INSERM UMR 1138, Equipe 22, Centre de Recherche des Cordeliers, Universités Paris 5 et 6, Paris, France.
Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.
BMC Med Inform Decis Mak. 2017 Aug 14;17(1):120. doi: 10.1186/s12911-017-0513-6.
Standards and technical specifications have been developed to define how the information contained in Electronic Health Records (EHRs) should be structured, semantically described, and communicated. Current trends rely on differentiating the representation of data instances from the definition of clinical information models. The dual model approach, which combines a reference model (RM) and a clinical information model (CIM), sets in practice this software design pattern. The most recent initiative, proposed by HL7, is called Fast Health Interoperability Resources (FHIR). The aim of our study was to investigate the feasibility of applying the FHIR standard to modeling and exposing EHR data of the Georges Pompidou European Hospital (HEGP) integrating biology and the bedside (i2b2) clinical data warehouse (CDW).
We implemented a FHIR server over i2b2 to expose EHR data in relation with five FHIR resources: DiagnosisReport, MedicationOrder, Patient, Encounter, and Medication. The architecture of the server combines a Data Access Object design pattern and FHIR resource providers, implemented using the Java HAPI FHIR API. Two types of queries were tested: query type #1 requests the server to display DiagnosticReport resources, for which the diagnosis code is equal to a given ICD-10 code. A total of 80 DiagnosticReport resources, corresponding to 36 patients, were displayed. Query type #2, requests the server to display MedicationOrder, for which the FHIR Medication identification code is equal to a given code expressed in a French coding system. A total of 503 MedicationOrder resources, corresponding to 290 patients, were displayed. Results were validated by manually comparing the results of each request to the results displayed by an ad-hoc SQL query.
We showed the feasibility of implementing a Java layer over the i2b2 database model to expose data of the CDW as a set of FHIR resources. An important part of this work was the structural and semantic mapping between the i2b2 model and the FHIR RM. To accomplish this, developers must manually browse the specifications of the FHIR standard. Our source code is freely available and can be adapted for use in other i2b2 sites.
已经制定了标准和技术规范，以定义电子健康记录 (EHR) 中包含的信息应如何进行结构化、语义描述和通信。当前的趋势依赖于区分数据实例的表示和临床信息模型的定义。双模型方法结合了参考模型 (RM) 和临床信息模型 (CIM)，在实践中采用了这种软件设计模式。HL7 提出的最新倡议称为快速健康互操作性资源 (FHIR)。我们研究的目的是调查应用 FHIR 标准对建模和公开 Georges Pompidou 欧洲医院 (HEGP) 的 EHR 数据的可行性，该医院整合了生物学和床边 (i2b2) 临床数据仓库 (CDW)。
我们在 i2b2 上实现了一个 FHIR 服务器，以公开与五个 FHIR 资源相关的 EHR 数据：DiagnosisReport、MedicationOrder、Patient、Encounter 和 Medication。服务器的架构结合了数据访问对象设计模式和 FHIR 资源提供程序，使用 Java HAPI FHIR API 实现。测试了两种类型的查询：查询类型 #1 请求服务器显示诊断代码等于给定 ICD-10 代码的 DiagnosticReport 资源。共显示了 80 个 DiagnosticReport 资源，对应 36 个患者。查询类型 #2 请求服务器显示 FHIR 药物标识符等于用法国编码系统表示的给定代码的 MedicationOrder 资源。共显示了 503 个 MedicationOrder 资源，对应 290 个患者。通过手动将每个请求的结果与通过特定 SQL 查询显示的结果进行比较，验证了结果。
我们展示了在 i2b2 数据库模型之上实现 Java 层以公开 CDW 数据作为一组 FHIR 资源的可行性。这项工作的一个重要部分是 i2b2 模型和 FHIR RM 之间的结构和语义映射。为了完成此操作，开发人员必须手动浏览 FHIR 标准的规范。我们的源代码是免费提供的，可以适应其他 i2b2 站点的使用。
