[%settitle EHR System Functional Model Map%] [%file newheader%] [%file newnavbar%]
Appendix: HL7 EHR System Functional Model and FHIR
| Responsible Owner: [[%wgt ehr%]]([%wg ehr%]) Work Group | Standards Status:Informative |
|---|
ISO/HL7 10781 EHR System Functional Model Release 2 provides a reference list of functions that may be present in an Electronic Health Record System. While FHIR is an implementation focused on exchange of information in healthcare, this often happens in the context of an EHR system and EHR record. This table briefly describes one way that FHIR can be used to meet the requirements described in the EHR-S FM and is provided to help readers of the FHIR specification understand how FHIR can be used. There are many other equally valid ways to implement the EHR-S FM and to make use of FHIR.
| EHR Function | FHIR Implementation Notes |
|---|---|
| TI.1 | Security |
| TI.1.1 | Entity Authentication |
| TI.1.2 | Entity Authorization |
| TI.1.3 | Entity Access Control |
| TI.1.4 | Patient Access Management |
| TI.1.5 | Non-Repudiation |
| TI.1.6 | Secure Data Exchange |
| TI.1.7 | Secure Data Routing |
| RI.1.1.4 | Information Attestation |
| TI.1.8 | Patient Privacy and Confidentiality |
| RI.1.1 | Health Record Information and Management |
| RI.1.22 | Data Retention, Availability and Destruction |
| RI.1.1.x.1 | Auditable Records |
| RI.2 | Synchronization |
| RI.1.1.13 | Extraction of Health Record Information |
| RI.1.1.1 | Store and Manage Health Record Information |
| RI.1.2.1 | Manage Structured and Unstructured Health Record Information |
| TI.3 | Registry and Directory Services |
| TI.4 | Standard Terminologies and Terminology Services |
| TI.5 | Standards-based Interoperability |
| TI.5.1 | Interchange Standards |
| TI.5.2 | Interchange Standards Versioning and Maintenance |
| TI.5.3 | Standards-based Application Integration |
| TI.5.4 | Interchange Agreements |
| TI.6 | Business Rules Management |
| TI.7 | Workflow Management |
The EHR system functional model describes several modes for interaction between systems. Each of these can be implemented in several different ways using FHIR
| Interaction Modes | FHIR Options |
|---|---|
| Unsolicited Notifications <br/> e.g., a patient has arrived for a clinic appointment |
- Create/update new resource via HTTP
- Push resources using Bundle
- Send FHIR Message (if appropriate event is defined)
| | Query/Response <br/> e.g., Is Adam Everyman known to the system? Yes, MRN is 12345678. |
- Search with parameters
- A query message (though not defined yet)
| | Service Request and Response <br/> e.g., Laboratory Order for Fasting Blood Sugar and a response containing the results of the test. | Could be supported either through Messaging or SOA solutions. Request/Response support is not yet defined | | Information Interchange between organizations (e.g., in a RHIO, or in a National Health System) |
- Pub/sub using bundles (push or pull)
- RESTful interface
- FHIR messaging
| | Structured / Unstructured clinical document, e.g., dictated surgical note | See the Documents |
The combination of a properly secured and managed FHIR server, along with enforced use of the AuditEvent and Provenance resources ensures that the core record management functions defined in the EHR-S FM are met (as follows). See the FHIR Record Lifecycle Event Implementation Guide for additional details.
- Lifespan/Lifecycle tracking, including capturing source, origination and authorship information, along with tracking of views and exchanges
- Attestation for accuracy and completeness, along with digital signature
- A full version history with content retention
- Retention and persistence
Additional functionality, not currently defined in FHIR, is required to ensure non-repudiation, access control, and consent tracking.
[%file newfooter%]