apidays Helsinki & North 2025 - APIs in the healthcare sector: hospitals interoperability with FHIR, Matias Aiskovich (Toptal)

APIs in the healthcare sector: hospitals interoperability with FHIR
Matias Aiskovich, Machine Learning Engineer/Bioinformatician - Toptal

apidays Helsinki & North 2025 - APIs for Innovation, Intelligence, and Impact
June 3 & 4, 2025

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Transcript

1. apidays-Matias Aiskovich APIs in the healthcare sector: Hospitals’ interoperability with HL7 FHIR HL7 ® International. HL7 & Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Matias Aiskovich
2. apidays-Matias Aiskovich About This Presentation • Disclaimer – Professional Opinion based on my extensive expertise: The views and opinions expressed in this presentation are my own and do not necessarily reflect those of any current or former employer, client, or organization with which I am or have been affiliated. 2
3. apidays-Matias Aiskovich About me:
4. apidays-Matias Aiskovich About me:
5. apidays-Matias Aiskovich Telemedicine image: https://www.iso.org/healthcare/telemedicine-equipment About me:
6. apidays-Matias Aiskovich Telemedicine image: https://www.iso.org/healthcare/telemedicine-equipment Prescription image: https://nabp.pharmacy/news/blog/revolutionizing-health-care-the-evolving-path-of-e-prescriptions/ About me:
7. apidays-Matias Aiskovich Telemedicine image: https://www.iso.org/healthcare/telemedicine-equipment Prescription image: https://nabp.pharmacy/news/blog/revolutionizing-health-care-the-evolving-path-of-e-prescriptions/ About me:
8. apidays-Matias Aiskovich Telemedicine image: https://www.iso.org/healthcare/telemedicine-equipment Prescription image: https://nabp.pharmacy/news/blog/revolutionizing-health-care-the-evolving-path-of-e-prescriptions/ About me:
9. apidays-Matias Aiskovich Why? 9
10. apidays-Matias Aiskovich Why is FHIR needed? 10
11. apidays-Matias Aiskovich Lost in translation Free-text + translation error Original note (in English) “Patient suffers from angina.” Clinical misinterpretation throat infection → prescribes antibiotics What was meant “angina pectoris” (chest pain due to myocardial ischaemia) SNOMED CT 194828000 ICD-10 I20.9 For informational purposes only 11
12. apidays-Matias Aiskovich Lack of interoperability • Patient drug errors, misdiagnosis and failure to prevent harm • Redundant testing • Time spent manually entering information • Length of stay from delays in information transfer $30B annually in the US Source: West Health Institute (2013) Source: The Value of Medical Device Interoperability: Improving Patient Care with more than $30 Billion in Annual Health Care SavingsExternal Link Disclaimer A discussion of the business case for medical device interoperability by West Health Institute. 12
13. apidays-Matias Aiskovich Fast Healthcare Interoperability Resources (HL7 FHIR) • Set of standards and definitions for APIs • Ideal: Build once for all Electronic Health Record (EHR) systems • Familiar tooling and technologies: ◦ XML/JSON ◦ REST ◦ OAuth • In the US, EHR vendors that have more than 83% of market share support FHIR Source: https://www.definitivehc.com/blog/most-common-inpatient-ehr-systems 13
14. apidays-Matias Aiskovich 14 FHIR example - Encounter definition Source: https://build.fhir.org/encounter.html
15. apidays-Matias Aiskovich 15 FHIR example - Encounter sample data Source: https://build.fhir.org/encounter-example-f201-20130404.json.html
16. apidays-Matias Aiskovich 16 FHIR entities relation
17. apidays-Matias Aiskovich 17 Share of information between different healthcare systems. Patient generated data. Exchange of information Medical applications which can be easily integrated into existing systems. Third-party applications AI - Research, simpler data streamline Support research What does interoperability enable? Icons images: Flaticon.com
18. apidays-Matias Aiskovich 18 Patient side - Apple health Source: https://www.apple.com/newsroom/2018/01/apple-announces-effortless-solution-bringing-health-records-to-iPhone/ https://institutions.healthrecords.apple.com/ Hospitals integrated with Apple health (through FHIR)
19. apidays-Matias Aiskovich 19 Doctors side - 3rd-party tools FHIR, OAuth2, and OpenID Connect Substitutable Medical Applications, Reusable Technologies (SMART)
20. apidays-Matias Aiskovich 20 How could this benefit a medtech company?
21. apidays-Matias Aiskovich 21 How could this benefit a medtech company?
22. apidays-Matias Aiskovich 22 How could this benefit a medtech company?
23. apidays-Matias Aiskovich 23 How could this benefit a medtech company?
24. apidays-Matias Aiskovich 24 How could this benefit a medtech company?
25. apidays-Matias Aiskovich 25 Epic Marketplace
26. apidays-Matias Aiskovich 26 Sandboxes
27. apidays-Matias Aiskovich 27 Sandboxes
28. apidays-Matias Aiskovich 28 Finland’s national profile for FHIR Source: https://hl7.fi/fhir/finnish-base-profiles/extensions.html
29. apidays-Matias Aiskovich 01 02 03 04 1989 29 2005 2014 2019 Evolution of HL7 Standards HL7 v2.x Electronic messages Lacked a consistent data model. HL7 v3.x Based on an XML encoding syntax. Complex to implement. Not Backwards Compatible. API technology, RESTful protocol First draft, Draft Standard for Trial Use 1 (DSTU1) HL7 FHIR Release 4 (R4) Stable "normative use"
30. apidays-Matias Aiskovich 30 FHIR - governmental support • Health Information Technology for Economic and Clinical Health Act Incentive Programs - Obama administration • “meaningful use” sets the specific objectives that eligible professionals and hospitals must achieve to participate in the EHR Incentive Programs • Promoting Interoperability Programs • GDPR: right to data portability • European Health Data Space Regulation (EHDS): Interoperable EHRs, 2026-2030. • eHealth Digital Service Infrastructure (eHDSI) • 2020-2030 CEF-Digital, Digital Europe Programme, EU4Health, Horizon Europe health 2010s +$25B HITECH Act Source: Recovery Act-Funded Programs 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program United States - 󰑔 European Union - 󰎾 2020s +€21B Source: The general data protection regulation applies in all Member States from 25 May 2018 European Health Data Space Regulation (EHDS)
31. apidays-Matias Aiskovich Conclusions • FHIR adoption rising and promising next 5 years in EU • Hopefully, lead to better patient care • New opportunities for developers and companies interacting with EHRs • Plenty of resources to support FHIR and SMART-on-FHIR development 31
32. apidays-Matias Aiskovich Acknowledgments Mikael Rinnetmäki FHIR Ambassador, HL7 Finland 32
33. apidays-Matias Aiskovich Matias Aiskovich matias.aiskovich@helsinki.fi
34. apidays-Matias Aiskovich 34 FHIR ecosystem Source: Driving Innovation in Health Systems through an Apps-Based Information Economy Mandl, Kenneth D. et al. Cell Systems, Volume 1, Issue 1, 8 - 13
35. apidays-Matias Aiskovich 35 Multi EHR APPs
36. apidays-Matias Aiskovich Finland healthcare regions Six EHR vendors used in Finland Source: Jormanainen, V., Parhiala, K., & Reponen, J. (2019). Highly concentrated markets of electronic health records data systems in public health centres and specialist care hospitals in 2017 in Finland. Finnish Journal of EHealth and EWelfare, 11(1-2), 109–124. https://doi.org/10.23996/fjhw.75554
37. apidays-Matias Aiskovich HL7v2 - sample message MSH|^~\&|GHH LAB|ELAB-3|GHH OE|BLDG4|200202150930||ORU^R01|CNTRL-3456|P|2.4<cr> PID|||555-44-4444||EVERYWOMAN^EVE^E^^^^L|JONES|19620320|F|||153 FERNWOOD DR.^ ^STATESVILLE^OH^35292||(206)3345232|(206)752-121||||AC555444444||67-A4335^OH^20030520<cr> OBR|1|845439^GHH OE|1045813^GHH LAB|1554-5^GLUCOSE|||200202150730||||||||| 555-55-5555^PRIMARY^PATRICIA P^^^^MD^^|||||||||F||||||444-44-4444^HIPPOCRATES^HOWARD H^^^^MD<cr> OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182|mg/dl|70_105|H|||F<cr> Source: https://ringholm.com/docs/04350_mapping_HL7v2_FHIR.htm
38. apidays-Matias Aiskovich HL7v3 - sample message <observationEvent> <id root="2.16.840.1.113883.19.1122.4" extension="1045813" assigningAuthorityName="GHH LAB Filler Orders"/> <code code="1554-5" codeSystemName="LN" codeSystem="2.16.840.1.113883.6.1" displayName="GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN"/> <statusCode code="completed"/> <effectiveTime value="200202150730"/> <priorityCode code="R"/> <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/> <value xsi:type="PQ" value="182" unit="mg/dL"/> <interpretationCode code="H"/> <referenceRange> <interpretationRange> <value xsi:type="IVL_PQ"> <low value="70" unit="mg/dL"/> <high value="105" unit="mg/dL"/> </value> <interpretationCode code="N"/> </interpretationRange> </referenceRange> Source: https://ringholm.com/docs/04300_en.htm
39. apidays-Matias Aiskovich Carequality - information exchange US Source: https://carequality.org
40. apidays-Matias Aiskovich 40 FHIR EU - government support evnue growth 0 00% 00% 00% 00% 00% 20XX 20XX 20XX 20XX 20XX Source: https://eur-lex.europa.eu/content/news/general-data-protection-regulation-GDPR-applies-from-25-May-2018.html#:~:text=Fu rthermore%2C%20the%20new%20right%20to,friendly%20solutions https://health.ec.europa.eu/ehealth-digital-health-and-care/european-health-data-space-regulation-ehds_en • GDPR: right to data portability (allowing individuals to move their personal data from one service provider to another) • eHealth Digital Service Infrastructure (eHDSI): prescription and patient summary. Based on HL7 CDA (XML), future services FHIR • European Health Data Space Regulation (EHDS): Interoperable EHRs, 2026-2030. EHRxF (European Electronic Health Record Exchange Format), policy framework, uses FHIR for some use cases Related economic incentives: • CEF-1 “Telecom” (not only for health) 2014-2020: €1.05 B • 2020-2030 CEF-Digital, Digital Europe Programme, EU4Health, Horizon Europe health: ~€21 B (not directly for FHIR) 2020s +€21B