FHIR Session 1 Word Scramble
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| Question | Answer |
| FHIR is a _____ specification? | Platform |
| The FHIR specification defines what? | a set of capabilities used across the health care process |
| What jurisdictions can FHIR be used in? | All |
| What context(s) can FHIR be used in | Many |
| How many FHIR Modules are there? | 13 |
| What are the M1 Modules? | Foundation |
| What are the M2 Modules? | - Implementer Support - Security & Privacy - Conformance - Terminology - Exchanging |
| What are the M3 Modules? | Administration |
| What are the M4 Modules? | -Clinical - Diagnostics - Medications - Workflow - Financial |
| What are the M5 Modules? | Clinical Reasoning |
| What are the categories of the Modules? | Infrastructure, Content, Reasoning |
| Which module levels are categorized as Infrastructure? | - M1 - M2 |
| Which module levels are categorized as Content? | - M3 - M4 |
| Which module levels are categorized as Reasoning? | M5 |
| Which Modules are in the Infrastructure category? | - Foundation - Implementer Support - Security & Privacy - Conformance - Terminology - Exchanging |
| Which Modules are in the Content category? | - Administration - Clinical - Diagnostics - Medications - Workflow - Financial |
| Which Modules are in the Reasoning category? | Clinical Reasoning |
| What are 3 helpful documentation pages? | - Common Use Cases - Resource Guide - Registry of Implementation Guides |
| What 4 items do all Modules contain? | - Scope & Index - Use Cases - Security & Privacy - Roadmap |
| What is contained in the Module scope and index? | Description of content and index of important content |
| What is contained in the Module use cases? | Guidance for common uses of the module |
| Which module component is a key resource for implementers? | Use Cases |
| What is contained in the Module roadmap? | where module content is in terms of overall progress |
| FHIR stands for? | Fast Healthcare Interoperability Resources |
| Who created FHIR? | HL7 |
| What is FHIR? | a next generation standards framework |
| What standards does FHIR leverage? | latest web: XML, JSON, HTTP, OAuth etc. |
| What is the strong focus of FHIR? | implementation |
| How does FHIR relate to other healthcare standards? | evolutionary development path from v2 and CDA that combines the best features of v2, v3, and CDA |
| How are FHIR solutions built? | assembling resources into working systems. |
| What are the modular components used by FHIR called? | Resources |
| What contexts is FHIR suitable for? | -phone apps - cloud apps - EHR based apps - server communication |
| How does FHIR kickstart development? | There are multiple implementation libraries and many examples |
| Who can use the FHIR specification? | It is free for use with no restrictions |
| Can a base resource be used as is? | Yes, it can. |
| How can a base resource be adapted? | Using a Profile to apply extensions, add terminologies, etc |
| What does the RESTful architecture provide? | seamless exchange of info using messages or documents. and service based architectures |
| FHIR specifications are? | concise and easily understood |
| What is a feature of the FHIR Serialization format? | it is human readable for ease of use by developers |
| FHIR and other healthcare standards (v2, v3, CDA) can? | coexist and leverage each other |
| Central challenge for healthcare standards? | variability due to diverse processes |
| What are profiles used for? | to add more control and meaning (constrain a base resource) |
| Is the FHIR standard Normative? | No, it has Normative portions |
| What is the FHIR Framework based on? | Resources |
| What is a resource? | An instance level representation of some kind of healthcare entity |
| Common features of a resource (5). | - a URL - common metadata - human readable XHTML summary - set of defined data elements - extensibility framework |
| How is a resource represented? | XML, JSON, or RDF |
| Each resource instance consists of (6) things: | - resourceType - id - meta - text - extension - data |
| ResourceType is? | - A required element of a resource instance that specifies the resource being represented |
| What is different about the id element in a resource instance? | - it is always present when a resource is exchanged, except during the create operation. |
| Describe the 'meta' section of a resource instance: | - It is usually present (missing if there is no metadata). - It contains the common use / context data to all resources. - Is managed by the infrastructure. |
| What is in the 'text' section of a resource instance: | XHTML that provides a human readable representation for the resource. |
| Is the 'text' section of a resource required. | No, but it is recommended. |
| What is the 'extension' section of a resource instance? | An optional section that contains one or more extensions to the resource. |
| meta.versionId | changes each time the resource content changes (except profile, security, tag) |
| meta.lastUpdated | changes when meta.versionId changes. generally not supported if meta.versionId is not supported. |
| meta.profile | asserts conformance to a profile. Can be changed as profile / value sets change, or as system rechecks for conformance |
| meta.security | security labels applied to resources. Updated when resource changes or when security sub-system chooses to |
| meta.tag | tags applied to a resource that relate to process and workflow |
| implicit Rules | indicates custom agreement about how resources are used that must be understood in order to safely process. (use is discouraged) |
| Create interaction | POST |
| Read interaction | GET |
| Update interaction | PUT |
| Delete interaction | DELETE |
| Search interaction | GET |
| History interaction | GET |
| Transaction interaction | POST {tx bundle} |
| Operation interaction | GET |
| Why is there variability in FHIR | - different geopolitical jurisdictions - different segments in healthcare |
| What is a resource URL? | It identifies the resource and specifies where it was or can be accessed from. It is optional and is not represented inside the resource, rather it arises in context use. |
| How are common business practices enforced in FHIR | They are not and cannot be. |
| How is variability handled? | Using the extensibility framework (extensions) |
| What is the focus of the Base resource? | general, common use cases |
| What is the FHIR version? | The version of FHIR which is in use |
| What is the record version? | The version that is used to track changes to resources |
| What is the business version? | The version used by humans to understand the version of the content, with a formal publishing cycle, that they are dealing with. |
| How is the FHIR version determined? | Usually fixed by the content |
| What are the (3) levels for the record version | - versioning and metadata is not supported - versioning and versionId meta property supported, with history kept - versioning and versionId meta property supported, with history not kept |
| How are FHIR servers expected to support versioning | There is no requirement to support it. |
| RESTful API - success message range | 2xx |
| RESTful API - error message range | 4xx |
| What (9) base properties are contained in all resources (when fully populated)? | - resourceType - id - meta.versionId - meta.lastUpdated - meta.profile - meta.security - meta.tag - implicitRules - language |
| What is the purpose of meta.profile? | It asserts conformance to a profile |
| When does meta.versionID change? | Each time resource content changes |
| When does meta.lastUpdated change? | When meta.versionID changes |
| When is meta.lastUpdated generally not supported? | When mets.versionID is not supported |
| When can id be missing from the base resource? | When the resource is created |
| When can the resourceType be missing from the base resource? | It is always present |
| What do meta.tag elements relate to? | Process and workflow |
| What are implicitRules? | base resource element that indicates a custom agreement about how resources are used that must be understood to safely process |
| A resource in FHIR is analagous to? | a form |
| FHIR Data is the same as? | Completed resources (instances) |
| What does each resource define? | a small amount of highly focused data |
| What does a collection of resources create? | a useful clinical record |
| User actions are the same as? | resource operations |
| Base resources are? | generic |
| What is the 80/20 rule? | focus on 20% of requirements that satisfy 80% of interoperability needs |
| When is narrative expected? | for most resource instances |
| How can narrative be generated? | from discrete info. may be free form text commentary |
| What are the 4 exchange mechanisms in FHIR? | REST, Documents, Messaging, Services |
| Which is the simplest exchange mechanism? | REST |
| Which exchange mechanism uses the Composition resource? | Documents |
| Which exchange mechanism uses the Message Header resource? | Messaging |
| Which exchange mechanism is typically used by decision support? | Services |
| Which (4) modules are of interest for clinicians? | - Clinical & Care Provision - Diagnostics - Medications - Administrative |
| 2 primary components of FHIR? | Resources & APIs |
| The Resource component of FHIR architecture are considered to be the _____? | Physical Models |
| The APIs component of FHIR architecture are considered to be the _____? | Interface implementations |
| What are the interfaces for interoperating? | APIs |
| Which interfaces are targeted by the FHIR specification? | RESTful interfaces |
| Resource definition | A collection of information modules that define data elements, constraints, and relationships for the 'business objects' most relevant to healthcare. |
| Architectural Framework contents | - verifiable and testable syntax - set of rules and constraints - methods and signatures for FHIR aware APIS - specifications for server implementation (capable of requesting/delivering FHIR business objects) |
| What is meant by the Architectural Principle 'Reuse & Composability'? | This is the 80/20 rule. Focus on 20% or requirements that satisfy 80% of interoperability needs |
| What is meant by the Architectural Principle 'Scalability' | Aligning FHIR APIs to REST architecture. |
| Why do we want stateless transactions? | They reduce memory usage. |
| What is meant by the Architectural Principle 'Performance'? | FHIR resources are lean and suitable for exchange |
| What is meant by the Architectural Principle 'Usability'? | Resources are understood by both technical and non-technical audiences even if JSON/XML syntax not understood. |
| What is meant by the Architectural Principle 'Data Fidelity'? | Strong typing and mechanisms for clinical terminology linkage and validations. XML and JSON can be validated against defined business rules. |
| What is meant by the Architectural Principle 'Implementability'? | Easily understood and readily implemented using industry standards and common markup and data exchange technologies |
| What are the decomposition components? | - Information Model - Constraints - Terminology - Usage |
| In Decomposition, what does the Information Model refer to? | Components related to the creation of FHIR resources - Resource - ElementDefinition - DataType |
| In Decomposition, what does the Constraint Model refer to? | Components related to constraints and validity - ConformanceStatement - Profile |
| In Decomposition, what does terminology refer to? | Components related to Clinical Terminologies and Ontologies - CodeSystem - ValueSet |
| In Decomposition, what does Usage refer to? | Components related to the use of FHIR in a run-time capacity - REST API |
| How many layers are there in the Composition Framework | 6 |
| Layer 1 of the Composition Framework | Foundation |
| Layer 2 of the Composition Framework | Base |
| Layer 3 of the Composition Framework | Clinical |
| Layer 4 of the Composition Framework | Financial |
| Layer 5 of the Composition Framework | Specialized |
| Layer 6 of the Composition Framework | Contextualization |
| Compositional Framework Layer 1 description | foundational resources, often for infrastructural tasks, that are generally not referenced by other resources |
| Compositional Framework Layer 2 description | most commonly used resources. They don't typically reference other resources but are often referred to. They have the highest consistency and rigor as well as the greatest governance |
| Compositional Framework Layer 3 description | Resources that are clinical and common. They can be used by themselves but typically reference layer 2 resources and are contextualized when referenced from layers 3, 4, and 5. |
| Compositional Framework Layer 4 description | Resources that build on clinical and base resources |
| Compositional Framework Layer 5 description | Resources for less common use cases that almost always reference resources in lower layers |
| Compositional Framework Layer 6 description | This layer does not contain resources. The components in this layer extend the framework |
| Purposes (3) of the Composition Framework | - organize resources for navigation and identification - classify resources into categories disseminate across layers to stratify commonness |
| Benefits (4) of Composition Framework | - Organization and manageability of health domains - Identifying commonality - Resource prioritization - Tiered governance levels |
| 3 FHIR interface definitionos | - iServeInstance - iServeType - iServeSystem |
| iServeInstance | methods that perform GET, PUT, DELETE |
| iServeType | methods that get type info or metadata |
| iServeSystem | methods that expose or enable system behaviour |
| What types of transactions are defined in FHIR specification? | Stateless |
| Transaction pattern? | request / response |
| Preconditions for security | - EMR implements needed APIs - EMR implements authentication / authorization - patient authenticated and authorized |
| Resource characteristics | - a common way to be defined and represented - a common set of metadata - a human readable part |
| FHIR modeling approach | compositional |
| Resources that describe how resources are defined and used | - Capability Statement - StructureDefinition |
| What do the FHIR Confluence Pages document? | - development processes - methodology - design decisions |
| Where are formal change requests submitted? | HL7 Jira |
| How can you access HL7 Jira from the specification? | Link at the bottom of every page |
| What is the FHIR online chat called? | Zulip |
| Aside from HL7 Jira, and Zulip, and Confluence pages, where else can you find information or provide feedback? | HL7 Forum and Stack Overflow (there is a tag) |
| How is the FHIR Specification licensed? | Under Creative Commons - "No Rights Reserved" |
| What are the registered trademarks of HL7 with regard to FHIR. (must be followed by circled R) | - HL7 - HEALTH LEVEL SEVEN - FHIR - flame logo |
| Copyright / trademark for FHIR | (C) and (R) to HL7 |
| Who has the right to maintain FHIR? | that remains vested in HL7 |
| FHIR Redistribition | is allowed |
| Derivatives / implementation products and services | can be created (can't claim HL7 endorsement) |
| What liability exists for HL7 and contributors | none accepted |
| How is an altered FHIR specification published? | it is clearly identified as a derivative and not FHIR itself |
| How can a derivative specification redefine what FHIR conformance means. | This is not allowed. |
| What are alternate ways of referring to the FHIR specification? | Using FHIR (R) or the FHIR logo (R) |
| How should FHIR be referenced in a document or presentation? | HL7(R) FHIR(R) Standard. FHIR(R) or FHIR(R) Standard on subsequent pages |
| Draft (Standards Development Definition) | Not complete enough or reviewed enough to be safe for implementation |
| Trial Use (Standards Development Definition) | Well reviewed. Ready for Production. No widespread use as yet. |
| Normative (Standards Development Definition) | Reviewed and implemented in a wide variety of environments. Considered "locked" and subject to inter-version compatibility rules. |
| Informative (Standards Development Definition) | Provided for implementation assistance |
| Deprecated (Standards Development Definition) | Outdated and may be withdrawn in future versions |
| Mixed Normative (Standards Development Definition) | Some Normative resources may have Trial Use elements. Some Normative pages may have Trial Use sections. |
| Purpose of Maturity Levels | To judge how advanced (stable) an artifact is |
| Maturity level 0 | Draft - resource or profile published in the current build |
| FMM1 | previous + - no warnings during build - responsible WG indicates it is substantially complete - FHIR mgmt group approved underlying resource/profile/IG proposal |
| FMM2 | previous + - artifact tested and supports interoperability among at least 3 independently developed systems leveraging most of the scope (>80%) based on at least one of the declared scopes - interoperability results reported to and accepted by FMG |
| Where would an artifact generally be tested | At a Connectathon |
| FMM3 | previous + - artifact verified by WG as meeting Conformance Resource Quality Guidelines - has been subject to a round of formal balloting - has at least 10 distinct implementer comments, from at least 3 orgs, resulting in at least 1 substantial change |
| FMM4 | previous + - artifact tested across scope - published in a formal publication - implemented in multiple prototype projects - responsible WG agrees artifact sufficiently stable to require consultation for non-backward compatible change |
| FMM5 | previous + - artifact published in two formal publication release cycles at FMM1+ - implemented in at least 5 independent Prod systems in more than one country |
| Tested across scope | - FMG signed off on lost of example contexts - for each artifact, either: - reviewed and approved by domain expert for scope area - mapped to existing implemented scope-are-specific standard - tested in an implementation |
| Maturity level | Strong relationship to stability. Higher level, more controls enforced. |
| Release Cycle | 18-24 Months Single Dev version Major cycles concluded by formal ballot (followed by publication) |
| version identification | publication.major.minor.revision |
| version identification - publication | trial use or normative version |
| version identification - major | Increments when a breaking change is made. Resets to 0 on new publication. |
| version identifaction - minor | Increments when official snapshot released. Resets to 0 when major changes Snapshots released approx 6 weeks before HL7 WG meetings |
| version identification - revision | The hash for the GIT version from which the specification is built Changes are made numerous times per day |
| Breaking change | change where the previously conformant applications are no longer conformant to the updated specification |
| Substantive change | changes that introduce new functionality, create new capabilities, but do not render existing application non-conformant. |
| Non-substantive change | Should not cause changes in any conformant application - section renumbering, correcting broken links, fixing typos, providing clarifications etc. |
| current build revision | always .cb |
| 3 ways to determine FHIR version | - fhirVersion in CapabilityStatement, StructureDefinition, or ImplementationGuide - fhirVersion parameter on the MIME-type that applies to the resource - specifying a version specific profile in Resource.meta |
| Forward compatibility | content that is conformant in an old release will remain conformant with future versions. |
| Backward compatibility | instances created against future versions of the specification will interoperate with older versions of the specification. * Not guaranteed by FHIR |
| 5 ways to maximize backwards compatibility | - ignore elements that are unexpected - ignore reference to unrecognized resources - ignore unrecognized codes in req and extensible bindings - ignore unrecognized search criteria - respond to commands on unexpected URLs with appropriate error codes |
| How should a deprecated artifact be handled? | Systems should continue to support but are discouraged from using |
| One strategy for conversion between versions. | use extensions |
| Compatibility rules - resource names - names/paths/meaning of existing elements - minimum cardinalities - immutable value sets - | wont be changed |
| Compatibility rules - optional elements/content | may be added (unless is Modifier) |
| Compatibility rules - descriptions - example and preferred bindings | may change |
| Compatibility rules - data types | will not be removed or changed |
| Compatibility rules - new data types - new operations | may be added |
| Compatibility rules - search criteria | may be added but not removed or renamed |
| Compatibility rules - existing parameters | will not be removed or renamed |
| Compatibility rules - exiting endpoints | will not be removed or renamed nor have expected behaviour changed |
Created by:
xjoaniex