Building Medical Applications and need access to a FHIR Server welcome to FHIR on Azure

[Lee Stott]

First published on MSDN on Nov 14, 2018

A key challenge for lots of Bio Medical, Bio Engineering and CS students, is building real code based on industry best practices and standards.

Many students, today have project tasks and assignments around gaining these specific skills. One of the most popular set of projects is around developing/building/deploying application for use within Healthcare.

As part of the process of undertaking these exercises, many students have to make themselves familiar with and provision state-of-the-art open and interoperable standards, such as FHIR API. From the experiences I have had over the past few years, this has been a painful process and many students simply did not know where to start to build FHIR capable services and importantly a FHIR server.

FHIR for clinical applications

FHIR is a flexible, extensible, and open source standard. Currently, FHIR includes resource definitions for health system administration, clinical management, diagnostics, medication management, and finance, as well as workflow and clinical reasoning. While the administrative and clinical data types are the most mature, but the FHIR standard continues to expand and include new data sets and definitions, vetted by the open source community. As it expands, FHIR, and the use of FHIR services to manage data in FHIR, can potentially be applied to new, diverse data sets for application in healthcare (e.g. social and demographic information, financial data sets, etc.).

Why is FHIR better than existing HL7 standards?

FHIR provides a simpler, easier-to-learn, pragmatic framework for health data interoperability. FHIR offers many unique improvements over existing standards, including:

· A strong focus on implementation – fast and easy to implement (multiple developers have had simple interfaces working in a single day).

· Multiple implementation libraries in a variety of programming languages, with many examples available to kick-start development

· The specification is free for use with no restrictions

· Interoperability is out-of-the-box– base resources can be used as is, but can also be easily adapted for local requirements

· Support for RESTful architectures, seamless exchange of information using messages or documents, and service-based architectures

· A strong foundation in Web standards– XML, JSON, HTTP, OAuth, etc.

· Concise and easily understood specifications

· A human-readable serialization format for ease of use by developers

· Solid ontology-based analysis with a rigorous formal mapping for correctness

FHIR services and standards allow medical department, trusts and applications to easily, securely and consistently integrate other apps that could improve care, whether developed by third parties or innovators within the Trust.

Welcome FHIR Server for Azure

This week we announced a OPEN SOURCE FHIR Server https://cloudblogs.microsoft.com/industry-blog/industry/health/fhir-server-for-azure-an-open-s... This is perfect for any student or academic, or health authority wanting to develop and deploy a FHIR service.

What is FHIR Server for Azure

FHIR Server for Azure on GitHub is an open source software (OSS) implementation of the emerging HL7 FHIR specification. Available November 12, 2018, FHIR Server for Azure helps make health data more open and interoperable by empowering developers to exchange and manage data using the FHIR specification. Microsoft is contributing this open source project to make it easier for organizations working with healthcare data to leverage the power of the cloud for clinical data processing and machine learning workloads.

What is FHIR and why it’s important?

Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) is the next-generation standard framework for healthcare interoperability. Developed by the HL7 healthcare standards organization (hl7.org/fhir), FHIR defines an extensible data model and a REST API (with create/read/update/delete/search) to simplify implementation and interoperability of health data.

The basic building block in FHIR is a Resource . Resources represent granular clinical concepts like “Patient” or “Observation,” and can be managed in isolation or aggregated into complex collections and documents. All Resources share the following characteristics:

· Standardized data elements each with a specified cardinality (e.g., 0..1 for an optional element like “Patient.birthDate”, or 0..* for a repeating element like “Patient.name”)

· Common data types for coded clinical data including primitive types (e.g., string, decimal) and complex types (e.g., CodeableConcept, Address) -- all informed by previous HL7 standards such as HL7 v2

· Common metadata elements like Resource id, version, tags and last updated time

· Human-readable serialization in JSON and XML for ease of use by developer

· Extensibility to augment standardized data elements in new use-case-specific extensions

FHIR Resources can be easily assembled into working solutions suitable in wide variety of contexts, making FHIR an important tool for interoperability.

Why Microsoft is investing in an open source FHIR Server

In August 2018, Microsoft joined with Amazon, Google, IBM and other companies in a commitment to remove barriers for the adoption of technologies that support healthcare interoperability, particularly those that are enabled through the cloud and AI.  Supporting FHIR and investing in open source software to enable FHIR is core to that commitment. We plan to enable a broad set of core services in the Microsoft Cloud to speak FHIR.

FHIR Server for Azure empowers developers – saving time when they need to quickly integrate a FHIR server into their own applications or providing them with a foundation on which they can customize their own FHIR service. As an open source project, contributions and feedback from the FHIR developer community will continue to improve this project.

In the healthcare industry, a transformation has been completed with the digitization of health data. The next horizon is now upon us to unlock the potential of that digitized data. Healthcare developers are being challenged to create pathways that bring diverse data sets together, and to build systems that learn from those data sets. Microsoft believes the best way to do that is to offer tools that allow developers to come together – for collaboration, creation, sharing, and building on each other’s work.

This project reaffirms that Microsoft is all-in on open source. We have been on a journey with open source.  Not only are we active, contributing members of the open source ecosystem, some of our most vibrant developer tools and frameworks are open source.

FHIR Server for Azure

FHIR Server for Azure is an open source software (OSS) implementation of the HL7 FHIR specification available on GitHub beginning November 12, 2018. The goal of this Microsoft Healthcare project is to enable developers to rapidly deploy a FHIR service.

With data in the FHIR format, the FHIR server enables developers to quickly ingest and manage FHIR datasets in the cloud, track and manage data access and normalize data for machine learning workloads.

FHIR Server for Azure is optimized for the Azure ecosystem:

· Scripts and ARM templates are available for immediate provisioning in the Microsoft Cloud

· Scripts are available to map to Azure AAD and enable Role Based Access Controls (RBAC)

FHIR Server for Azure is built with logical separation, enabling developers with flexibility to modify how it is implemented, and extend its capabilities as needed. The logic layers of the FHIR server are:

· Hosting Layer – Supports hosting in different environments, with custom configuration of Inversion of Control (IoC) containers.

· RESTful API Layer – The implementation of the APIs defined by the HL7 FHIR specification.

· Core Logic Layer – The implementation of the core FHIR logic.

· Persistence Layer – A pluggable persistence provider enabling the FHIR server to connect to virtually any data persistence utility. FHIR Server for Azure includes a ready-to-use data persistence provider for Azure Cosmos DB (a globally replicated database service that offers rich querying over data).

Use Cases

FHIR Server for Azure has been designed to support modern app patterns and use cases. Data is accessible through a standard set of APIs defined by the FHIR specification. While the use of a FHIR service can be applied in numerous places, some of the best scenarios for implementation are below:

· Interoperability: Health systems can facilitate interoperability and normalization of data between disparate systems through FHIR APIs and a FHIR service

· IOMT: Startups and new device/app developers can document and share data in the FHIR format, facilitating faster integration with provider and payer ecosystems (e.g. sending data to EHRs via FHIR APIs)

· Research: Leveraging data in FHIR formats can help to expedite normalization of data for data scientists and researchers and allows for more granular control of data that needs to be shared across groups.  By enabling role-based access controls (RBAC) and audit logs, the use of a FHIR service allows data owners more control over data sharing.

Downloading FHIR Server for Azure

FHIR Server for Azure is available on GitHub at https://github.com/Microsoft/fhir-server

How much will the FHIR Server for Azure cost?

FHIR Server for Azure is an Open Source Software (OSS) project under the MIT license, and thus is free to use and modify. As a developer-first company, Microsoft is investing in this OSS FHIR project to help facilitate interoperability and innovation across the healthcare ecosystem.

FHIR Server for Azure

FHIR Server for Azure is an open source project for any organization building healthcare solutions with clinical data. The FHIR standard and the service that manages data in FHIR can be applied in multiple scenarios, but some of the most powerful will be in use cases where normalization of diverse data sets, control of data flow, and integration with existing healthcare systems is required.

License Requirements for the FHIR Server for Azure OSS project

FHIR Server for Azure is available under an MIT license.

What version of FHIR does the FHIR Server for Azure OSS project support

As of November 12, 2018, the FHIR Server for Azure is based on FHIR v3.0.1 (Safe for Trial Use 3 aka STU3), released April 19, 2017.

Can FHIR Server for Azure be used in all Azure regions

FHIR Server for Azure can be deployed into nearly any Azure public region. The GitHub documentation includes an “easy button” that deploys FHIR Server for Azure into an Azure public region.

Is Microsoft supporting FHIR in its products and services

Yes. The FHIR standard is now available for Microsoft Azure, Dynamics 365 and Microsoft Teams, and FHIR is used in the Azure Security and Compliance Blueprint - HIPAA/HITRUST Health Data and AI .