A short case study series exploring FHIR and its potential in healthcare
Dr Dean Mohamedally, UCL Computer Science
Prof Neil Sebire, GOSH DRIVE
The DRIVE unit based at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) is a world first and unique in the United Kingdom’s National Health Service (NHS). It is a major innovation hub for hospital systems and over the past two years since its creation, it has become a central London lab for experimental clinical systems development.
Cindy Rose, CEO for Microsoft UK, has seen a major Azure foundation at the hospital with DRIVE enabling a new generation of clinical informaticians, health data scientists and AI for healthcare to be created, under a Digital Research Environment (DRE).
In partnership with Aridhia who work on the Azure based DRE for the hospital, a tertiary experimental student-safe Azure implementation populated with synthetic data has been building up on its portfolio of FHIR and Smart on FHIR project platforms.
Separately, FHIR and its history in clinical data formats and formal specifications have been explored by several generations of computer science and clinical informatics students at UCL. The maturity of FHIR R4, Microsoft Azure's new FHIR technologies and Aridhia’s synthetic data environment for students to work on hospital R&D, have all combined to fuel a powerful triad for future interoperability standards development.
GOSH has been a client in the UCL Industry Exchange Network (UCL IXN) since 2018. In partnership with UCL Computer Science and the UCL IXN, GOSH DRIVE has supported numerous student projects to develop early Proof of Concept technology, such as data science dashboards and mobile app prototypes.
GOSH DRIVE projects conduced in partnership with the UCL IXN programme focus on three key areas
- Interoperability
- Efficiency
- Innovation
Also referred to as the the IEI method of prototyping projects, all student projects usually fall into one or two of these categories. The following hackathon session describes an early attempt at all 3 simultaneously – to model with interoperability, bring new methods to existing work flows and to demonstrate what innovation can do for healthcare developer communities. This forms a well defined solution in Computer Science education, to explain to our students, how do we manufacture new compliant healthcare components.
GOSH FHIRWorks 2020 and the GOSH FHIR ToolSuite Project
In hospitals today outside of GOSH, we may find:
A doctor still needs to manually dial from a medical system to reach a patient.
A receptionist has to manually collect the data for a patient letter from multiple sources.
A ward round still needs a look-up of paperwork.
GOSH FHIRworks 2020 with the UCL IXN in early March before the Covid-19 lockdown saw over 100 FHIR demonstrators being built as open source, for GOSH DRIVE and the NHS to challenge ideas like these. Our students were openly tasked to connecting it to any developer environment, any technology stack and any platforms that had an interesting and relevant use case. In parallel, a team of final year and MSc students also worked from January to March with GOSH DRIVE to develop a FHIR ToolSuite to accelerate the development of FHIR applications with Azure at GOSH.
Prof Neil Sebire, Director for GOSH DRIVE gave the keynote highlighting the need for applications of FHIR (and SMART on FHIR) to be explored.
Taking on a specific role to demonstrate software manufacturing processes with healthcare informatics standards, over 100 Computer Science students were tasked with 15 open ideas which we called the FHIRworks challenges 2020, with the GOSH FHIR ToolSuite project available to assist them:
- Generating letters, forms and documents prefilled from FHIR records (Word and PDF)
- Graphing data from FHIR records
- Making use of Azure and AzureML with FHIR
- Making use of external cloud systems with FHIR
- Responsive design app form filling pushing data with a FHIR record
- Responsive design app form pulling data from a series of FHIR records
- Security and connection management of FHIR records access
- Using FHIR to generate communication channels between patients and doctors (such as Skype/MS Teams)
- Using Voice to access, search and perform actions with FHIR records including chatbots
- Searching for information in FHIR records (NLP, tables, data) including requests over SQL and converting into FHIR queries
- Retrieving FHIR records and showing on a wearable, IoT or sensor device, or pushing data from a wearable, IoT or sensor device to a FHIR record
- Showing FHIR record data in a VR/AR environment
- Generating a synthetic FHIR record against a set of rules
- Create a dashboard of FHIR service specifications
- Students own defined option for use of a FHIR record or series of FHIR records
The students demonstrated a great variety of technology innovations that haven’t been seen with the hospital. FHIR demos with Samsung Watches and Intel portable NUC computing hardware, to making use of Microsoft AzureML and Jupyter Notebook services with FHIR datasets, creating NLP chatbots, automating video conferencing over Skype, filtering location data from FHIR on maps, rendering patient FHIR records in 3D, combining VR into game engine templates, IoT devices with 3D printing that recognise FHIR records and multilingual voiceprint analysis... This is the spirit of invention.
“Amazing projects in 48 hours, can’t wait to see the best ones taken forward by DRIVE and more widely. Hackathons are a huge amount of behind the scenes work, so many thanks." - Prof Neil Sebire
We thank GOSH DRIVE, Prof Neil Sebire, Sheena Visram, Dr Atia Rafiq, Daiana Bassi, Usman Bahadur, Jo Stiles, Wendy Richards, Dave Twiselton, Dr Graham Roberts, the CS comms team, all of the CS students who participated around the clock, the staff who came to support and the companies that came together to unite healthcare with FHIR for GOSH and the NHS that made this hackathon possible. Our students were reviewed onsite by a wonderful guest team of industry technology specialists from a number of companies, Aridhia, NTTData, IBM, Intel, GOSH and EMIS Health alongside NHS staff. They participated in a Dragons Den session for students to explore the rationale and potential of their projects. A special event online with some of our top entries was held as a Team’s session with senior specialists from Microsoft Redmond with the FHIR Azure Healthcare team in April.
A very well done and congratulations to the winning 2nd year UCL CS students on the hackathon:
Adnan Ahmad
Afiq Bin Samsudin
Alex Niculae
Alex Tcherdakoff
Bilal Tariq
Charles Cowan
Cheng Xuyou
Ethan Wood
Eunice Chandra
Henry Zhang
James Zhong
Jan Kolarik
Joel Morgan
Lilly Sinek
Louis Phillips
Mark Anson
Muna Aghamelu
Nayana Dasgupta
Nicolas Ford
Noan Le Renard
Rajesh Goyal
Rakshita Kumar
Rikaz Rameez
Yuheng Wang
Zi Lian Lim
Special recognition goes to the ToolSuite team: Anthony Cheng Vojtech Adam, Carmen Ibanescu, Yutong Wang, Junda He, Abhinath Kumar and Suyash Kabra for their tools for Azure.
All of the open source code for these students’ projects are hosted by Apperta Foundation, which supports open source projects for the UK’s NHS.
The following case studies using Microsoft technologies have been chosen by Microsoft for highlighting in this blog series.
ToolSuite Team
Ethan Wood FHIR-Display
Louis Philips Statistical Solution for Synthetic Data
Lim Zi Lian FHIR Data Visualization
Lilly Sinek AR Clipboard
Alexandru-Vlad Niculae Group Therapy Demonstrator with Skype
On to the next hackathon!
Microsoft
