Interoperability standards are a key component to opening up NHS Wales architecture. Making the way we interact with our systems consistent and standardised can improve information standards and the quality of information in systems used across the NHS in Wales. It will make integration of systems easier and better understood and by publishing national standards help develop a truly open platform for Wales. HL7 FHIR is a big part of this.
The Welsh Government’s (WG) Digital Architecture Review set out the need to create an open digital architecture, utilising and implementing open standards to allow greater interoperability between health and care organisations. This sentiment is echoed in “A Healthier Wales”, the Welsh Government strategy for health and are which states the need to:
“Develop an ‘open platform’ approach to digital innovation, through publishing national standards for how software and technologies work together, and how external partners can work with the national digital platform and national data resource.”
The Digital Health Ecosystem Wales (DHEW) and National Data Resource (NDR) programmes are working to help open up the NHS Wales technical architecture to other Welsh health and care organisations, as well as partners in the public and private sector. We are doing this by engaging with industry and through the Beta NHS Wales Developer Portal to help healthcare providers understand both existing NHS Wales APIs (Application Programming Interfaces, the gateways that define how IT systems interact) and promote the development of new FHIR APIs.
The NDR aims to enhance data sharing across Wales and beyond by creating a more collaborative or standardised approach. Creating and using FHIR APIs that will use nationally agreed data standards will enable the seamless sharing of health and care information between interoperable systems.
Mark Frayne is Assistant Chief Architect on the NDR programme and previously worked in the DHEW team. Mark’s role is to translate the objectives of the NDR programme into a technical strategy for interoperability and FHIR data standards.
On his role he said:
“My role surrounds interoperability. The NDR programme is all about making better use of data to support patients and systems - not just secondary and primary care, but also social care and others, to enable us to link all that data together.
“We have lots of data on patients that exist in many different systems. It is often difficult to get information from all those systems to give a joined-up picture of the patients’ health data and social care data.”
So why FHIR?
When looking at interoperability we need to appreciate how important it is to have a standard approach to how health care systems can speak to each other. FHIR is a standard for healthcare data exchange, giving a structure and framework for information common in a healthcare setting - a common language which enables healthcare applications to speak to each other.
FHIR solutions are built on a set of modular components called resources, such as Patient, Organisation or Practitioner. These resources can easily be assembled into working systems that solve real world clinical and administrative problems. Other benefits in using FHIR include it being developer- friendly and has a specification that's free to use. It supports restful architecture for easier integration development which results in less effort to on-board new systems. The use of FHIR resources give many benefits as well - resource data can be sent into FHIR APIs as interconnected grouped ‘bundles’ or as individual resources.
Another benefit of FHIR is the ability to use Profiles. Although by default a FHIR resource will have common values that can be saved (for example, a Patient has a gender and name) you can also set (through Profiles) limitations, extensions and localised standards for resources.
The NDR team are collaborating with NHS Digital to create a set of FHIR standards across the UK. The programme, known as UKCore, has been led by NHS Digital teams in England, with the NDR team taking an active role in contributing to these UK national standards for FHIR.
“If we adopt a set of FHIR profiles, they will formalise the use of FHIR in the UK and Wales, so it’s important that all those stakeholders are engaged in defining those standards.
“It’s essential that, organisations can feel involved, and that their knowledge and understanding is considered.”
The DHEW team have already developed a series of experimental APIs which can be viewed through the NHS Wales Developer Portal. These have been created to demonstrate how NHS data could be made available via FHIR APIs and helped inform our understanding of how we can progress FHIR standards in Wales. Next steps are for the NDR and the Ecosystem teams to look at how open standards can be set for using FHIR in Wales as well as how FHIR APIs can be taken to production. This will take the team in two directions – the Interoperability Standards Working Group and the NDR work with the Yorks and Humber Care Record.
Interoperability Standards Working Group (ISWG)
To help solidify what the interoperable standards for Wales should be, the ISWG has been formed with representatives from Health Boards, key stakeholders and members of NDR & Ecosystem Teams. The initial focus is on standardising FHIR resources for Wales. Already discussed and approved have been some of the foundational rules and conventions for the use of FHIR in Wales – such as naming conventions for Wales’ value sets and code systems so that they can be published in a reliable and consistent manner. The group is also focusing on the data standards around migration of Organisational Reference Data to FHIR. Reference data is a crucial element and building block in the FHIR strategy and development.
Yorkshire and Humber Care Record (YHCR)
The NDR architects have also analysed the innovative work undertaken by the YHCR, which has successfully developed and implemented its own set of standards and is recognised as a leader in interoperability in the industry.
Mark Frayne added:
"In formulating the strategy, our remit is to look at other organisations with similar challenges facing healthcare organisations in Wales. We have been engaging with YHCR, which is a leader in the field of interoperability and their implementation is very impressive. If we could mirror that knowledge and expertise we will benefit greatly from those collaborations.”
The proposal, to implement the same architecture from YHCR into NHS Wales system, was agreed and the proof of concept is being developed.
The role of the interoperability standards is crucial in linking up systems and data, both for the use by systems providing direct care, and by the systems of analysis that the NDR programme is seeking to provide. Previously, data standards have been mainly applied to the data that is exported from clinical and administrative systems into data warehouse and clinical audit data collections. This often results converting or mapping data in order to meet these standards and is a time consuming and difficult task.
It’s important we implement information standards across the NHS in Wales. By the use of FHIR and FHIR profiles we can ensure that when data is sent between systems information standards are adhered to and implemented. The ultimate aim is always to ensure the best possible patient care, Streamlining and unifying healthcare data via the use of FHIR standards is one way of contributing to this aim.