: FHIR Skype Chat Logs

  A lot of the working business of the FHIR project team is done over Skype. In the interests of transparency, we’re now publishing logs of the skype chats.

• 02-Jun-14: The PCEHR Review, and the “Minimum Composite of Records” #2

  This post is a follow up to a previous post about the PCEHR review, where I promised to talk about medications coding. The PCEHR review quotes Deloittes on this:

• 30-May-14: South American FHIR Connectathon

  There will be a FHIR Connectathon for South American participants on Sept 3rd in Buenos Aires. The connectathon will be held in association with CAIS 2014 (Argentinian congress on Health Informatics).

• 30-May-14: Happiness

  John had a Great Big Integration Engine on;

• 28-May-14: Double Layer OAuth

  At the last connectathon, we had two servers offering OAuth based logins. They took two totally different approaches:

• 23-May-14: #FHIR - looking for translators

  One of the parts of the FHIR specification is a translations file. This is an XML file that includes a whole series of user-level messages that implementers may find useful, along with translations to other languages. A typical entry looks like this:

• 21-May-14: Question: v2.x delimiter escape sequences

  Question:

• 20-May-14: The PCEHR Review, and the "Minimum Composite of Records"

  So the PCEHR review has finally been released, and I’ve been reading with considerable interest. I’m going to stick to analysing the technical recommendations that they make, starting with a group of recommendations they call the “Minimum Composite of Records”:

• 20-May-14: Question: use of HL7 v2 for specialist Letter

  Question:

• 13-May-14: Sharing Healthcare Data Between Primary and Secondary Usage

  One of the difficult problems associated with healthcare information is sharing data between primary users and secondary data. In fact, it’s come up in quite a few places recently, and seems to be causing more noise than light. The problem is that these two user bases have such radically different views of how the data should be understood.

• 10-May-14: Summary of #FHIR progress at the HL7 WGM in Phoenix

  Well, another HL7 Working Group Meeting (WGM) has come to an end. It was a big week for FHIR, so here’s a summary of the more significant outcomes:

• 05-May-14: #FHIR ValueSet Editor

  FHIR contains a set of conformance-related resources. These are used to describe h0w an application uses FHIR, and can be used to generate code, test conformance, and determine whether systems can interoperate:

• 05-May-14: #FHIR, and recursive standards development

  So Sean Nolan from Microsoft blogged about how he wasn’t that excited about FHIR:

• 27-Apr-14: Setting the Hay on Fire

  Quoting from Australia’s Birthstain: The Startling Legacy of the Convict Era, by Babette Smith (Amazon Kindle link):

• 27-Apr-14: #FHIR DevDays, Amsterdam in November

  in November, I’ll be at the FHIR Dev Days:

• 24-Apr-14: CDA Academy does FHIR

  After the Phoenix HL7 working meeting, I will be Annapolis the week after at the Lantana CDA Academy.

• 17-Apr-14: New CDA Stylesheet

  From Keith’s blog:

• 16-Apr-14: #FHIR: Subscribing to a server

  This question has come up several times lately, so I thought I’d show how to subscribe to a server.

• 15-Apr-14: Question: HL7 Open source libraries

  Question:

• 15-Apr-14: #FHIR FAQs and Knowledge Base articles

  HL7 has published a set of FAQs and knowledge base articles about FHIR, that cover questions about the following aspects of the FHIR specification:

• 10-Apr-14: Questions about Questionnaire

  One of the themes of the connectathon that will be held in a few weeks in Phoenix is using the questionnaire resource. That’s generated lots of attention to it, and a number of questions about how to use a questionnaire to drive a form to collect answers from a person. For the purposes of the connectathon, the answers are here:

• 09-Apr-14: SQL Injection attacks against HL7 interfaces

  One of the questions that several people have asked me in the discussions triggered by the report of CDA vulnerabilities is whether there is any concern about SQL injection attacks in CDA usage, or other HL7 exchange protocols.

• 08-Apr-14: Security cases for EHR systems

  Well, security is the flavor of the week. And one thing we can say for sure is that many application authors and many healthcare users do not care about security on the grounds that malicious behaviour is not expected behaviour. One example that sticks in my mind is one of the major teaching hospitals in Australia that constantly had a few keys on the keyboard wear out early: the doctors had discovered that the password “963.” was valid, and could be entered by running your finger down the numeric keypad, so they all used this password.

• 08-Apr-14: Further Analysis of CDA vulnerabilities

  This is a follow up to my previous post about the CDA associated vulnerabilities, based on what’s been learnt and what questions have been asked.

• 07-Apr-14: CDA Security Issues and implications for FHIR

  Overnight, Josh Mandel posted several security issues with regard to CDA:

• 04-Apr-14: CDA Use in the PCEHR: Lessons learned

  I wrote an article for the latest edition of Pulse IT (page 53) called “CDA Use in the PCEHR: Lessons learned”:

• 28-Mar-14: Office for the iPad, and Dropbox

  I woke up to a lovely piece of news this morning: Office has finally been released for the iPad. Yay!

• 28-Mar-14: #FHIR for Clinical Users

  One of the outstanding issues for FHIR has been to make the specification more penetrable for clinical users - or, more precisely, for non-technical users. The framing of what FHIR is made in a technology setting, and if you aren’t familiar with the technologies, then it’s hard to know where to start. I committed to doing something about that, so here’s a short “FHIR for Clinical Users” introduction:

• 27-Mar-14: CDA: What information from the Entries has to go in the narrative?

  Most CDA implementation guides, and many tutorials - including some of both I wrote myself - say something like this:

• 26-Mar-14: The importance of examples

  On an HL7 mailing list, there’s a rather active discussion that is happening about a particular feature in CCDA (allergy lists). It turns out that one of the bits of the CCDA specification is somewhat obtuse (surprise!), and there’s more than one opinion on what it means and how it’s supposed to be used. I’ll probably end up posting on the specific subject when (if) there’s closure to the subject.

• 26-Mar-14: Concern on Allergies in CCDA

  In my last post, I referred to an ongoing discussion on an HL7 forum:

• 25-Mar-14: Question: Whats a conformant #FHIR Server?

  Question

• 23-Mar-14: Question: #FHIR, complexity, and modeling

  Question:

• 20-Mar-14: Question: Should value sets include nullFlavor Values?

  Note - mostly, the questions I post on my blog are implementer focused questions. This is different - it’s from a discussion between myself and a HL7 vocab work group co-chair. It’s about a particularly unclear and relatively distant corner case in the CDA specification space, but I thought I’d post it here to get the answer into google. If you don’t even understand the question, don’t worry…

• 20-Mar-14: HL7 Standards and rules for handling errors

  It’s a pretty common question:

• 17-Mar-14: Clinical Safety Workshop

  This workshop provides a set of tools and knowledge that will help healthcare application designers create safer software. Attendees will work through real, practical examples that demonstrate clinical safety issues in application design, and also cover general clinical safety thinking, coding, presentation, data management issues, and the looming regulatory process.

• 16-Mar-14: Testing FHIR Data types for equality

  One of the more difficult parts of building an object library is deciding what to do about equality checking. There’s several common operations where you want to do equality checking:

• 11-Mar-14: Understanding v2 Acknowledgements

  Almost always, when you send an HL7 v2 message, you need or get an acknowledgement message back from the destination system. This post describes how these acknowledgements work.

• 11-Mar-14: Set the RIM free!

  Last week I met some enterprise architects who are doing a major project around enterprise modeling in a healthcare project. Without ever having learnt anything about the RIM, they had reproduced the Entity -> Role -> Participation -> Act -> Act Relationship cascade, though their pattern was not so solid, and they had slightly different names for these things.

• 05-Mar-14: Upcoming event: FHIR Dev Days in Amsterdam in November

  European readers should take note of a developer focused FHIR educational course being held in Amsterdam in November:

• 04-Mar-14: Ineroperability and Safety: Testing your healthcare integration

  John Moehrke has a new post up about the importance of testing:

• 28-Feb-14: FHIR Foreword

  FHIR is not a book, and it was not written by a single author; it’s a draft standard, and it was produced by a whole team of people. The formal credits page lists a lot of people, and even that’s being selective. Even though so many people have contributed, I thought I’d post my own personal foreword here:

• 28-Feb-14: #FHIR at #HIMSS14

  I have just returned from an exhausting 3 days at HIMSS in Orlando. For general news, see HISTalk for Feb 24, 25, and 26, or Inga for Feb 24, 25, 26.

• 28-Feb-14: #FHIR and confusion about the 80/20 rule

  One of the most common misconceptions out there about the FHIR is about the 80/20 rule we use when debating whether fields should be included in resources.

• 25-Feb-14: JSON, property order, polymorphism, and streaming based parsers

  On the FHIR email list, we’ve been discussing a proposal to simplify the FHIR JSON representation.

• 21-Feb-14: #FHIR and the cost of standardization

  In an article about FHIR, Eliot Muir is quoted as saying:

• 19-Feb-14: Question: v2 Encoding type field

  Question:

• 19-Feb-14: FHIR: The Future of Interoperability

  

• 18-Feb-14: #FHIR - still a long way to go yet

  While working with one of my Customers (NEHTA), this diagram went past, a powerpoint mock-up of a GP system went past. They’ve given me permission to take it out of it’s context, and use it for something else (thanks). So here’s the GP system mock-up:

• 17-Feb-14: Terminology derived invariants in FHIR

  Over on David More’s generally controversial Australian Health IT Blog, I’ve been drawn into a discussion about a number of weaknesses in the FHIR examples with Eric Browne, who says (among other things):

• 13-Feb-14: FHIR Server Upgrade

  I have upgraded my server to support the DSTU version of FHIR. In addition, the server now supports the _text search parameter.

• 11-Feb-14: Question: openEHR and FHIR

  Question from Heather Leslie:

• 03-Feb-14: FHIR DSTU is published

  We have now published the DSTU version (draft standard for trial use - effectively a beta) of FHIR at http://hl7.org/fhir.

• 01-Feb-14: Question: FHIR Schemas

  Question:

• 28-Jan-14: Follow up workshops: Clinical Safety for Healthcare Applications

  Back in November I ran a clinical safety workshop for the MSIA in Sydney. I had several requests for follow ups in Melbourne and Brisbane, so I will be holding follow up workshops on March 11 (Melbourne) and Mar 13 (Brisbane). I’ll do more if there’s sufficient interest.

• 16-Jan-14: I will not be at San Antonio

  Next week is the HL7 working group meeting, in San Antonio this time. The WGM is where most of the work of developing a standard gets done.

• 16-Jan-14: Guest Post: FHIR Ballot Process

  GE have asked for another round of FHIR balloting. See here and here. I don’t have time to commit my thoughts to the blog in a measured way - it’s very hard to comment rationally on this matter, and I don’t have time. So instead, Lloyd McKenzie volunteered this as a guest post:

• 15-Jan-14: Question: HL7 v2 Backwards Compatibility

  Question

• 31-Dec-13: FHIR DSTU Candidate Posted & Version Question

  So today, to mark the end of the year, we’ve posted the final DSTU candidate version of FHIR.

• 18-Dec-13: Turtles all the way down

  It’s a common pattern in IT: recursion, where a pointer for what to do next brings you back to where you already are.

• 18-Dec-13: Question: translating v2 to FHIR

  Questions

• 18-Dec-13: Question: RDF versions of FHIR

  Question

• 17-Dec-13: Question: v2 optionality

  Question

• 13-Dec-13: FHIR Server Updated

  I have upgraded my test FHIR server to the latest FHIR version. The server is found at http://fhir.healthintersections.com.au

• 12-Dec-13: Question: Exchanging CDA

  Question:

• 05-Dec-13: Open Sourcing my FHIR Server

  Since early in the FHIR development process, I’ve maintained a FHIR server at http://hl7connect.healthintersections.com.au/svc/fhir. Everyone in the community uses this for learning FHIR, testing their implementations, and it’s the de facto reference server (which was my intent).

• 03-Dec-13: Question: Past Medications in FHIR

  Question: 

• 02-Dec-13: Question: RIM XMI Files

  Question

• 20-Nov-13: Question: Multi-part surnames

  Question:

• 19-Nov-13: Question: Starting with HL7

  Question:

• 19-Nov-13: Question: More Starting with HL7

  Question:

• 17-Nov-13: Underlying Issues for the pcEHR

  There’s an enquiry into the pcEHR at the moment. As one of the small cogs in the large pcEHR wheel, I’ve been trying to figure out whether I have an opinion, and if I do, whether I should express it. However an intersection of communications with many people both in regard to the PCEHR, and FHIR, and other things, have all convinced me that I do have an opinion, and that it’s worth offering here.

• 14-Nov-13: Standards and Research: like Slinky-Dog

  From my friend Heather over at Archetypical:

• 14-Nov-13: Complexity of Standards - Updated

  Someone asked me to update the diagram, from The Complexity Of Standards:

• 08-Nov-13: Change to HL7 Ballot sign-up processes

  From HL7:

• 06-Nov-13: UUID in CDA/SPL? - uppercase or lowercase?

  UUIDs may be represented either in uppercase or lowercase. Lowercase is common in Unix, and uppercase is common on windows (COM).

• 06-Nov-13: Documents are only immutable as a matter of policy

  One of the issues that kept coming up when we were discussing documents in FHIR last week is that notion that documents are immutable, and can’t change. Take, for instance, this, from the comments:

• 05-Nov-13: Question: When should you adopt FHIR?

  Question: 

• 05-Nov-13: More fun with original Text

  As I’ve described before (and here) originalText is a challenge.

• 31-Oct-13: Unique Device Identifiers in FHIR

  The FDA and partners around the world are in the process of introducing a new identification framework for medical devices called the “Unique Device Identifier” (UDI). They asked for FHIR to “support” UDI. But what does that mean?

• 31-Oct-13: Straw Poll: FHIR Document Resource Name

  FHIR defines a resource called Document. It describes a way to assemble a set of resources to act as a “Clinical Document” - an set of resources that have an attested content, and carry their own context. Kind of like CDA - in fact, a lot like CDA.

• 30-Oct-13: What impact will FHIR have on the Healthcare Integration Market?

  Yesterday, I gave a FHIR update as a keynote presentation at the International HL7 Interoperability conference (IHIC) on the subject. You can get my slides from the IHIC website or the FHIR SVN. As part of that presentation, I discussed the likely impact of FHIR on the Healthcare Integration Market.

• 30-Oct-13: Clinical Safety Workshop for Healthcare Application Designers

  On November 12 in Sydney, I’ll be leading a “**Clinical Safety for Healthcare Application Designers” **workshop on behalf of the Clinical Safety committee of the Australian Medical Software Association (MSIA). This is the blurb that went out to MSIA members today:

• 14-Oct-13: On the subject of original text for Codes

  In the various coded data types defined by HL7 across v2, v3, and FHIR, there’s a property named text or originalText that is defined using some variant of these words:

• 09-Oct-13: Updated note about MIMS codes in CDA documents

  When representing MIMS codes (from their Integrated Data Solutions Product) in CDA documents, you use the OID 1.2.36.1.2001.1005.11.1:

• 02-Oct-13: Why healthcare interoperability standards arent perfect

  Referring to HL7 and other SDO’s, Tim Cook writes:

• 02-Oct-13: Question: v3 development resources

  Question

• 28-Sep-13: On the future of CDA

  I’ve had several questions about my comments on the future of CDA in the Structured Documents working group (SDWG) this week, so I thought I’d clarify here.

• 20-Sep-13: Clinical Safety: Mandatory Fields

  This post is actually prompted by the FHIR ballot, where there’s a whole swag of ballots saying that the minimum cardinality of a field should be 1, not 0. But it’s a generally tough issue - when is it right to set a minimum cardinality of 1?

• 18-Sep-13: FHIR ballot: Race and Ethnicity

  This will be the first of several posts exploring issues raised by the FHIR ballot.

• 08-Sep-13: Process for Conformance Checking a CDA Document

  One of the things I’ve done a lot of this year is conformance checking CDA documents in several different contexts. Since someone asked, here’s my basic methodology for conformance checking a CDA document:

• 05-Sep-13: Clinical Safety: Trust between Humans and Machines

  Great post by Bruce Schneier:

• 04-Sep-13: Question: What does an empty name mean?

  I was recently asked whether this fragment is legal CDA:

• 28-Aug-13: Clinical Safety and sharing data

  An institution has a health record eco-system that is distributed and poorly connected. Due to technical, procedural and policy issues, the data is divided into a series of different silos, and there’s not a lot of inter-connection between them. Though - presumably - the systems have connection points through the patient clinical process, because of differences in perspective and purpose, different information is collected, and because of various system design approaches and various lapses in system continuity (the fog of war), the data is a little out of sync.

• 23-Aug-13: HL7 glorious nation interoperated most

  It’s been too long since I had anything funny or humorous on the blog…

• 21-Aug-13: Clinical Safety and Data Duplication

  Here’s how to kill patients:

• 16-Aug-13: Question: Medication Checking in a FHIR eco-system

  Question:

• 14-Aug-13: Technical Error in CDA Implementation Guides for ETP, PCEHR

  There’s a technical error that runs through most of the CDA implementation guides that we have, including ETP, and other pcEHR related ones.

• 13-Aug-13: Webinar: Embedding clinical safety in medical software implementations

  Tomorrow I’m giving a webinar for MSIA members called “Embedding clinical safety in medical software implementations”. MSIA members can consult their MSIA releases for webinar details.

• 09-Aug-13: FHIR DSTU / Connectathon Stable Version Posted

  We’ve posted the stable version of the FHIR specification that will be used for the DSTU ballot opening in a few days, and also this version will be the one used for the connectathons in Cambridge and Sydney. Some minor cosmetic changes are anticipated, but nothing of substance, in particular there will be nothing that changes the schema anymore. So we are now in the connectathon freeze.

• 09-Aug-13: Challenges funding standards development

  My good friend Dave Shaver writes:

• 24-Jul-13: Do vendors like standards or not?

  Quoting from discussion on David More’s blog:

• 19-Jul-13: Why attend the Australian FHIR Connectathon?

  So this week, while I was at HIC 2013, I spoke to a number of vendors about the FHIR connectathon to be held in Sydney in late October in association with the IHIC 2013 meeting. Most of the vendors have heard of FHIR, and expect that it will have a major impact on them at some stage, but are still unsure about attending the connectathon.

• 10-Jul-13: Question: FHIR Versioning

  Question:

• 10-Jul-13: eHealth Interoperability Conference, Sydney, Sept 12

  

• 02-Jul-13: NEHTA Clinical Documents: How not to represent an MRN

  The FAQ about how to represent an MRN, my prior post and the forthcoming handbook for representing Australian identifiers all agree that MRNs are represented like this:

• 27-Jun-13: NullFlavor on Intervals of time

  Here’s a sample that I see fairly often:

• 06-Jun-13: Question: Alerts in v2 messages

  Question:

• 30-May-13: Updated Indy IdHL7

  And while I’m on the subject of Indy and updating old libraries, several people have asked me about whether there’s a current copy of IdHL7.pas.

• 30-May-13: Question: IHE PIX v3 Acknowledgement

  Question

• 29-May-13: IndySoap lives Again

  Many years ago, I wrote an web services library for Delphi called “IndySoap”. It took a WSDL and generated delphi code that could then be used to implement a client or a server, and was published as open source. For me, it was a real learning process, both in terms of http, xml, and web services, and also - because we dynamically generated machine code, and I thought that was risky  - we wrote a very thorough test suite. It was my first exposure to TDD.

• 29-May-13: ACIR Codes (for OID 1.2.36.1.2001.1005.17)

  The OID 1.2.36.1.2001.1005.17 is registered for Australian Vaccine Code. The description is:

• 28-May-13: Question: Act-relationship for Pathology Dissection

  Question

• 27-May-13: Here be Dragons

  Keith’s got a post up entitled “Here be Dragons”:

• 22-May-13: NEHTA: Guidance relating to Clinical Document Presentation

  I am pleased to be able to draw your attention to a newly released document from NEHTA entitled “Supplementary Notes for Implementers Relating to Clinical Document Presentation”. Quoting from the document:

• 21-May-13: Question: Positional location of OBX-3 codes and AS 4700.2

  Question:

• 12-May-13: Outcomes from Atlanta HL7 Meeting for FHIR

  Well, I’m now nearly home from the long week that is the HL7 Working Group meeting. It now goes for 7 long days from Saturday morning through to Friday afternoon. This meeting was held in Atlanta - I’d like to make some comment about Atlanta but the only time I got out of the hotel was to go to Dave Shaver’s Corepoint Party (thanks Dave).

• 25-Apr-13: Securing your REST API

  Over the weekend, I spent several days working on integrating OAuth authentication and authorization into my FHIR server. Really, I’m primarily interested in authentication - if the user authenticates to the server, they get open access. So the functionality I implemented was that I will accept logins from any Facebook or Google user.

• 12-Apr-13: Question: Does HL7 free IP mean open?

  Question

• 12-Apr-13: FHIR - what is interoperability?

  Well, FHIR is starting to really make progress. There’s been quite a few blog posts about it recently:

• 10-Apr-13: Question: HL7 v2 case sensitivity

  Question:

• 21-Mar-13: Australian FHIR Connectathon and Tutorial

  We’ll be holding a FHIR connectathon here in Australia as part of the IHIC 2013 – International HL7 Interoperability Conference in Sydney in late October 2013 (around 28-30).

• 12-Mar-13: Question: FHIR and un-semantic interoperability

  Question:

• 12-Mar-13: Question: Diagnostic reports in CCDA documents

  Questions:

• 04-Mar-13: Question: Delphi Code for converting a UUID to an OID

  This is sort of turning into a pretty common question - I had no idea that so many vendors still use delphi: if you are using delphi, how do you convert a GUID to it’s OID representation? Well, here’s the code:

• 04-Mar-13: HIMSS 13 - New Orleans

  I am at HIMSS 13 in New Orleans for the next few days.

• 03-Mar-13: Repository Based Exchange

  Classically, HL7 has divided exchange of information between two applications into 3 different paradigms:

• 25-Feb-13: Do I need to render the CDA Narrative?

  In a couple of different CDA implementation contexts, the same question has come up: does an application receiving the CDA document need to render the document using the narrative, or can it simply ignore the narrative and process and display the structured data? If it can, under what conditions is that OK?

• 24-Feb-13: Question: Interpretation of multiple pre-conditions in CDA

  Question:

• 22-Feb-13:

  Question

• 11-Feb-13: Question: Co

  Question:

• 11-Feb-13: Problems with PBS codes

  The Australian PBS codes are used to describe the medications for which the Australian government offers rebates under the Australian Pharmaceutical Benefits Scheme. The codes are published as part of the rules definitions tables, and can be found here. In living memory, the codes have consisted of 4 digit codes followed by a alphabetical check letter. For instance, the code for a particular packaging of Simvastatin (used to be a clinical interest of mine) is “2011W”, and you can get the full details for this code at http://www.pbs.gov.au/medicine/item/2011W (note that this is not case sensitive, and http://www.pbs.gov.au/medicine/item/2011w also works).

• 09-Feb-13: Identifiers in NEHTA Clinical Documents

  There’s not a lot of good information around about handling identifiers in CDA documents. I’ve written about it before, but I’m not aware of anything else that’s publicly available. My previous post was “Identifiers in CDA Documents- Reporting Tool” and I really recommend that you read that one first. This post provides advice for how to use identifiers in NEHTA Clinical Document CDAs. In the course of time, this advice will develop into an official NEHTA FAQ, but I’m writing the guts of it here to get comment on it first.

• 09-Feb-13: FHIR Resources and Unicode

  In the FHIR specification we say that the basic language for resources is unicode:

• 08-Feb-13: Question: CD data type and value sets

  Question:

• 28-Jan-13: Question: HL7 v2 Query Semantics

  Question:

• 17-Jan-13: Standards have no sense of humor

  FHIR is a draft standard that is early in it’s ballot cycle. It’s a reasonable anticipation that it will end up as a ISO standard in the fullness of time. But for now, it’s just a draft standard. Writing a standard is a huge piece of work, and you have find entertainment where you can…. with that in mind, I added a couple of jokes to the specification.

• 15-Jan-13: Question: UnitID and UnitType in CDA

  Question:

• 09-Jan-13: FHIR Extensions, the 80/20 rule, DICOM and the LONG tail

  As part of FHIR, we have said that resources will only contain the “core” elements, and those not widely used will be delegated to a robust extension mechanism.

• 07-Jan-13: Implementing XDS on a FHIR Server

  This is a follow up to an earlier post, Implementing ATNA on a FHIR server, and a preparative post for the XDS-focused FHIR Connectathon to be held this weekend.

• 04-Jan-13: Question: FHIR date formats in JSON

  Question:

• 03-Jan-13: Question: How to use FHIR for ABBI

  Question:

• 31-Dec-12: FHIR and the need for identified resources

  One of the fundamental tenets of REST is that resources are unambiguously identified. Specifically, for REST,  the identification is an accessible URL that can be used to address the resource with certainty.

• 29-Dec-12: Database schema for my FHIR server

  Several implementers have asked me what database I use for my FHIR server, and how I structure the database.

• 14-Dec-12: Question: Special Characters in HL7 v2

  Question:

• 12-Dec-12: Remote Participation in the FHIR Connectathon

  We’ve had a request to participate in the FHIR connectathon remotely. In other words, people would like to participate in the Connectathon, but won’t be in Phoenix.

• 10-Dec-12: Implementing ATNA on a FHIR server

  This is the first of a series of posts that I’ll be making about the trial implementation of the IHE XDS profile using FHIR resources. Note that the status of the FHIR resources for XDS is a strawman - both HL7 and IHE are looking at these and evaluating their suitability for use for providing a mobile friendly gateway to an XDS system, but neither organization has committed to this approach yet - we have to see how well it works.

• 07-Dec-12: FHIR Webinar - reference and additional answers

  This week I did a webinar on FHIR for HL7. They’ve posted the recording of it (2012 December 4 Ambassador Webinar: Fast Healthcare Interoperability Resources (FHIR) (70.26 MB)), along with my slides (PDF version of the slides here).

• 05-Dec-12: Question: How does the HL7 v3 Dynamic Model work

  Question:

• 26-Nov-12: Question: v3 Lab Ordering Support

  Question

• 20-Nov-12: Using Dates, Times, Timezones and Intervals in NEHTA Clinical Documents

  There’s been a few queries from implementers about the best way to represent dates and times in the NETHA Clinical Documents. It’s not as obvious as it probably should be for several reasons:

• 20-Nov-12: Upcoming HL7 Australia Seminar

  There’s an HL7 Australia seminar next week:

• 20-Nov-12: Question: FHIR and JSON

  Question:

• 20-Nov-12: FHIR Tutorials at the Phoenix Meeting

  Unfortunately there is a problem with the description of the FHIR tutorials in the meeting brochure for the upcoming Phoenix meeting. The brochure describes 3 FHIR tutorials:

• 20-Nov-12: Cross-walk between HTML and CDA Narrative

  As a followup to yesterday’s post about converting from html to CDA narrative, the following table summarises the differences between HTML and CDA narrative:

• 18-Nov-12: Incorporating HTML Diagnostic Reports in NEHTA CDA Documents

  A vendor asks how to include a report like the one in this OBX into a NEHTA CDA document (copied from a real report, with only names and the link URL changed):

• 16-Nov-12: Administrative Observations in NEHTA CDA Documents

  All the NEHTA CDA Implementation Guides specify a section called “Administrative Observations”. This is where information that is logically part of the context of the document - administrative type things such as patient age - that don’t fit into the relatively tightly controlled CDA header go. A question has arisen over whether a document has to contain an administrative observation section or not. This arises because of this mapping in the CDA IG:

• 07-Nov-12: FHIR Ballot Issue: Alignment of demographics with v/xCard

  One of the ballot comments received on FHIR was this:

• 30-Oct-12: Interpreting RIM Objects Safely (Exclusion Statements)

  One of the most difficult parts of the RIM based content models - including CDA - is how to interpret and/or query them safely. In the past I volunteered to write something about this:

• 21-Oct-12: Date validation for exchanged data

  A question arose in the PCEHR program: is the date 00010101 a valid date in CDA, and if not, what is the valid date range allowed?

• 16-Oct-12: The pulse of the HL7 profession

  David More drew my attention to “New poll takes pulse of HL7 profession”, and I couldn’t resist making some comments on it.

• 15-Oct-12: Question: How are alerts exchanged in v2?

  Question:

• 15-Oct-12: FHIR Ballot Issue: Representation of Identifiers

  Theory

• 15-Oct-12: FHIR ballot issue: Identifying an extension

  This issue is a follow on to the previous post about representing identifiers in FHIR.

• 13-Oct-12: GPL v3 and Java programs

  The GPL v3 includes this definition:

• 12-Oct-12: Australian IHE Connectathon

  I have been at the IHE Australian connectathon all week. I came to test the HL7Connect XDR implementation - send and receive CDA documents/packages as part of an XDS infrastructure.

• 11-Oct-12: HL7 Email List setup

  I have a gmail account (grahameg) and also health intersections email is hosted on GMail. in order to keep all my mail in one place, I forward everything from healthintersections.com.au to my main gmail account. But I use @healthintersections.com.au as my main presence - so set up GMail to set this as the reply-to address. But on my iPad, the standard Mail program doesn’t let me set the reply-to address. So if I answer an email from an HL7 list from my iPad, the response comes with a reply-to of my GMail address.

• 05-Oct-12: NEHTA Clinical Documents: Understanding the Rendering Specification

  The CDA Rendering Specification is a highly technical specification that describes the basic rules for how CDA documents can be presented. The document itself doesn’t provide the rationale and scope of the rendering specification - what it does and doesn’t do (and why) - in language that is comprehensible to a non-technical user. This blog post is an attempt to fill that void.

• 04-Oct-12: Question: ISO 21090 namespace

  Question:

• 03-Oct-12: FHIR Issue: removing the element from all resources

  From the beginning, every FHIR resource has included an element as the first element of the resource:

• 01-Oct-12: Question: Where can I find CCDA supporting information?

  Question

• 01-Oct-12: Question: ISO 21090 Schema

  Question

• 01-Oct-12: Question: CCDA, typeCode and DRIV

  Question

• 27-Sep-12: Question: Australian PCEHR HPI-I in XCN

  Question:

• 26-Sep-12: NEHTA Clinical Documents: Notes on the usage of templateIds

  Normal NEHTA CDA Clinical Documents carry two templateId values at the root of the document:

• 20-Sep-12: Question: GTS cardinality in CDA

  Question:

• 20-Sep-12: NEHTA Clinical Documents: UCUM alert

  The PQ data type has two important properties, value and unit:

• 17-Sep-12: FHIR Issue: Invariants based on dataAbsentReason

  This is a ballot comment made against the FHIR specification:

• 17-Sep-12: Standa

  Vince MacCauley has written an article about standards development in Healthcare IT in Pulse IT. He starts with an interesting claim:

• 15-Sep-12: FHIR Report from Baltimore Meeting

  Well, the Baltimore HL7 Working Group Meeting has (finally) come to end. It’s been an extremely busy meeting, and HL7 is certainly facing some new and difficult challenges in the near future.

• 13-Sep-12: In which I steal the Ad-Hoc Harley Award...

  It’s the annual HL7 Plenary workgroup meeting. This means that there’s a few little extra administrative-type events here, and one of those events is the presentation of the “Ed Hammond Volunteer of the year” award. This is a particularly prestigious award, made to only a very few people who have gone beyond the call of duty to push the cause of HL7 - that is, development of healthcare standards and interoperability. The recipient list is a small and select bunch.

• 13-Sep-12: FHIR Connectathon Press Release

  

• 11-Sep-12: FHIR Extensions

  HL7 faces a fundamental challenge in formulating it’s standards: the business of providing clinical care is wildly variable around the world. The process flows, and even the ways people think about the problems they are trying to solve and describe vary wildly. Further, there’s no central standards body that sets standards for the provision of healthcare process around the world - indeed, for cultural and political reasons, the different countries solve the problems of healthcare radically differently. Even within countries, standards, regulations and funding policies with regard to forcing common practices have dubious success.

• 10-Sep-12: FHIR Connectathon Report

  The first FHIR connectathon was held in Baltimore Saturday Sept 8th.

• 08-Sep-12: FHIR Ballot Summary

  Here’s a summary of the outcomes from the FHIR ballot:

• 06-Sep-12: Can HL7 derive revenue from Tooling?

  One of the proposed sources of revenue to replace the IP based income for HL7 is “tooling”. What kind of tooling could generate this kind of income stream for HL7? Since I can’t imagine other SDOs adopting HL7 tooling (RMIM designer, Rosetree etc) for free - let alone for a decent amount of money - it’s going to have to be implementation tooling that HL7 can sell to implementers - whether members or not.

• 05-Sep-12: Guest Post: Lloyd McKenzie on HL7s IP Announcement

  Note: This is a guest post from Lloyd McKenzie, a follow up to my previous post. These are not necessarily my opinions, though I sort of generally agree. I’ll happily post other guest posts on this subject if people submit them to me.

• 04-Sep-12: NEHTA Clinical Documents: FAQs now public

  null

• 04-Sep-12: HL7 IP to be free to use

  So, as widely distributed in the last few hours, HL7 IP is to be free to use:

• 03-Sep-12: NEHTA Clinical Documents: Conformance Levels and Diagnostic Investigations

  CDA defines 3 conformance levels:

• 30-Aug-12: Why I am withdrawing from the Australian Delegation to Baltimore

  The Australian government has a program that supports Australian delegate’s travel expenses for the purpose of attending international standards meetings and representing Australia. We contribute our own time, but the government reimburses our direct expenses. In exchange, we must represent Australian interests and agreed positions, and we must contribute to a published report about what happened at the meeting. I’ve discussed the usefulness of this report before.

• 24-Aug-12: Roadmap to Blog

  I write about a number of different subjects. This page is an index of the more important posts.

• 24-Aug-12: Representing Pathology reports in NEHTA Clinical Documents : Date Time Field

  In a previous post, I discussed how to represent a pathology report in a NEHTA clinical document. As part of that post, I wrote that a pathology report has the following data item:

• 24-Aug-12: NEHTA Clinical Documents: The importance of the FAQs

  The NEHTA Clinical Document Specifications are available at the Software Developers Resource Centre (Note that these are registration protected, because you have to make certain legal agreements before you can use the documents, and also so that you can be notified of any changes). But anyone can register, and get access to these documents.

• 24-Aug-12: Identifying Humans

  The third requirement for interoperability is good identification policies. And the most common problem in healthcare identification is identifying people.

• 23-Aug-12: IP Gambit Ploys

  Given that all my work products are inteclletual property, I always pay a great deal of attention to matters of copyright, moral rights, patents and so forth in documents that I sign, particularly including contracts.

• 15-Aug-12: NEHTA Clinical Documents: SHS Medical History

  In previous posts (here and here) I covered the exclusion statement. Now I can move on to talking about the SHS Medical History Section, which contains a simple list of a patient’s past procedures and problems/diagnoses.

• 15-Aug-12: NEHTA Clinical Documents: Exclusion Statements 2

  As promised in the last post, this is a summary of the sections in the 5 main clinical documents, which sections are required to be present, and which have exclusion statements:

• 14-Aug-12: What can a Vendor do to prepare for Interoperability Challenges?

  This content is taken from a presentation that I made to the Australian Aged Care IT Vendors Association AGM today.

• 14-Aug-12: NEHTA Clinical Documents: Exclusion Statements

  This is the first of a series of posts looking at implementation issues associated with NEHTA clinical documents. These are based on the common questions I get from implementers. The focus of the first few posts is going to be the “Medical History” Section in the SHS, and the related sections in other documents. But before I can consider those sections in detail, I need to talk about Exclusion Statements in general.

• 14-Aug-12: NEHTA Clinical Documents: ANZSCO codes

  One of the coded values that appears throughout the NEHTA Clinical documents is ANZSCO (Australian and New Zealand Standard Classification of Occupations) codes. Most participants - particularly healthcare providers -  have a required code that indicates their occupation. This was not expected to be a problem because assigning an ANZSCO code is part of registration for an HPI-I, and therefore it was expected that sourcing the ANZSCO code would be straight-forward. However HPI-I take up is slow (see this Australian Article, or here if you aren’t registered). If there’s no HPI-I - and you don’t know the ANZSCO code for the provider - then what do you do? This leads you into an easily misunderstood area of ANZSCO itself.

• 13-Aug-12: The coming doom of old media

  I try to keep this blog on topic to Healthcare IT interoperability as much as I can, but this is too tempting to resist. For a dose of daily light relief, I long ago subscribed to Sharky. While I read it, I check out other featured blog posts from various pundits on current happenings in the IT world - generally about how Microsoft is drowning in the sea of Apple.

• 02-Aug-12: MSIAs Clinical Messaging Profile

  Yesterdays’s post about Healthlink’s Messaging Quality Initiative created some email chatter, and I need to issue a couple of clarifications. But I should also explain the process:

• 01-Aug-12: Healthlinks Messaging Quality Initiative

  From the ever excellent Pulse-IT:

• 31-Jul-12: The standards process

  A quote from Tim Bray:

• 27-Jul-12: PBS Codes in CDA Documents: codeSystemVersion

  Many of the CDA documents that will be part of the overall Australian National Electronic Health Record eco-system include medication information (including dispensing information in some cases). Many of the source systems use PBS codes to represent the medications.

• 26-Jul-12: Identifiers in CDA Documents- Reporting Tool

  This post is prompted by the intersection of two issues:

• 24-Jul-12: Question: How to populate OBX-23?

  Question:

• 20-Jul-12: Question: Where do lab result interpretations go?

  Question:

• 09-Jul-12: Free UCUM Validation Service

  We needed a simple UCUM validation service to call from the FHIR schematron rules - i.e. is this UCUM code valid? Is it of the right dimension (time, length etc)?. So I’ve put one up here: http://hl7connect.healthintersections.com.au/svc/ucum?format=text/html

• 08-Jul-12: Question: What happened to the Eclipse OHF code?

  The Eclipse OHF project was retired after community interest was diverted to The Open Health Tools project. What happened to the source?

• 05-Jul-12: FHIR for a HL7 v2 person

  It’s pretty easy to explain FHIR to a version 2 person.

• 04-Jul-12: Validating Name Characters

  Well, the pcEHR go-live hasn’t gone that well. One particular feature that’s attracted some attention is that fact that the pcEHR won’t accept people with some unusual characters in their surnames.

• 30-Jun-12: FHIR for CDA and v3 implementers

  The previous post explaining FHIR for a v2 implementer generated some private comments which leads to me to post two more lists: FHIR for  CDA and V3 implementers.

• 29-Jun-12: Rendering Attachments in CDA

  Yesterday’s post about pathology attachments in NEHTA Clinical Documents generated two follow-up questions which are pretty general to CDA:

• 29-Jun-12: Link from a CDA narrative to another CDA document in an XDS repository

  So, a use case has come up in the pcEHR for a CDA document that links to another CDA document in an XDS repository (Consolidated View, actually, for those who want to know). So how to do that?

• 28-Jun-12: Add Pathology Report Attachments to NEHTA Clinical Documents

  In previous posts, I’ve shown how to represent a pathology report in a NEHTA Clinical document, and how to convert the PIT format and the TX format into the CDA narrative format. I pretty much left it as an exercise for the reader to represent the pathology report as an attachment. This post explains how to do that.

• 27-Jun-12: Questions about FHIR

  I have been keenly following your writings on HL7 for the past few years. I think that FHIR is a great idea and am  keen on taking this forward in XXX.

• 26-Jun-12: FHIR Connectathon

  I haven’t been very active with the blog lately - I’ve had my head down preparing for the upcoming FHIR ballot and connectathon.

• 26-Jun-12: Empty Address Use

  I’ve been working on the premise that there’s never any empty attributes or tags in a CDA document.

• 12-Jun-12: Representing Pathology reports in NEHTA Clinical Documents

  This is the 3rd post in a series focusing on the representation of pathology reports in NEHTA clinical documents. The context of this work is that a clinical system is assembling a clinical document for some kind of summary report - a discharge summary, an event summary, or a referral - and document will include a set of pathology reports.

• 11-Jun-12: Transforming Pathology PIT reports into NEHTA Clinical Documents

  This is the second of a series of posts dealing with representing pathology reports in NEHTA Discharge summaries. The first post dealt with the transforming the TX format into CDA. This post deals with the PIT

• 10-Jun-12: The fly in the XHTML ointment: CSS

  In CDA R2, the narrative portion of the document is a format that is based on XHTML, but is not actually XHTML. HL7 provides an xslt that does a reasonable job of transforming it to XHTML for display, but the consequence of this is that authoring the narrative is hard - there’s no off the shelf authoring tools for the CDA narrative.

• 04-Jun-12: Converting HL7 v2 Text to CDA

  This is the first of a series of posts dealing with representing diagnostic reports in CDA here in Australia.The first example is an HL7 v2 TX segment, like this:

• 27-May-12: Inviting you to the FHIR connectathon

  On Saturday September 8, we will be holding a FHIR connectathon in Baltimore, MD (USA) as a prelude to the next HL7 Working Group Meeting, where we’ll practice interoperability using FHIR.

• 15-May-12: Updated list of FHIR Sessions at Vancouver WGM

  Here, as promised, is an updated list of FHIR Sessions here in Vancouver WGM, starting from now:

• 08-May-12: Question: Identifying the organisation of a referring provider (AS 4700.6)

  Question:

• 05-May-12: HL7 Progress Report

   

• 04-May-12: Clinical Safety Case: Email Sending Rules

  It seems like there’s been a meme running around Australian clinical circles about how the coming of e-health, and particularly the deluge of mobile apps that is just around the corner means that there needs to be good clinical safety governance. Here’s a good example:

• 02-May-12: Lifecycle of an Interface

  In the beginning, there’s a rush of excitement, and the interface is conceived.

• 02-May-12: FHIR Sessions at HL7 WGM in Vancouver

  Several people have asked me about when there will be FHIR sessions at the Vancouver Meeting.

• 30-Apr-12: Question: Interpreter Needed flag in HL7 v2

  We’ve been asked to update a patient’s “Interpreter Needed” flag across HL7 V2.x. I can see the Primary Language field as part of the PID, but cant see any reference to “Interpreter Required” in my reading of the specs. Have you come across this being sent as HL7 in your travels?

• 12-Apr-12: Kestral Computing P/L: Serious HL7 supporter

  Prior to setting up Health Intersections, I used to work for Kestral Computing P/L, the leading provider of Radiology and Pathology Information systems in Australia. A big part of Kestral’s business is Interoperability, which is how I got my first exposure to HL7.

• 03-Apr-12: Question: What are the rules around use of SUBJ relationship in CDA?

  In the following example from CCD there is an EntryRelationship has a type code of “SUBJ” However the CDA spec says the following which is only valid for OBS to OBS.

• 02-Apr-12: FHIR Licensing Update

  I’ve had a number of queries about the status of FHIR licensing. Here’s an update.

• 01-Apr-12: Question: OIDs for v2 tables

  Is there an oid for HL7V2 Tables, ideally with an extension matching the table number for each V2 table? (We have created a local one, but wonder if there is an official one.)

• 25-Mar-12: Good Specifications: Ernest Hermingway vs Leo Tolstoy

  How long should a good standard be? Just how many words should it have?

• 21-Mar-12: An implementer in the hand is worth two in the bush?

  Let’s say..

• 18-Mar-12: Does UML Tooling actually work?

  UML tooling is driving me nuts. I’m really looking for something rather simple - at least I think it should be simple. I want to be able define a class model (classes, associations, attributes, data types, cardinalities, and stereotypes and property strings), and be able to share that class model (including it’s visual layout) with other UML modeling tools. And since UML modeling tools are (supposed to be?) used by development teams, I want one that reliably supports a version control system (“reliably” appears to exclude Enterprise Architect). And it should be affordable (free or <$300ish per seat)

• 15-Mar-12: CIMI at the Crossroads

  The Clinical Information Modelling Initiative (CIMI, see here, and here) is

• 14-Mar-12: Technical Correction in Data Types R2 / ISO 21090

  According to the data types, the PostalAddressUse Enumeration is based on the code system identified by the OID 2.16.840.1.113883.5.1012. But if you look up that OID in the OID registry (or the MIF, for insiders), you see that:

• 14-Mar-12: Question: should you use Concept Ids or Description Ids in HL7 instances?

  Question:

• 09-Mar-12: Good Exchange Specifications are messy

  It’s a paradox of software code: while we all strive to produce beautifully organized code, the hallmark of code that’s actually had a lot of exposure to the real world use is that it’s messy. people have had to fix specific things that are wrong, but they’ve tried, as much as possible, to leave all the things that are known to be fit for purpose in place.

• 09-Mar-12: Authority is given, not taken

  Real authority is not something that you can take, that you can purchase, that you can steal. It’s something that other people give you freely of their own accord. There’s no other way to get it. It’s important to distinguish power from authority - power is only ever taken, and never given. The two things are closely related - having authority in a sub-group (i.e. the armed forces, or the engineering department) can help you acquire power in a wider sphere. Authority is better than power, because having authority means that people want to do what you tell them.

• 08-Mar-12: More follow up from the Senate Enquiry: Security

  h/t to Bridget Kirkham from MSIA for pointing out an amazing submission to the Senate enquiry into the pcEHR from AusCERT:

• 08-Mar-12: Data quality requirements in v3 data types are both necessary and spurious

  There’s three design features in the v3 data types that help make v3 very hard to implement. And they’re so low level, they undercut all the attempts at simplification by greenCDA, etc, and none of that stuff makes much difference.

• 02-Mar-12: Question: how to represent mobile phone numbers in HL7

  Question:

• 28-Feb-12: Good Exchange Specifications: Interoperability vs Intraoperability

  There’s two very different approaches to getting systems to exchange data.

• 26-Feb-12: Comments on the senate enquiry on the PCEHR

  Going through the recent transcript of the Australian Senate enquiry into e-health, I found this, from Vince Macaulay, spoken as a representative of the MSIA (I am also a member).

• 13-Feb-12: Whats a Good Exchange Specification?

  There’s a lot of different standards for exchanging healthcare information out there. Here’s one reason from the ever funny XKCD:

• 13-Feb-12: Good Exchange Specifications: Microsoft vs Apple

  One of the early choices you have to make in building a specification is around how to leverage your domain analysis. It’s a question of how you use your story boards. There’s the Apple way, and there’s the Microsoft way.

• 08-Feb-12: An API is just another exchange specification?

  Because the specifications for data exchange are so hard, a number of government projects around the world are focusing on releasing libraries that wrap the complexities of the standard behind a local implementation that is easier to use. At least, that’s the theory. (or, alternatively, vendors provide such libraries. sometimes, vendors provide the libraries commercially with a government subsidy).

• 07-Feb-12: Response to Critical Safety Issue for the PCEHR

  While I was on leave at Tamboon Inlet (and completely off the grid), Eric Browne made a post strongly critical of CDA on his blog:

• 19-Jan-12: FHIR Report to HL7 Architecture Co-ordination Council

  This is a written version of the report I gave to the HL7 Architecture Co-ordination Council (technically, the SAIF roll-out project), at HL7 concerning the development of the FHIR project (It has considerable similarity to the last post, made before the HL7 meeting):

• 16-Jan-12: FHIR Report for the San Antonio Meeting

  The prototype HL7 standard I am working on with a few others used to be called “RFH” (Resources for Health) but the marketing committee has now branded it “FHIR” (pronounced “Fire”, as in HL7 Fire). It can be found here.

• 16-Jan-12: Complexity of Standards

  I’m in Singapore this week, speaking at the 2011 Healthcare IT standards Conference. It’s a real pleasure to be in Singapore meeting with many people I’ve corresponded with over the years, but never met, and also exploring such a great city. In addition, I’ve had many deep and interesting discussions around how to progress either Singapore’s Healthcare system needs, or international standards (or both). Today, I spoke on sharing the experience I’ve learned over many years in my many and varied roles in HL7 and other standards contexts.

• 21-Dec-11: Health Intersections is 1 year old

  I’m back after a few days down following a hosting problem.The original host took my site down since it was occupying too much CPU time. I don’t know what the cause of that is, but we’ve taken the opportunity to migrate to a better host. I’ll be bringing the old site back piece by piece so that hopefully we can pin point the problem if there is one.

• 12-Dec-11: Everything you didn’t want to know about the GTS data type

  Of all the HL7 / ISO 21090 data types, by far the most complex is the General Timing Specification (GTS). (Aside: I usually say that CD is the most complex data type, but it’s not; it’s just that people use CD as hard as they can, where as one glance at GTS convinces almost everybody to keep things as simple as they possibly can.)

• 09-Dec-11: Question: Australian Health Information Security Requirements

  This report of a breach of personal health information has been doing the rounds lately - it’s a very well written, from a great blog, and it’s deservedly getting a lot of attention. I sent it to several contacts in Australian commercial vendors, and one of them came back to me with a question:

• 07-Dec-11: Discussion Form

  There’s been some discussion lately that there’s no real discussion forum for healthcare interoperability here in Australi. A couple of people suggested that my blog is the default place as it is - but a blog is not a good place for a community forum.

• 07-Dec-11: Australian Extensions to HL7 v2 table 0396

  HL7 v2 table 0396 is the list of known coding systems in HL7 v2. The table is very US centric, and most of the main Australian coding systems are not found in the HL7 international table 0396. Through the IT-14 sub-committees, HL7 Australia has long had the practice of extending this table, but there has been no systematic approach to doing so. We need a single list that gathers everything that is used together.

• 06-Dec-11: Question: Are v2 codes case sensitive?

  Question:

• 02-Dec-11: Question: Interoperability vs Integration

  A regular Chinese correspondent asks:

• 01-Dec-11: Data types and irrelevant features

  There’s been quite a bit of criticism of the ISO 21090 data types because they include features that aren’t relevant in every case where they are used, and it’s annoying to have to deal with the features when they don’t apply to the use case at hand. See here for an example, or the comments here, and there was more less-informed criticism of this at the CIMI meeting yesterday.

• 25-Nov-11: How to identify AMT in CDA documents and HL7 messages

  One of the more controversial subjects that came up yesterday at the HL7 Australia meeting was how to represent AMT in CDA documents, and HL7 messages. The fundamental question is whether AMT is identified as the same coding system as SNOMED-CT or not.

• 24-Nov-11: Coding System Representation in v2 messages

  At the HL7 Australia meeting today, it became clear that we need to improve the way that coding systems are represented in HL7 v2 messages.

• 23-Nov-11: Australian HL7 Meeting Tomorrow

  Tomorrow is an Australian HL7 meeting. The subject of the meeting is around using codes and identifiers in both HL7 v2 messages and CDA documents. I’ve observed these things being done badly in v2 messages across the country in many contexts, and the step up in rigour that CDA represents is proving challenging for Australian implementers. Hopefully tomorrow will help. I’m making a presentation on coding in CDA documents - the source is here.

• 20-Nov-11: Question: What content can ED contain?

  One of the most frequently asked questions is what content the V3 data type ED (“Encapsulated Data”) can contain.

• 20-Nov-11: Question: Intervals and Boundary Imprecision

  Introduction

• 16-Nov-11: Clinical Informatics Standards

  While I was in Singapore, there was a panel discussion of the degree to which clinicians need to be involved in the formation of healthcare IT standards. I was somewhat surprised to hear that the outcome of the discussion was that there is no need for clinicians to be involved in them at all.

• 13-Nov-11: Semantic Interoperability #2

  I’ve been chatting to Stephen Lynch from CSC (here in Australia) about the holy grail of healthcare interoperability, “Semantic Interoperability”, which is a follow up to this post on my blog. Stephen sent me this link:

• 06-Nov-11: Question: Titles in Names in ISO 21090

  Question:

• 04-Nov-11: Signing HL7 v2 Messages

  There’s a generic requirement to sign healthcare messages. For different people, it means different things.

• 02-Nov-11: Just what is HL7 v3?

  Quoting from Karen Dearne in The Australian:

• 01-Nov-11: XML Cowboys

  While I was in Singapore recently, I spoke about the lessons I’ve learned through my various experience in Healthcare Interoperability. Much of what I spoke about has already been posted to my blog before, but one thnig I spoke about was “XML Cowboys”, which had an unexpected resonance in Singapore.

• 01-Nov-11: Question: Can you use .zip support in ED?

  Question:

• 01-Nov-11: National Projects and Standards

  It’s something you can see all around the world: governments sponsoring large national healthcare projects of one form or another (EHRs, prescription systems, HIEs, etc), and the bodies running these projects getting very involved with international healthcare standards bodies (HL7, IHTSDO, IHE, etc) (yes, I know IHE isn’t a standards body. but everyone knows what I mean). I’m referring to ONC, Infoway, Connecting for Health, NEHTA, etc (btw, declaration: I’ve worked for nearly all of these - or still do - in their standards programs).

• 25-Oct-11: CD Question: using codes in multiple related fields

  This question comes from Singapore: how to you manage displayName, originalText, and most of all, translations, where you have multiple related and overlapping fields. This isn’t a simple question - just explaining the question is going to take quite a bit of content, let alone the answer (such that it is).

• 18-Oct-11: HL7 v3 Data types R1/R2 difference analysis

  This Data Types R1 to R2 Presentation is the presentation used for the Data Types R1 vs R2 video.

• 13-Oct-11: Bugs in the CDA Instance Editor

  The CDA Instance Editor is starting to get used for CDA validation here in Australia. As part of that use, several issues have cropped up in the CDA validator:

• 07-Oct-11: v2 to CDA Mapping: Data Types

  A couple of weeks ago, I held a v2 to CDA mapping course (See here). Overall, the course was a success - at least, that’s the feedback I had from the attendees, who left with a much deeper understanding of the problem space for mapping from HL7 v2 to CDA, and the ways to approach solutions. Several of the participants asked me if I was going to run the course again, since only some of the people in their institution could attend. Well, it depends on interest - if you’re interested, let me know.

• 24-Sep-11: Speaking in RIM grammar

  On Thursday and Friday this week, I held a a two day course teaching how to map from Australian v2 messages to Australian CDA documents. My course went a lot further than Keith’s excellent chapter in his CDA book on the subject, because the mappings were made in the presence of both v2 and CDA implementation guides (Australian Standards and NEHTA specifications). As part of the course, I tried to teach the attendees how to speak in RIM grammar - you need to, in order to map miscellaneous v2 concepts- there’s a lot of them - into the clinical statement pattern. Obviously there’s a lot of prior art about -the NEHTA specifications and more widely, the combined IHE/HL7 implementation guides and most of all the consolidated health story Implementation Guide - but it’s common to encounter data concepts that simply haven’t been mapped to any clinical statement pattern, let alone the simple one in CDA.

• 24-Sep-11: Question: how to code a prescription with "PRN"?

• 21-Sep-11: Where can I get good introductory resources for Healthcare Standards

  I am very new to the healthcare / IT and standards, but since I have changed jobs recently, now have to grasp what’s going on in terms of interoperability of healthcare systems within a rather short period of time. HL7, IHE websites are overstuffed with terminology incomprehensible for me. It left me wondering - do resources like “Healthcare interoperability for dummies” exist? Any advise (links to resources, training seminars, books, etc) on how to start digging into the field would be very appreciated, thanks!

• 21-Sep-11: Question: Illegal symbols in my CDA?

  Question: I have an xml file that gets sent to a cda.xsl in order for it to print out nicely via a web browser. The problem is that I am getting symbols like &188 (hex-BC)and &189 (hex-BD) and &190 (hex-BE) which represent fractions 1/4, 1/2, 3/4 is there a way to define this so that the browser doesn’t choke on the xml file that is created from the EMR system?

• 19-Sep-11: Question: ED.integrityCheck

  Question: When using the ED datatype with a reference to an external file (e.g. an image), does the integrityCheck attribute contain a secure hash of

• 16-Sep-11: RFH: Outcomes from San Diego meeting

  Previously, on this blog, I proposed an idea for consideration by the fresh look task force: “Resources For Healthcare”. The proposal was widely discussed here at the San Diego meeting, and many people have asked me for a report on how the discussions went. This is the report.

• 13-Sep-11: Question: What is IHMSDO and what does Resources for Health have to do with it?

  I attended your RFH session earlier today which was both rather crowded as well as informational.  In the video available at[http://www.youtube.com/user/

• 08-Sep-11: Question - should I use v2 or v3 for teleradiology

  Question:

• 06-Sep-11: How do you put tablets in PQ.units?

  This is one of the top 3 questions about the data types:

• 31-Aug-11: Question: how to use ISO 21090 with ISO 11179

  Question:

• 29-Aug-11: Question: How to code Substance Administration in CDA?

  Question:

• 26-Aug-11: Announcing a new training course: v2 -> CDA mapping

  With the various NEHTA related implementations, and the coming implementation of the pcEHR, there’s a real swell of CDA implementations around the country.

• 25-Aug-11: Question: where does IVL_TS.value come from?

  The abstract IVL type has the interval properties "low", "high", "width" and "center". So why does the IVL_TS type (the XML rendition of the abstract, in principle, statement of the IVL data type) have a value element in it - where does that come from?

• 25-Aug-11: How much should we engage with a standard?

  This morning I was on a conference call with Nicholas Oughtibridge from the NHS when he briefly outlined a series of levels at which an organisation can engage with standards. I thought his overview was highly worthwhile passing on, and with Nicholas’ permission, I share his document below. The document is shared under the UK Open Government Licence at [http://www.nationalarchives.

• 23-Aug-11: Question: Using PV1-3 ("PL: Person Location")

  Question (originally submitted to Keith Boone, but we swap when appropriate):

• 20-Aug-11: v3 has failed? Summary of comments

  My post “HL7 needs a fresh look because V3 has failed” generated a huge number of page hits (more than any other page already), and lots of comments, both private and public.

• 20-Aug-11: The Road [Not] Taken

  Just like there’s a well recognized grieving process, it seems to me that there’s a process for an organization that faces a strategic challenge.

• 20-Aug-11: HL7 needs a fresh look because V3 has failed

  A few months ago, I posted a call for input into the HL7 Fresh Look Taskforce. HL7 wouldn’t need to have a fresh look task force if it hadn’t lost it’s way, and it wouldn’t have lost it’s way if v3 hadn’t failed. But it has:

• 20-Aug-11: A comparison of v3 and RFH

  Klaus Veil asked me for a comparison of v3 and my alternative proposal (RFH), to help people understand the differences. This is a list of some of the differences.

• 18-Aug-11: Resources For Health: A Fresh Look Proposal

  The remit of the HL7 Fresh Look Taskforce is:

• 17-Aug-11: Question: v2 CX vs v3/ISO 21090 II

  The question is:

• 17-Aug-11: Question: is there a general guide for implementing CDA

  Question:

• 16-Aug-11: Question: How to store a CDA document in a relational database

   

• 16-Aug-11: Is GreenCDA the answer?

  As expected, comments to my previous post are running hot - both public and private. I’ll try and deal with some of them. Firstly, I’m going to deal with the idea that greenCDA is the answer. Robert Worden posted a comment in response to my previous post:

• 16-Aug-11: HL7 can have a fresh look because v3 succeeded

  Well, yesterday’s post about HL7 v3 failing certainly struck a nerve, particularly in private comments. One person picked up on the fact that it wasn’t the entire story. HL7 does have a Fresh Look Task Force. It has particularly notable participation: the Health IT leads for 5 or 6 national programs, some outstanding recognized individual contributors to the state of the art in health IT, and it’s met several times over the last few months (Hopefully some progress reports will come out soon). This doesn’t come from nowhere - HL7 matters: people care. HL7 is important. And that’s because v3 succeeded. And it has:

• 15-Aug-11: The XML consensus is breaking down

  It seems to me that there’s 3 distinct camps for how to solve IT problems: Objects, Documents, and Data. You might describe them differently, of course.

• 10-Aug-11: What makes Healthcare different?

  Tom Beale has picked up on a thread about what makes healthcare different (and kindly cited my earlier post on the subject).

• 10-Aug-11: The CDA Book

  I came home today after a long day at work (In Brisbane) to find a package waiting for me: Keith Boone’s “The CDA Book”. Keith was nice enough to send me a personally autographed copy as thanks for my reviewing the data types section.

• 05-Aug-11: CDA @ Health Beyond

  null

• 02-Aug-11: v2 escaping question

  When a v2 message is created, 5 characters are reserved as special separators in the syntax. The usual characters are

• 02-Aug-11: HL7 v2 FT Type

  HL7 v2 defines an FT data type, but it’s very poorly documented. Worse, the documentation is focused on managing text and cursor on a terminal screen. The basic idea of the FT data type is that you have a stream of text with a series of embedded commands such as

  This is a line.br\This is a new line

  . The

  characters mark the start and end of the content (HL7 v2 syntax) and the embedded commands begin and end with the specified escape character, which is usually “".

• 02-Aug-11: HL7 v2 FT Datatype Documentation

  null

• 01-Aug-11: Why does NEHTA use CDA?

  In a comment on an earlier post, I referred to

• 27-Jul-11: Straw Poll: Choice of a CDA packaging specification

  One of the more difficult issues facing the NEHTA CTI team is what to choose for a technical CDA packaging strategy. We need a coherent strategy because CDA documents have assorted attachments. These attachments can include things like:

• 22-Jul-11: Why do I need an HL7 license? How do I get one?

  The comments in the thread on a prior post lead to someone submitting this question:

• 21-Jul-11: v2.7 Analysis from Ringholm

  Recommended reading for V2 people:

• 21-Jul-11: Response to comments on NEHTA ETP specification by Medical Objects

  Yesterday at the HL7 Australia meeting, Jarrod Davison from Medical Objects made a presentation about the NEHTA ETP (Electronic Transfer of Prescriptions) that was highly critical of the specification.

• 20-Jul-11: Free V2 to CDA Tool Release

  Background

• 20-Jul-11: CDA Tools

  AS4700.2 V2 to CDA Generator

• 16-Jul-11: ISO 21090: Underlying design propositions #2

  This is a follow up for ISO 21090: Underlying design propositions #1

• 16-Jul-11: ISO 21090: Underlying design propositions #1

  In a previous post (see here), I promised to talk about the underlying design issues that are implicit in ISO 21090. ISO 21090 has attracted some strenuous criticism because of it’s underlying design characteristics. The primary critic is Tom Beale, though he’s not the only one.

• 16-Jul-11: Because everybody hates OIDs

  In a recent post, John Halamka says:

• 14-Jul-11: We need a standard web / sms gateway protocol

  A quick internet search (here: try this) shows that there’s hundreds of web <-> SMS gateways out there. But they are all using their own protocols, so far as I can tell - there’s no standard protocol.

• 14-Jul-11: Version 2 and character sets and encoding

  I’ve been rewriting my v2 parser and trying to make it fully conformant to the v2 specification with regard to character sets. It’s a tough problem. There’s several parts of the problem that make it tough.

• 06-Jul-11: How do I represent end of lines in text content in HL7 v2?

  This is a fairly common question because the HL7 v2 standard doesn’t actually describe how to do this explicitly. That’s because there’s several options. But first, background:

• 30-Jun-11: Not getting the Concept

  This morning I wake up to a new post from Barry Smith at HL7-Watch entitled “HL7 attempts to get things clear about its own use of the word ‘concept’”, in which he criticises HL7 for it’s definition of Concept as found in the V3 Core Principles.

• 26-Jun-11: What makes healthcare special?

  An insightful and blunt take-down of Google from Mr HISTalk:

• 19-Jun-11: Reader vs Writer

  There’s a a trade-off between reader and writer in most interoperability specifications, though it’s not always widely appreciated. What suits the reader is sometimes the exact opposite of what suits the writer.

• 15-Jun-11: If your Healthcare IT standard was a River Boat...

  I spotted this: If your programming language was a boat, and it got me thinking… what if your Healthcare IT standard was a River Boat? (A river boat is a hat tip to the old, but wrong, bridge metaphor for interoperability).

• 14-Jun-11: Fresh Look Taskforce Follow Up #1

  One of the things that people say about HL7 is that it is no longer producing specifications that are useful for implementers, that give implementers what they want.

• 14-Jun-11: Any good books about HL7?

  These are the books I recommend:

• 11-Jun-11: Useability vs reusability

  It’s an issue that runs through IT - the payoff between use and reuse. See, for instance, this paper (and also this). The problem with reusing code is that it creates multiple dependencies on a single piece of code, and changes for one functionality can break another that’s completely unrelated - and, more importantly, untested (cause tests never cover every scenario the users are going to come up with).

• 02-Jun-11: Do ADT^A11 msgs cancel/discharge all messages for an acct?

  Acct = account? And account = admission. I presume. On that basis, the definition of A11 is :

• 01-Jun-11: Repeating String Fields

  It’s a design pattern that I come across fairly often across all sorts of modeling paradigms. It’s a simple one too: a field/property/whatever that is a list of strings of no fixed content.

• 30-May-11: Moving the deck chairs around the titanic

  In a recent post, Tom Beale argued that one of the central planks of good object design is a principle he called the FOPP (fundamental ontology property principle) principle:

• 29-May-11: What are three things everyone should know about working with HL7 standards?

  I got this question through the “Ask an HL7 Question” page. Thanks Erica

• 21-May-11: Writing a book

  Several people have commented to me after reading my blog that I should write a book.

• 21-May-11: When to use GreenCDA on the wire

  GreenCDA is a general approach for using an intermediate use-case specific representation to make it easier to produce fully conformant CDA documents. As well as defining this general concept, the greenCDA specification lays down a general examplar of this approach using an intermediate modular XML form with accompanying schemas loosely based on the existing CDA implementation guide.

• 21-May-11: Healthcare is Special

  Healthcare is special. Things that work in other industries won’t work in healthcare.

• 21-May-11: Australian HL7 meeting report from Orlando

  A requirement of being part of the Australian delegation to the HL7 meeting is that we much submit a report about the meeting to Standards Australia. Then one of the delegation (Heather Grain this time) gathers all our reports into a single report and it is published on the web.

• 18-May-11: The Wreck of HL7

  A wonderful contribution from Jean-Henri Duteau:

• 17-May-11: NullFlavor

  One of the most obvious design features of HL7 v3 is that every class and data type includes the property “nullFlavor”, which provides a reason why the data is (if it has a value), missing, incomplete, or an improper value. This post is my tutorial documentation for NullFlavor.

• 17-May-11: NullFlavor follow up

  The last post explains NullFlavor. It’s not a short explanation. But incomplete data quality is like that. Half the explanation is about the problem, and half about the solution.

• 17-May-11: In which I visit Snomed-CT, and find myself in a tight place

  I’m going to assume that you, the reader, are familiar with Snomed-CT. And that you’re well aware that Snomed-CT is marketed as the premier way to achieve consistent, unambiguous, reproducible expression in medical records.

• 17-May-11: HL7 Fresh Look Task Force

  The HL7 board has authorized a new “Fresh Look” Task Force to examine the best ways we can create interoperability solutions, with no pre-conditions on what those solutions might be.   The idea is that, knowing what we now know from what has already been created within HL7 and by other groups outside of HL7, what would be our best approach to interoperability solutions?

• 16-May-11: HL7 Question: If a v3 datatype has a nullFlavor, what other properties can have a value?

  All the v3 data types include an attribute “nullFlavor. If it has a value, it indicates that the value is either missing, incomplete, or somehow invalid with regard to the rules associated with the use code.

• 14-May-11: Requirements for Interoperability

  The essence of interoperability is to get computer systems talking to each other, to get them to exchange information and make use of it. It’s just like people: they need to be able to get together, have a conversation, and understand each other. So the basic principles of interoperability are just communication theory, and it’s all about the people. In order to understand each other, people and computers need to have the follow elements:

• 14-May-11: Messages, Services, and Documents

  One of the open debates in HL7 is the difference between messages (or messaging), services, and documents. How different are they? If they differ, how? And what does that mean?

• 14-May-11: Interoperability Requirements #5: Behavioral Agreement

  With the layers we have already considered, we can exchange data, define meaning, agree how to identify things, and then build them into greater structures that define a package that moves between systems. To complete the picture, we need to define what exchanges can happen, when they happen, and how they relate to the business processes they serve (whereby “business processes” actually means clinical processes as well). These things describe the behavior of the systems.

• 14-May-11: Does anybody out there love the RIM?

  The most remarkable aspect about the wide feedback I’ve received about the HL7 Fresh Look taskforce is the comments about the RIM.

• 14-May-11: Context of Interoperability (2)

  Charlie Mead sent me this, from the NCI CBIIT Enterprise Service Specification Team, since it’s quite relevant to several of my posts.

• 12-May-11: SAIF

  Several people have asked me both in the comments and in private comunications to comments on SAIF (link to wikipedia - and source), and how it relates to what I’m writing. And I suppose that since my name is on it, I better make some comment.

• 12-May-11: Interoperability Requirements #6: Common Understanding

  Finally, in order to be able to exchange data, two systems (or the people responsible for making them exchange data) need to share a common understanding about a number of other things, things that are taken for granted by the participants, an agreed context of operations.

• 12-May-11: HL7 here we come!

  null

• 10-May-11: Microsoft, Skype, and Bad metaphors for Interoperability

  So Microsoft is going to buy Skype for 8.5 billion. Wow. Of course, that’s 8.5 billion of today’s US dollar, which is worth a whole lot less than it used to be a few years back. Still, that’s a lot of money. A whole lot more than Australia is spending on an whole new EHR system.

• 07-May-11: Interoperability Requirements #4: Information Structures

  Given an agreed way to exchange data, clearly defined concepts of meaning, and common ground for how to identify entities, systems are able to exchange meaningful data. But what data? What do the systems say to each other? Some structure is required that assembles these things into meaningful packets of information so that business functionality can be implemented. Continuing the language comparison, this is equivalent to grammar and structures such as lists and paragraphs.

• 05-May-11: RIM Diagram

  For reasons I don’t properly understand, HL7 publishes a crude low resolution diagram of the RIM backbone classes. It appears that a better resolution version doesn’t exist. So here’s one I made myself.

• 05-May-11: Enhanced CDA Diagram

  When Sarah Gaunt, who works on CDA specifications at NEHTA, first started working on CDA, she made this diagram. It’s the standard CDA viso diagram, with markup on the diagram to show which attributes are fixed, and required or optional (you can’t otherwise tell from the diagram).

• 04-May-11: Interoperability Requirements #3: Identification Policies

  As well as agreed meaning for concepts, if we are to exchange information about things, we have to be able to identify things. You can’t have any useful interoperability talking about “some patient” being admitted to “some hospital by some Doctor” (well, politicians try to do it). You have to identify them in some systematic way.

• 04-May-11: Interoperability Requirements #2: Common Terminology

  In order for people to understand each other, not only must they be able to exchange words with each other, they must agree about what they mean. In the context of natural language, dictionaries define the agreed meanings of the words that we use. In the same way, two information systems exchanging information need underlying formal definitions on which they can depend to use the information. The systems that define these meanings are referred to variously as “Terminologies”, “Vocabularies”, “Code Systems”, “Classifications”, “Semantic Webs”, and “Ontologies”, though a whole lot of other words are also used. None of these words have quite the same meaning; for simplicity, this book will use “terminology” as a general descriptor for structured definitions of meanings.

• 03-May-11: Limbo

  The essence of interoperability is to get computer systems talking to each other, to get them to exchange information and make use of it. It’s just like people: they need to be able to get together, have a conversation, and understand each other. So the basic principles of interoperability are just communication theory, and it’s all about the people. In order to understand each other, people and computers need to have the follow elements:

• 03-May-11: Interoperability Requirements #1: Transmission of Data

  In order to communicate, healthcare systems must exchange data through some transmission channel. The basic requirements are simple: it must be possible to move a sequence of bytes from one computer to the other, and the bytes need to encode some higher level of meaning (“format”) that can be extracted. In general, there needs to be some framing protocol so that the start and end of the sequence can be recognized, and sequence needs to be correctly maintained. If the conversation between the computers is bi-directional, the transfer of the sequence of bytes must be di-directional too.

• 02-May-11: We dont need no Semantic Interoperability

  What we need in healthcare is “Semantic Interoperability”. That’ll solve all our problems. That’s what they all say (here’s the most recent case).

• 01-May-11: Taking a fresh look at the community

  A couple of private emails I’ve received suggest that my take on the Fresh Look task force is ducking the real issue, that I’m not thinking wide enough. The real issue, they say, is that

• 01-May-11: Design by Constraint – not as useful as people think (#4)

  This post is the last part of the Design by Constraint series (first post)

• 01-May-11: Design by Constraint – not as useful as people think (#3)

  This post is part of the Design by Constraint series (first post)

• 30-Apr-11: Design by Constraint - not as useful as people think (#2)

  This post is part of the Design by Constraint series (first post)

• 30-Apr-11: Design by Constraint - not as useful as people think (#1)

  Design by Constraint is  a framework pattern used in a number of specifications across healthcare, including a number of high profile standards. It’s a great way to deal with the problem of ensuring semantic consistency in a large information design, but the engineering outcomes are rather less than optimal.

• 30-Apr-11: Context of Interoperability

  Interoperability Law #1 says that Interoperability is all about the people.

• 29-Apr-11: Can we enforce Healthcare Interoperability standards by law?

  Professor Jon Patrick says:

• 27-Apr-11: CDA Stylesheet Control

  We’ve been having a rather intense debate within NEHTA about stylesheet control with a CDA implementation community.

• 26-Apr-11: My iPhone has a life of its own

  So the latest news is that your iPhone tracks your location, and you can use this to get a view of where you’ve been. So of course, I had to have a look, and here’s my map - where I’ve been in the state of Victoria recently:

• 23-Apr-11: The 3 laws of Interoperability

  1. Interoperability: it’s all about the people

• 23-Apr-11: Law #3: Healthcare Software: Cheap, Flexible, Interoperable – you can have any two

  Healthcare software is expensive. Always much more expensive than people want it to be. But there’s some aspects of this that a lot of people don’t understand.

• 09-Apr-11: Law #2: Complexity: you can move it around, or externalize it, but you can’t make it go away

  Healthcare Interoperability projects are complex; they are made up of lots of people and a great number of data items, each with their own complexity, and usually with subtle interactions between the data, the business processes, and the people involved. Generally, the complexity arises from three different sources:

• 09-Apr-11: Law #1: Interoperability: it’s all about the people

  In the ancient pre-history of Healthcare Interoperability (the early 90’s), it was actually hard to get two different systems to exchange bytes with each other. It often required arcane and black magic with serial cables, little black boxes with blinking lights, and weird operating system drivers and commands. If you wanted two different systems to exchange data, it was a major project to get them talking – and you got them talking before you invested in doing anything with the data, in case the whole thing failed at that point. And you kept the data as simple as possible, because the whole thing was likely to blow up in your face anyway.

• 28-Mar-11: HL7 standards V2 vs V3: a letter to "S"

  So, though a long process I don’t care to think too much about, I got dragged into a discussion with an anonymous HL7 member (“S”) over on Barry Smith’s HL7 Watch blog. It’s hard to engage with someone you know anonymously, and then the discussion suddenly (and unexpectedly) broke out into useful content. But it was getting unwieldy responding through Barry’s blog, so I chose to make a longer response here.

• 09-Mar-11: When to Profile ISO 21090

  This post is a follow up to discussion in an Australian Standards Committee (IT-14) yesterday over whether Australia should profile ISO 21090 for use in Australia

• 31-Jan-11: ISO 21090 FDIS approved

  ISO 21090, “Healthcare Data Types” has passed the final ballot cycle (known as FDIS - Final Draft Information Standard). It’s been a long 8 year saga since Charlie McCay and I first imagined it, and realised that the long stand-off between CEN/ISO and HL7 regarding data types could be resolved.