brms and fhir integration - microsoft
TRANSCRIPT
BRMS and FHIR Integration
A User Story
Ravi Juneja, MBASr. Manager Enterprise Systems, IT GroupFresenius Medical CareMay, 2018
3
Fresenius Chairside – World’s largest Healthcare Deployment
up to 100k Treatments/day8 Time zones
Advances in medicine and technology
All the research in the world is meaningless unless it turns into meaningful results for patents, which is why our research and development eforts are designed to quickly turn new fndings into market-ready products. This quick tme to market enables us to ofer safer and more efectve individualized treatment to each and every patent. We focus on technologies to reduce product size and simplify their use, while integratng various treatment elements to create holistc therapy systems.
Sustained growth in patent numbers
It is estmated that by 2020, there will be 3.8 million kidney patents worldwide, fueled by an increase in the number of people who sufer from diseases such as high blood pressure and diabetes. As the number of kidney patents rises, health care systems across the globe will be challenged to fnd the resources to care for them. Meetng the resultng demand for safe, efectve and efcient therapies and associated technologies and products is central to our research and development actvites.
Increase in concomitant diseases
Our society is aging overall and the risk of developing end-stage renal disease increases with age. As patents age they also experience a greater likelihood of developing concomitant diseases such as cardiac and vascular conditons. Treatng these patents’ comorbidites is increasingly a focal point of our research and development eforts.point of our research and development eforts.
Rising cost pressure in health care
An aging populaton, growth in chronic illnesses, and the desire to ofer new and improved technologies in patent care all present major long-term fnancial challenges to health care systems across the globe. For this reason, we believe successful product innovatons must not be not only high quality, but also afordable. Based on our experience operatng dialysis clinics, we consider these two priorites to be entrely compatble.
Factors driving change at Fresenius
HIE
Fresenius External Apps…
Data Layer
DATA WAREHOUSEDATA WAREHOUSEAPPLICATION DATABASES
Integraton - ETL
DATA ACQUISITIONCONFORMANCE & INTEGRATIONS - PUBLISH...
PERIMETER SECURITY
Nephrologists Other Providers Ancillary Services Hospitals Nursing Homes SNIFs Health Plans CMS Regulatory Agencies Social & Community
Services
EXTERNAL SOURCESEMPI
OTHER FRESENIUS LINES OF BUSINESSSpectra LabsFresenius RxVascular CareUrgent CarePhysicians Groups
FRESENIUS KIDNEY CARE
Shared Services
Security, ERP, HR,… Hosted Locally
Oh wait… ours is a typical healthcare enterprisemultiplied by 100
Clinical Services
EMR, PHRHosted Locally
Financial Services
Admissions, BillingHosted Locally
Portal Services
ContentHosted Locally
Ours is a typical healthcare enterprise
The Rise of the API in Healthcare
• Fast Healthcare Interoperability* Resources• Exchanging electronic healthcare informaton
• Built on modern web technologies - using REST API.• XML or JSON (Javascript Object Notatonn
• Clients to integrate, request and transfer data between diferent systems.
• FHIR Resources – recipe used to exchange informaton and simple to use and easy to extend
• FHIR Specifcatons - Defnes a way in which resources can be exchanged between diferent systems.
• Resource format is defned by the REST call exchanging the data.
• Goal is to make healthcare informaton portable and interoperability beter.
* noun: interoperability - the ability of computer systems or sofware to exchange and make use of
informaton.htps://www.hl7.org/fir/
WHAT is FHIR (nickname FIRE)
FHIR Resources• Resource Categories
ClinicalAllergiesConditonsProcedureAssessment…
AdministratonPatentsPracttonerOrganizatonHealthcare Service…
DiagnostcsObservatonDiagnostc ReportBodySiteQuestonnaireResponse….
MedicatonsMedicatonMedicatonOrderMedicatonAdminImmunizaton….
FinancialCoverageEligibilityEnrollmentClaim….
WorkfowTaskEncounterAppointmentScheduleSlot….
SecurityProvenanceAuditEventConsent….
FHIR Resources – API syntax• Patent resource
htps://fir-qa.fmcna.com/STU3/firapi/Patent/P5000307186?_format=json
URL Resource ID Parameter
Response - Body
• Resource identty and metadata
• Human readable
• Extensions
• Standard data contents
"resourceType": "Patent",
"id": "P5000307186",
"meta": {
"versionId": "1",
"lastUpdated": "2018-04-10T21:19:25.341-04:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"htp://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\">ACESRel2.32SVN <b>TESTPATIENTSVN </b></div><table class=\"hapiPropertyTable\"><tbody><tr><td>Identfer</td><td>5000307186</td></tr><tr><td>Address</td><td><span>32 Hartwell Avenue </span><br/><span>LEXINGTON </span><span>MA </span><span>USA </span></td></tr><tr><td>Date of birth</td><td><span>03 August 1976</span></td></tr></tbody></table></div>"
},"identfer": [
{
"type": {
"coding": [
{
"system": "htp://hl7.org/fir/v2/0203",
"code": "MR"
}
]
},
"system": "urn:oid:2.16.840.1.113883.3.7418.2.1",
"value": "5000307186"
}
],
"name": [
{
"use": "ofcial",
"family": "TestPatentSVN",
"given": [
"ACESRel2.32SVN"
]
}
],
Resource Identty and Meta data
Human Readable Text
Standard Data and Content
Response - Body
Fresenius FABRIC is
Collaboratve app development
Secure User and backend integraton
Transformatve power of technology
High performance and availability in all data centers
Fresenius FABRIC enables to
Harness and encourage user engagement
Transform a system of record into a system of
engagement
Unleash back-end data
Reduce development tme and efort
Fresenius FABRIC Fresenius Advanced Backbone of Reusable Integrated Components
SMART Healthcare Applicaton Platorm for Patents, Clinicians, Physicians
SMART concepts Substtutable Medical Applicatons & Reusable Technologies
Fresenius Clinical Systems approach to APIs
FABRICApplicationsApplications
EnterpriseApplicatons
Web-based Applicatons{External & Local}
Business IntelligenceReportng & Analytcs
Portal Services
ApplicationsApplications
EnterpriseApplicatons
Web-based Applicatons{External & Local}
Business IntelligenceReportng & Analytcs
Portal Services
DATA
Fresenius Kidney
Partners
Spectra
& Shiel
Fresenius Vascular
Care
National Cardio-vascular Partners
. . .
FMCNALines of Business
. . .
Fresenius
Rx
Fresenius
Health
Care
Medspring
SoundPhysicians
SoundPhysicians
FMCNALines of Business
Workfow
Rules Engine
Data Transformaton
Services(Restul, FHIR, API…n
Orchestraton
Development Platorm
eCF eCC Rx FVC
Fabric concept
Fabric FHIR manifestation – Internal applications and consumers
SPA SPA, SWIFT, Android
Care Coordinaton
Patent PortalOrderingChartng
Clinician PortalAdmissions
Populaton Care ManagementPoint of Care EHR
User provision
Business Applicatons
Spring BootContainer
SPA
SPA Service
Jboss EAPContainer
MPASpring BootContainer
SPA Service
Business ApplicatonDomain Services
FHIR
FABRIC
Enterprise Healthcare Data
Precision Nephrology
Data Transformaton
Restul, FHIR, API…
Orchestraton
Development Platorm
OpenID Connect and Oauth2.0
Workfow Engine
STU3 FHIR Server
DATAClinical Financial
Pharmacy others
INTRANET
OpenID Connect SSO
FABRIC = (ESB + Platorm as a Service)
SECURITY – MONITORING – AUDITING _ DEPLOYMENT
Workfow Engine(Business and Service)
Messaging Data Transformaton
Services(Restul, FHIR, API…)
Orchestraton Development Platorm
SMART OS – RedHat 6.x
SMART PaaS - Platform as a Service (container manager) – FABRIC8
SMART Containers – OSGI, SPRING BOOT (JVM stacks – Oracle WebLogic, JBoss EAP, Tomcat, Node.js)
SMART ESB – Web Services Apache CXF, Apache Camel Routes, Persistence (Mongo DB), back ends MS SQL, Oracle DB..
SMART SOA – FHIR Healthcare API, User Authorization, Caching, Workflow
SMART DATA – FHIR Resources
SMART APPS – Angular Apps
SMART Paas – OpenShif 3.0
SMART Containers – Docker
SMART SOA – Data Virtualizaton
Current Layers Evolving Layers
Open Source with Commercial License Support
Fabric layers under the hood
FHIR on FABRIC – The APIs
ClinicalAllergiesConditonsProcedureClinical ImpressionAssessment…
AdministratonPatentsPracttonerRelated PersonOrganizatonHealthcare Service…
DiagnostcsObservatonDiagnostc ReportBodySiteQuestonnaireResponse….
MedicatonsMedicatonMedicatonOrderMedicatonAdminImmunizaton….
FinancialCoverageEligibilityEnrollmentClaimEOB….
WorkfowTaskEncounterAppointmentScheduleSlotSupplyRequestSupplyDelivery….
SecurityProvenanceAuditEventConsent….
DocumentCompositonDocumentManifestDocumentReference….
FABRIC
eCC eCFFHIR
BPM ESB
MS SQL MS SQL
EAP, SPING BOOT
HL7 FHIR API STU-3
JBOSS FUSE INTEGRATION
JBOSS BPM SUITE
COMPONENTS
Security Audit
Cache
PharmRx
MS SQL
KCNG KC EMPIOPEN SOURCE
Oracle
onBase
SMART DATA BPMFHIR Workfow, Business ProcessDual Data Center HA Actve-Actve
JBPM Suite, KIE Knowledge Is Everything (Drools, jBPM, OptaPlannern
BPMN 2.0, BEPLUser, Role and Credental BasedAuthoring, SimulatonData Modeler ted to FHIR Object ModelDeployment Management, Analytcs
BPM under the hood
SMART DATA BPMFHIR Workfow, Business ProcessDual Data Center HA Actve-Actve
BPM and FHIR under the hood
WHY BRMSWe Hear Yes
• Business automaton
• Segregate Rules and applicaton code
• Business user friendly
• UI tools for business
• Developer tool with eclipse• Marketplace -> Redhat developer studio
• Decision service -> Rules Engine
• Business Process Module
Use Case
• FEA drugs are expensive.
• Requires extensive approval process.
• Process is / was manual.• Clinics submits requests for a patent on a paper form.
• FEA department reviews each requests – approve or deny.
• Operatonal integrity team enters assessments in the EMR for each approved patent.
• Approval requires the patent to be Financially eligible and Clinically eligible for certain drugs. Clinical Eligibility is required.
P&T (Pharmaceutical and Therapeutics) Project
•Phase I (Sensipar and Parsabivn
•Phase II (Dialyser and other FEA drugsn
P&T (Pharmaceutical and Therapeutics) Project • Phase I
• Nightly Process (Sensiparn• Run a query for Financially Eligible(FEn Patents – add them to group in FHIR / FABRIC
• Run rules for Clinical Eligibility (CEn
• If clinical eligible (passed thru all rulesn
• Add this patent to CE group.
• Create an assessments – approved for the drug to be added to their order (treatmentn
• Find patents from FE group that are not CE and run rules to see if the have become CE.
• P&T UI (Sensipar denials and Parsabiv Approvals and other FEA drugs Approvalsn
• Check if the Patent is FE
• Run rules for Clinical Eligibility (CEn
• If clinical eligible (passed thru all rulesn.
• Create an assessments – approved for the drug to be added to their order (treatmentn
P&T Deployment
FHIR DATA MODEL
BRMS MODEL
BUSINESS RULES – Denial Rules
BUSINESS RULES – Acceptance Rules
Data passed to Rules Engine
"valueString":"{\"patentMrn\": \"5000307404\",\"patentVoid\": \"2026253\",\"userLoginId\": \"TPTCommitee\",\"clinicId\": \"1271\",\"formUsage\": \"Excepton Medicatons\",\"formUsageDisplayName\": \"Formulary Excepton Medicatons\",\"formElementName\": \"FE_4%SodCitBox\",\"assessmentData\": [{\"name\": \"SCH_EnttyName\",\"value\": \"1271\"}, {\"name\": \"FE_SensiAuth\",\"value\": \"FHIRAUTOMOTIVE\"}, {\"name\": \"FE_SensiStDt\",\"value\": \"20180105\"}], \"medRequestJPAId\":\"MRP1170106328\"}"
ROI – automated process
Automated Manual
Form Submissions
Form Submissions
ReviewReview
Manual EntryManual Entry
Nightly ProcessNightly Process
Denials using UIDenials using UI
Times 1000 clinics
ROI – Cost Beneft
• Time spent on one approval• 1-2 hours per request
• 100 requests per day• Hours saved per day 100 to 200 person hours
• Projected 500 requests per day with Sensipar
• Manual hours saved
• Cost of project recovered in 2 -3 months
BRMS Challenges – Worth Investing time and money Time consuming at frstInital setupTrainingConsultant help – extremely helpful
Initalizing variables
Learning MVEL dialect
Understanding of Rules group
Ataching rules in the Process
Conversion of FHIR objects
Executon of Rules
List of resources htps://access.redhat.com/documentaton/en-us/red_hat_jboss_bpm_suite/
https://www.drools.org/learn/documentation.htmlhtps://www.drools.org/learn/video.htmlhtps://www.drools.org/learn/slides.htmlhtps://www.drools.org/download/download.htmlhtps://docs.jboss.org/drools/release/6.5.0.Final/drools-docs/html_single/htps://github.com/gigamailer/simplenin/blob/master/Mastering%20JBoss%20Drools%206-Packt%20Publishing%25282016%2529.pdf
htps://github.com/marianbuenosayres/jBPM6-Developer-Guidehtps://www.amazon.com/jBPM-Developer-Guide-Mariano-Nicolas/dp/178328661Xhtps://www.javacodegeeks.com/minibook/jboss-drools-cookbookhtps://github.com/kiegroup/droolshtps://github.com/kiegroup/drools/tree/master/drools-exampleshtps://github.com/kiegroup/drools/tree/master/drools-examples/src/main/resources/org/drools/exampleshtps://developers.redhat.com/products/red-hat-decision-manager/download/htps://developers.redhat.com/products/bpmsuite/download/?sc_cid=701f2000000tvRKAAY&gclid=EAIaIQobChMIhMaNjf202gIVDBBpCh2PcAR3EAAYASAAEgJxyPD_BwE
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