FHIR Engine: Using FHIR to Manage Events in Child Health

Philip Graham, Digital Programme Lead for the Lancashire and South Cumbria Sustainability and Transformation Partnership attended the May 2018 INTEROPen Board to present a paper on a prototype Events Management Service (EMS) which he and his team have been developing. This service allows systems that capture clinical data, such as maternity, GP, health visiting, school nursing, A&E, etc. to publish or send events in real-time to a middleware service, the EMS.

The events captured represent small discrete parts of a full clinical record, such as an immunisation, that need to be proactively shared. Systems that have a legitimate need to receive events create subscriptions on the EMS that indicate the events they are interested in. These could be based on NHS number, or geographical location (child’s postcode as recorded on PDS is within Lancs geographical footprint), or provider association (registered with a particular Lancs GP). When the EMS receives an event it matches it to all relevant subscriptions and sends it, again in real-time, to the subscribers.

This interoperability pattern is useful for clinical pathways where it is difficult to be deterministic about who you need to share data with or where there are many parties you want to share the same bit of data with. It is particularly relevant to child health, but is also applicable to many other health domains. That is why the EMS has been designed as a generic capability, it is not specific to child health.

Since May, Lancashire and South Cumbria STP has developed a Technical Implementation Guide (see preview) and would like to share this webex demonstration of the system in action:

In Lancashire, the eRedbook is creating a subscription for the NHS number for the child the red book is about. It then receives any events associated with that NHS number from the EMS.

NHS Digital are also developing a national EMS which could be used locally as an alternative to a regionally deployed EMS or in conjunction with one. We are working closely with Lancs to ensure EMS, national and local, become plug and play commodity interop. capabilities.

The events themselves are modelled in FHIR. These are based on the PRSB Healthy Child Record standard which was produced through extensive clinical consultation and contain not just the usual PRSB record headings, but detailed logical data models.

The PRSB standard was used by NHS Digital to provide a set of alpha FHIR Event specs based on DSTU2 last year are here.

Based on feedback from Lancashire and the associated suppliers, Philip and his team have been using this set of recently -released beta FHIR Event specs, based on DSTU3, for the prototype. These FHIR profiles are going through the formal INTEROPen curation process.

Phil and his team are hoping to move to the development of a live operational service by the end of 2018, using the beta specs as the starting point. Their First of Type experience will feed useful information back to NHS Digital on the beta specs, which they hope will allow them to be uplifted to Release Candidate and then to go Live as soon as possible.


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