The audience of this document are internal NHS Digital programmes and external INTEROPen stakeholders and implementation sites using CareConnect FHIR specifications. It is assumed that the reader has a basic understanding of HL7 FHIR.
What is FHIR curation?
FHIR Curation is a clinical and technical assurance process, where a team of subject matter experts map use case specific clinical information models, for example, allergies and adverse reactions in the e-discharge summary, to HL7 international FHIR resources.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 this mapping process, a variety of decision are made, 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 used to then build UK specific FHIR profiles, called CareConnect profiles.
The INTEROPen board has agreed the following definitions for UK CareConnect Level 2 and Level 3 profiles. Level 2 profiles are UK “parent” or “core” profiles. Level 3 profiles are use case specific e.g. problem lists for inpatient discharge summaries.
Based on these definitions, there are two separate DDMs:
- The Level 2 DDM documents how the international FHIR profiles have been modified for use in the UK, thus creating the UK CareConnect Level 2 profiles.
- The Level 3 DDM documents which Level 2 CareConnect FHIR profiles and their elements are needed to support the particular clinical use case in question. Depending on the Use Case, new Level 3 profiles maybe required and/ or implementation guidance is issued to describe how existing Level 2 profiles should be used to support the Use Case.
Further guidance on DDMs is available here.
The INTEROPen CareConnect Level 2 CareConnect profiles are published on the HL7 UK FHIR server and there are separate CareConnect Level 3 profiles for national services, such as GPConnect and the Transfer of Care initiative.
Why do we need it?
- The curation process will produce 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.
- Supports consistency in the FHIR profiles and the value sets used; this supports interoperability
- Create a working group of clinicians, clinical informaticians, technical modellers , terminologists, clinical safety and vendors working together and sharing and best practice.
How long has it been going on for?
The curation process for FHIR STU3 started in November 2017 and completed in March 2018 for 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 process curated 15 CareConnet FHIR profiles in 5 months at an average of 3 profiles/month. A lesson learnt 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.
Lesson learnt presentation available here
Full feedback results available here
NHS Digital Recognition Award submission
The process was updated based on the feedback above. The updated process was used to curate Digital medicines, Reasonable adjustments
How does it work?
It is recommended that the INTEROPen curation process is changed as below to reflect end to end process and lessons learned till date:
- Include suppliers/First of Type sites representatives in the core team, the suppliers who have plans of immediate implementation will be given priority.
- The scope of the process to include uplifting of profiles and publication of specifications in a single sprint.
- INTEROPen supplier consultation as a single call instead of Introduction and approval calls as the number of review comments on the DDM are minimal between calls and most of the discussion is on the call itself. This will also give more time to core team to prepare for the INTEROPen call.
- Clinical safety to have a dedicated call at the end of the sprint to cover clinical safety hazard log and clinical safety report. This will mean clinical safety resources will not need to attend all the calls.
The revised process has three phases (see figure 1). The first phase involves creating a first draft of mapping by a core curation team which is presented to the INTEROPen community in a single consultation call/workshop (Phase 2). This is followed by review of published profiles and review of implementation guidance for the alpha specification which is published at the end of the spirit.
Figure 1- FHIR Curation Process
Several FHIR profiles can be bundled up together for a use case, but in some cases for complex information models or use cases, for example medications, it might take upto 3 weeks to curate one profile. The average throughput with current resources is expected to be around 2.5 profiles per month.
The table below describes a template schedule of engagement activity with the INTEROPen community.
|Use case or Information model phases|
|Core team review (mappings)||Week1|
|Consultation week||Week 2|
|Review profiles/specifications||Week 3|
|Publish alpha specifications||Week 4|
What are the key inputs and outputs?
The inputs to the curation process require the team which requires a curated FHIR profile map to 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 will need to commit its resources to attend core curation team calls, Mondays (1130-1430) and wednesdays (1300-1500) and INTEROPen community curation call on fridays (930-1130). 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.
The outputs of the curation process 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
- Published level 2 and level 3 profiles
- Published alpha specifications
How do we get involved?
If you would like to get involved in the FHIR curation, please email FHIRcuration@nhs.net
Previous iteration of the FHIR Curation Guide is available here: http://www.interopen.org/2018/07/05/fhir-curation-guide/