Rationale

The Standards and Interoperability Lab – Asia (SIL-Asia) was established by the Asia eHealth Information Network (www.aehin.org) in 2017 with support from the Asian Development Bank to serve the interoperability needs of countries in the Asia Pacific region.

Specifically, the lab was established to provide technical support to countries in their digital health implementations. The technical support includes capacity development, project collaborations, creation of knowledge materials, and building of communities of practice.

Today, Health Level Seven International – Fast Healthcare Interoperability Resources (HL7-FHIR) is the emerging standard in health data exchange and sharing. HL7-FHIR uses the power of the web to exchange data across disparate platforms and technologies. Health Information Exchanges, Hospitals Information Systems, and even large tech companies, such as Google and Apple, are using HL7-FHIR in handling health data. Google Healthcare provides Application Programming Interfaces (APIs) that can be accessed by EMRs to share data with web applications (and vice versa). One of the standards being used is HL7 FHIR. Apple uses HL7 FHIR to connect the Apple Health App to various EMRs/EHRs and even wearables such as the Apple Watch.  

Because of the ease of using it, FHIR has driven the development of more health-related applications, outside of the traditional Electronic Medical Records (EMRs) or Electronic Health Records (EHRs) This includes the development of mobile applications or applications based on wearables. HL7-FHIR leverages the use of APIs to improve access to health data being used by different EMRs. Countries around the world, like the United States, Netherlands, and in Asia (Viet Nam, Philippines) are adopting HL7-FHIR to be the baseline standard of their respective health information exchanges. 

The goal of this workshop is to provide an overview of HL7-FHIR to digital health practitioners in the region. Specifically, the workshop aims to show how HL7-FHIR as a standard can be implemented in national digital health programs. This workshop is being organized by the Standards and Interoperability Lab – Asia (SIL-Asia), which has been established by the Asia eHealth Information Network (AeHIN) and the Asian Development Bank (ADB) as a shared resource in the Asia Pacific Region for capacity building on health standards and interoperability. The lab has been established to provide technical assistance to countries as they develop their digital health infrastructure.

Benefits of using HL7 FHIR

1. FHIR is based on web standards technologies. This means that any web-based application can easily integrate with FHIR.
2. FHIR already has a built-in server with an internal database. Implementers only need to create interfaces with the server.
3. -FHIR provides a plug-and play mechanism for EMRs
4. There are multiple implementation libraries to kickstart development
5. Specification is free to use
6. Follows 80 – 20 rule

Training Information

In the three-day workshop on HL7-FHIR, plenary sessions will be held by invited speakers. Since it is expected to have participants with different backgrounds and levels of knowledge on HL7-FHIR, parallel workshops will also be conducted to ensure that attendees will be able to participate in areas where they are most interested. Finally, the workshop will culminate through a design thinking session. This session aims to identify key workflows or use cases where HL7-FHIR will provide the most value. Participants will be requested to prepare use cases before the workshop (in discussion with program managers and policy makers in their respective countries) to provide the most value to their health systems.

Learning Outcomes

At the end of this three-day workshop, participants should be able to:

1. Appreciate HL7-FHIR as a standard in comparison with other HL7 standards;
2. Perform Create, Read, Update, Delete (CRUD) Operations on a FHIR server;
3. Model health-related workflows and health-related forms using FHIR resources;
4. Implement a FHIR server; and
5. Identify workflows where FHIR can provide value to the countries’ health sector.

Participants

The expected total number of participants will be 30 – 40. Expected invitees are from Sri Lanka, Thailand, Malaysia, Viet Nam, Myanmar, Indonesia, Taipei-China, and the Philippines. The program is expected to benefit digital health implementers (both those with experience using FHIR and those that are new to FHIR), policy makers, and health practitioners/clinicians. There will be parallel sessions to ensure that participants may be able to attend an area that will benefit them. An ideation workshop will be done towards the end of the workshop to identify workflows/specific projects where FHIR can be used in countries.

Parallel Sessions

• Modelling in FHIR – This session will focus on how clinical stories can be modelled using FHIR resources. This session will have impact for clinicians as they will see how the usual clinical workflows are processed by FHIR.
• CRUD + Search on FHIR – This is a beginners session on how FHIR can be used using standard web tools. This is an introductory session and participants don’t need any programming background to participate in this session.
• Smart on FHIR/SmileCDR – This is for advanced FHIR programmers. In this session, the group will look into the latest innovations that’s centered on HL7 FHIR. Participants are expected to have a working knowledge on HL7 FHIR.
• Applying the Digital Health Impact Framework on HL7 FHIR Adoption– This session is mostly for policy makers. The goal of this session is to develop a business case on why an interoperability standard such as HL7 FHIR should be adopted. The DHIF process developed with support from SILA will be utilized. 
• Creating a simple web application with a FHIR server (with CRUD + SEARCH) – This session is a continuation of the earlier introductory workshop. In this session, participants will be working on a simple web application that will utilize HL7 FHIR techniques in sharing, editing, viewing health data. Prerequisite: Knowledge in php programming
• Integrating FHIR with Health Information Systems (OpenIMIS, OpenMRS, DHIS2) – In this session, various technical experts will discuss how HL7 FHIR was integrated with the respective health information systems. 

Lead Trainers

• Philip Christian Zuniga
• Rose Ann Zuniga
• Raymond Sarmiento
• James Agnew
• Joanne Mendoza 
• Ada Angeli Cariaga

Expected Outputs

1. Survey of HL7 FHIR Use in the Region
2. Learning Materials
3. FHIR Use Cases
   

Program

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