Committee Approval Date:
Patient Care WG, approved at 2020-09-28 Monday 5:00pm conference call: Meeting minutes
Contributing or Reviewing Work Groups:
Primary sponsor: Patient Care WG
Co-sponsor: EHR WG (approved 2020-09-29)
FHIR Development Project Insight ID:
Pending (PSS has been submnitted)
Scope of coverage:
This project's main goal is to develop a FHIR implementation guide to support interoperable information exchanges between healthcare practitioners responsible for collaborative and shared care of patients suffering from eye disorders.
The scope of this project is constrained by a finite set of business and clinical use cases (see project page) in the ophthalmic medical domain.
The business/administrative and clinical workflow from these use cases are used to identify the business and clinical datasets and mapping the data components onto FHIR resources, where necessary, extensions to and profiles of relevant FHIR resources will be created.
The output of this process would be a FHIR implementation guide that defines/describes the profile, extension and terminology/value-set artefacts, and to provide technical and clinical guidance on their implementations to EHR and other technology providers.
This multi-stakeholder /and multidisciplinary project. The target groups include but not limited to:
- Clinicians (ophthalmologist, optometrists, other medical and surgical practitioners and specialists)
- Payors/funders (including government bodies and insurance payors)
- EMR/EHR developers
- Ophthalmic diagnostic/measurement devices developers/producers
This project aims to broaden the scope of FHIR’s real world applicability in the ophthalmic (eye diseases) domain. The IG will target the universal realm as at least 3 countries have expressed interest in participation.
We will approach the IG development in phases, dividing the scope into disease categories, or ‘modules’. Each module IG submission will be use-case driven; the use cases and accompanying artefacts required will be outlined in the IG proposal. Beginning in May 2021 with a ‘retinal disease’ module for approval in the ballot, our aim is to submit new modules for approval in sequential ballot cycles.
Wherever possible, we will leverage existing FHIR profiles, extensions and value-sets, and other international works such as:
- IHE’s previous work on codifying ophthalmology for the ‘Genera Eye Evaluation ’ cCDA (GEE). (https://www.ihe.net/resources/technical_frameworks/#eyecare),
- ICHOM’s standardized health outcome datasets,
- Save Sight Institute’s registry data dictionaries.
This project will take an incremental approach to the clinical domains with retinal problems as the first set of clinical use cases to be addressed by the implementation guide.
The Ophthalmic FHIR IG contents can be accessed through the link below:
Proposed IG realm and code:
FHIR Core version(s):
FHIR Core R4
Content will be maintained by the Ophthalmic project group under HL7 PCWG sponsorship, updated at least as often as required to keep the IG from expiring
Provides representation of ophthalmic domain and related clinical and administrative data elements in the FHIR format to support effective collaborative and continuity of care of patients suffering from eye conditions.
The implementation guide provides representation of ophthalmic and related clinical and administrative data elements in the FHIR format and defines where these elements should be represented to support collaborative and continuity of care of patient suffering from eye conditions, including supporting applications to funding bodies/payors for prior authorisations of a set of ophthalmic treatments and procedures. It describes the necessary operations and transactions needed to generate, aggregate and exchange ophthalmic related administrative and clinical data. The project is clinical and business use case driven and starts with conditions affecting the retina and incrementally expand to cover other ophthalmic structures.
The primary audience for this specification is EHR independent application developers especially specialist ophthalmic EHR developers, ophthalmic diagnostic device manufacturers, and IT departments at implementation sites. Secondary target audiences are consumers of ophthalmic specific data such as clinicians, researchers and payers.
This proposed IG provides the rules and methods to achieve this aggregated view within the ophthalmic and related clinical care domains, pulling data from all systems where patients receive care.
This work has been engaged by the following stakeholders:
- Peak ophthalmic specialty societies (RANZCO, AAO)
- Large ophthalmic clinical registries across the globe (SSR, ICHOM, AAO’s IRIS registry)
- Ophthalmic-focused digital platforms and companies (tele-health solutions, remote devices etc. eg OCULO etc)
- Ophthalmic EHR vendors (eg - EyeMD)
- Ophthalmic device manufacturers (eg - Hedelberg Engingeering, Zeiss, Optos)
See above re: EHR and device vendors and eyecare specific digital information information sharing platforms.
As outlined in the PSS, we will reference the following external specifications:
- IHE’s previous work on codifying ophthalmology for the ‘Genera Eye Evaluation ’ cCDA (GEE).
- ICHOM’s standardized health outcome datasets
- Save Sight Institute’s registry data dictionaries
- Standard terminologies, such as:
- ICD9 (WHO)
- ICD10 (WHO
- SNOMED-CT (http://snomed.info/sct); CSIRO SNOMED browser (http://ontoserver.csiro.au/shrimp/licence.html)
- LOINC (http://loinc.org)
- AMA's CPT codes (http://www.ama-assn.org/go/cpt)
- RxNorm (NLM - http://www.nlm.nih.gov/research/umls/rxnorm)
- DICOM code definitions (https://www.dicomstandard.org/wgs/wg-09/)
- Medical Device Codes (urn:iso:std:iso:11073:10101)
- NCI metathesaurus (http://ncimeta.nci.nih.gov)
- UCUM (http://unitsofmeasure.org)
Examples of interoperability exchanges this IG will facilitate include:
1 - between ophthalmic diagnostic devices (eg OCT machines) and EMR
2 - between the various EMRs of different eye care providers (including between patients with chronic conditions who. are co-managed by optometry and ophthalmology)
3 - between ambulatory surgery centres and EMRs in the ophthalmologist and optometrist office
Although this IG does not depend on other IG, Its functionality and adoption will be significantly enhanced by implementation with guidance from other IGs (eg - Da Vinci for prior authorization)
We do not expect others to depend on our IG, although implementers drawing upon other published IGs may look to out IG for clinical guidance about how to apply it specifically as it may relate to eye care (eg - Da Vinci for prior authorization)
Participation in May 2021 Technical Connectathon: Ophthalmology track
We expect to have our final draft ready by August 2021 in preparation for the September 2021 ballot cycle.