The following post is intended for readers with a basic understanding of HL7 FHIR. If you would like to find out more about FHIR, you may enjoy watching our playlists on the INTEROP SUMMIT YouTube channel.

What is FHIR curation?
FHIR Curation is a clinical and technical assurance process, where a team of subject matter experts (the INTEROPen Community Curation Team) maps use case specific clinical information models to HL7 international FHIR resources, for example, mapping allergies and adverse reactions in the e-discharge summary. This mapping produces a “profile” of the international resource. The mapping, or profiling process, occurs as a project within the INTEROPen community. The current curation process is working on FHIR STU3 version.

During the mapping process, the curation team has to make a number of decisions, for example, the use of appropriate terminology bindings, such as SNOMED CT. These mapping decisions are recorded in the Design Decision Matrices (DDMs) which are then used to build UK specific FHIR profiles, called CareConnect profiles.

The INTEROPen board has agreed the definitions for UK CareConnect Level 2 and Level 3 profiles. Parent profiles (Level 2) and use case specific profiles (Level 3) e.g. problem lists for inpatient discharge summaries, are produced to support information exchange.

 Level 2 CareConnect profiles can be found on the HL7 UK FHIR server

Currently, NHS Digital is using the INTEROPen curation process to develop CareConnect Level 3 profiles for national services, such as GPConnect and the Transfer of Care initiative.

 Level 3 CareConnect profiles under development can be found on the API Hub


Why do we need FHIR curation?

  • The curation process produces a FHIR profile that is fit for purpose as it has had clinical, terminology, technical and vendor input.
  • It helps those who will be implementing the headings understand the rationale and details behind the content. It also challenges the clinical requirements where they are insufficiently detailed, resulting in a more robust definition.
  • It supports consistency in the FHIR profiles and the value sets used; this supports interoperability.
  • It creates a context where clinicians, clinical informaticians, technical modellers, terminologists, clinical safety experts and suppliers of IT software are working together and sharing and best practice.

How long does FHIR curation take?
It depends. The curation process for FHIR STU3 started in November 2017 and, in March 2018, completed its work on the Transfer of Care and GP Connect use cases. The four Transfer of Care use cases covered were:

  • Inpatient discharge summary
  • Mental health discharge summary
  • Emergency care discharge summary
  • Outpatient letters

The team followed this process to curate 15 CareConnet FHIR profiles in 5 months at an average of 3 profiles/month. Several FHIR profiles can be bundled together for a use case but, in the case of more complex information models or use cases, for example medications, it might take up to 3 weeks to curate one profile. The average throughput with current human resources is expected to be around 2.5 profiles per month.


Curating the curation process

A “Lessons Learned” survey and webex was held in March 2018 which recommended that the FHIR curation is set up as a Business As Usual(BAU) service with a revised and improved process based on the feedback, including a maintenance function.


How does it work?
The revised process has three phases (see Figure 1):

  1. The Core Curation Team creates a first draft of mapping which is presented to the INTEROPen community in an introductory webex or workshop.
  2. There is a review period of 10 elapsed days during which INTEROPen community members can comment on the draft FHIR mapping.
  3. Following the review period, the INTEROPen Community Curation Team discuss and seek agreement on key comments during an Approval Call.

The methodology has received a Clinical Authority to Release certificate from the NHS Digital Clinical Safety Team. The safety care case is available here. The Hazard Log is here.

Figure 1- FHIR Curation Process

 

The table below provides a template schedule of engagement activity with the INTEROPen community:

Use Case or Information Model Phases

INTEROPen Community Curation Webex Timetable

Introduction (Phase 1)  

Week 1 (Friday webex)

Review period (Phase 2)

Week 2 (No webex)

Approval (Phase 3)

Week 3  (Friday webex)

Introduction (Phase 1)

Week 4 (Friday webex)

Review period (Phase 2)

Week 5 (No webex)

Approval (Phase 3)

Week 6 (Friday webex)

 

What are the key inputs and outputs?
The team which requires a curated FHIR profile map must provide an introduction of their project to the Core Curation Team for the work to begin.

Example inputs are:

  • Strategic Overview
  • Use Cases, including description of clinical workflows and key interactions
  • Clinically assured (e.g. PRSB) Information models/datasets
  • Patient journeys with example clinical content
  • Architecture  overview
  • Initial list of FHIR resources for use cases
  • Initial plan including deployment approach
  • List of engaged vendors and First of Type sites

The team must commit to attending Core Curation Team calls, Mondays (11.30 – 14.30) and Wednesdays (13.00 – 15.00) and INTEROPen Community Curation Calls on Fridays (09.30 – 11.30). The team must provide their own Clinical Lead to own and sign off the final curation products. It is recommended that other programme resources e.g. Business Analyst, Project Manager and Technical Architect, also join both Core Curation Team and INTEROPen community calls. The slots for curation calls are fixed and can’t be changed to ensure availability of the Core Team and INTEROPen community attendees.

Example outputs are:

  • Level 2 CareConnect profile DDM with agreed design decisions/actions (e.g. FHIR extensions, cardinality restrictions, etc.)
  • Level 3 CareConnect profile DDM with use case specific decisions/actions  
  • Agreed SNOMED CT/dm+d value sets/refsets
  • Implementation guidance
  • Changes in the proposed information models

The curation process does not actually create the FHIR profiles; these are delivered currently by the NHS Digital Data Standards team separately, who apply the design changes recorded in the DDMs and publish these “curated” CareConnect profiles online. This is followed by development of FHIR APIs or message specifications by the messaging team to assemble the curated profiles for publication.

How can I get involved?
If you would like to get involved in the FHIR curation, please email FHIRcuration@nhs.net or check out the STU3 Profile Curation forum on Ryver 

FHIR Curation Guide

2 thoughts on “FHIR Curation Guide

  • 24th August 2018 at 13:17
    Permalink

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    Reply
    • 12th November 2018 at 08:52
      Permalink

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      Reply

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