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FHIR standards in healthcare: an interview with Lyniate

In this interview feature, Matt White speaks with John Mitchell, Implementation Consultant at Lyniate, and James Hardacre, Senior Implementation Consultant specialising in Rhapsody by Lyniate, to explore and discuss FHIR standards.

Can you briefly take me through the background to FHIR and HL7?

James: I used to be heavily focused on HL7 v2 and always have been for around 15 years and I just thought FHIR was never going to happen. After looking further into it, I couldn’t understand how it was working; I wanted to know how I could convert from HL7 v2 into FHIR, and I could not get a straight answer from anybody.

Technically, converting from HL7 to FHIR is not the way to think about it because although it is possible, it is a different mindset. HL7 is the event-driven standard, whereas with FHIR, information is stored and then queried on the FHIR server it is stored upon; it is a very specifically structured file.

John: A lot of our customer projects are focused to integrate their internal systems with one another. More recently the focus has also been externally as well, such as using FHIR standards to send electronic discharge summaries from a hospital setting to primary care.

We are starting to see a shift away from integration within the organisation to a more broadly defined version of integration that includes those external entities. We have been working on developing a new standard based on the FHIR standard, to be able to capture data and communicate it to support these customer projects.

Could you take me through some use-case examples?

John: Following the NHS mandate that FHIR should be used in October 2018, we started getting a lot of queries hoping we would have a black box to send HL7 into and it will just spit out FHIR. It was not possible. Initially we had a number of different ways we were creating and exploring FHIR for customers, and we’ve since honed that down.

One project as part of the NHS Global Digital Exemplar programme was with Mersey Care NHS Foundation Trust, who were given some extra funds and started producing FHIR. They then had Fast Followers behind them who would just follow the steps of what Mersey Care had done and not create FHIR for themselves. This project went well.

We had other people who had asked us to work with FHIR, where someone was sending them FHIR and they could not handle it, so they wanted us to change FHIR back into HL7—to reverse engineer FHIR, to deconstruct FHIR.

Examples do vary. One customer had all the necessary data and told us they were using a chair interface to create FHIR. We had never heard of a chair interface before and they were using it quite blasé. We found out that a chair interface was someone sitting on a chair and cutting and pasting data!

One significant example: we worked with CliniSys Group during Covid, who had Rhapsody embedded within their clinical laboratory management solution and used it to support the system set-up of new labs and to prepare the Nightingale Hospitals.

In March 2020, government leaders mandated that every lab doing Covid tests must use NPEx to exchange data in the fastest possible timeframe. NPEx is using CliniSys solutions embedded with Rhapsody to achieve this. Data exchange through the NPEx is important because it allows test orders to be distributed to labs that have the most capacity to perform the test.

Could you tell us about the Co-Creation Lab?

James: The Co-Creation Lab is a Lyniate enterprise to provide an opportunity to collaborate and create innovative solutions tailored to specific needs.

The lab is a design environment where Lyniate and partners converge to develop, prototype and operationalise solutions addressing persistent and emerging interoperability issues.

One of the pieces of work I am focusing on is a converter that will allow customers to collate all the information that they need, the bare minimum, to create an electronic discharge summary. The data will come from lots of different places in order to collate it for it then to be sent it to Rhapsody to convert it into a true FHIR EDS.

John: It is the goal of these customers to translate HL7 messages to FHIR; messages that state when a patient should be discharged, or similar instruction.

The Co-Creation Lab is essentially a troubleshooting section of the company, and the goal of it is for us to help customers to do something that is not out of the box — a big project that would benefit us to understand it, and benefit them to understand it, and also benefit our other customers in understanding it as well.

The idea is to equip Rhapsody with tools and to make it as simple as possible, just to receive input in HL7 and send it through this black box and it will generate FHIR; that’s the holy grail of HL7 to FHIR because that’s what most of our customers want. The Co-Creation Lab is pretty cool!