FHIR interoperability platform choice - interop

I want to create an interoperability platform FHIR compliance with a complex business logic.
Our clients can send FHIR resources to platform.
The best architecture by best practise documentation is an ibrid system FHIR + SOA, as this link says.
Now I write two examples of scenario I must to manage:
The first:
I want to create a ServiceRequest resource with a subject where I know only the fiscal code as identifier. If I need other informations about the subject I can query an external database, for example, to know name, surname and others.
I can do this, send to my interoperability platform only a Service Request as follow?
"resourceType" : "ServiceRequest",
"subject" : {
"reference" : "Patient?identifier=FISCALCODE"
}
and so on
The second:
I want to create a ServiceRequest resource with a RelatedPerson linked in the requester tag.
The RelatedPerson is not a fully registry, I know only name and surname and a link to patient.
I must create a SOA method createServiceRequest where I must to pass two parameters the ServiceRequest and RelatedPerson? Or I can use a CRUD method for Bundle resource where I put as entries my ServiceRequest and my RelatedPerson?
So if I try to summarize, the possible ways are:
Create a method createMyMethodName(ServiceRequest serviceRequest, RelatedPerson relatedPerson)
Creation and exposure of this method is it FHIR standard?
If the answer of first quesiton point is YES, in my platform I'll have a lot of custom methods but I have a very strict control on the input informations
Use a CRUD Bundle method where I pass into the Bundle resource the following entries: ServiceRequest, RelatedPerson
In this way I expose only one method to write on my platform, but I must to implement a lot of code to manage all input bundles with several different entries (I suppose a mega switch and then for each branch I apply the business logic controls to accomplish my business logic rules)

This response is not intended as a complete response to your question and comes from a US perspective; however, you may find the perspective useful.
Gotcha with identifier queries
"reference" : "Patient?identifier=FISCALCODE"
As written, your ?identifier=FISCALCODE will query the FISCALCODE key against all code systems. I think what you want is to specify a code system, e.g. ?identifier=<CodeSystem>|<FiscalCode>
This is a common gotcha that's buried in the FHIR search documentation.
You'll either have to reference an existing code system, e.g. an Italy specific implementation guide analogous to US Core that contains the list of FiscalCodes, or author your own.
Which FHIR integration paradigm are you using?
Before diving into the createMethod vs Bundle question, I think it'd be useful to step back and pick an overall FHIR integration approach.
In my opinion, there are three major approaches:
Load data into an existing stand-alone FHIR server
Challenge: Drift between data loaded in FHIR server and other data warehouses
FHIR server queries non-FHIR API
Challenge: Duplication between FHIR API and non-FHIR API
NB: In the limiting case, there is no data stored in the FHIR server proper. Adding to the confusion, some will call this implementation a "FHIR gateway" instead of a "FHIR server."
FHIR server queries staging database for FHIR data
Challenge: Must write data access for each FHIR resource and each data element.
In the future, there may be a fourth approach where one uses the FHIR mapping language in real-time from an intermediate source model to multiple targets.
Your "CRUD Bundle method" is more in-line with POSTing data to a stand-alone FHIR server, whereas your "createMyMethodName" is more in-line with writing DAOs (Data Access Objects) to an external database.
In the limit where you don't need to maintain synchrony between the FHIR server and source data systems, importing data into a stand-alone FHIR server is much less work.
In the limit where you already have mappings to an intermediate data model (in the US, many large service providers will have mappings to either the USCDI or the Common Clinical Dataset), you'll have an easier lift writing CRUD in the FHIR server against an existing database.
For a more in-depth discussion, there was a FHIR integration patterns talk at FHIR Dev Days 2018, starting at Slide 21. Note that the author assumes a familiarity with architectural patterns such as the facade pattern.
Select a stand-alone server or library
Unless you have a compelling requirement or are a large company, it's advisable to use an existing open-source stand-alone server or library implementation. The three most popular are:
HAPI-FHIR (Java)
Microsoft (.NET)
IBM (Java)
If taking the stand-alone option, popular commercial FHIR servers
Microsoft (hosted in Azure)
Smile CDR (commercial version of HAPI-FHIR)
Firely Vonk

Related

Microservice architecture with strong binding to external API

Lets say I have multiple domain services for book, review and customer with a database each and a BFF as proxy/mediator for the client. The BFF brings all data together and communicates with non-domain-services. There is also an external API where some data is fetched from or sent to:
I am facing some issues here:
isolation: The book model is distributed over several services which also implies a lot of request/response mapping. Ergo: If the book domain model changes I have to change a lot of stuff, although, according domain modelling or microservices should rather prevent developers from adjusting multiple services/interfaces.
external dependencies: Unfortunately, in the real life scenario it is even worse, because the book service is implicitly highly coupled to the external API, meaning that, if the book model of the external API changes, the book service will probably change too.
validation: AFAIK validation should belong to the domain service. In the real life scenario however, I have to access author, customer and book at once, in order to do business validation.
Can you give me some direction how to deal with these issues?

Setting up SMART app for FHIR and utilizing existing resources

I am learning about building a SMART app on FHIR for accessing EHR. I was going through the available documentation and reading material but there's one thing which I am not clear about.
Is there a way that I can access the existing patient's data i.e. I skip the part where I create and upload the FHIR data/resource and just validate and utilize the existing data?
Are there any services, that are available for that?
Many around the industry host FHIR servers as "sandbox" environments so you don't have to spin up an Azure server and load it with resources.
SMART hosts a sandbox at https://launch.smarthealthit.org with sample patients - and can do the SMART OAuth functionality as well.
The SMART landing page lists several EHR vendor sandboxes which will give you a mix of testing tools - some can get you all the way to working SMART on FHIR app with fake patients.
There are also many sandboxes that don't have SMART on FHIR in front of them -
Redox
ONC
Vonk/Firely
test.fhir.org
SMART accesses information over a FHIR interface - so the desired data must be exposed in a manner compliant with the FHIR's requirements for a RESTful search call. That doesn't mean the data must be stored as FHIR or must be moved to a FHIR server. Lots of systems with non-FHIR-based data stores are capable of providing access to that data over a FHIR interface. However, you'll have to build that interface. There are third-party tools that can help you build the interface, but given that each legacy system stores data differently, there's nothing that would do it 'automatically' without manual mapping effort.

What FHIR API would enable one to write notes to patient chart - specifically in Epic

I'm looking for a way to write notes into patient chart in Epic. Couldn't find any current FHIR specs about writing notes , but I didn't find this proposal http://wiki.hl7.org/index.php?title=ClinicalNote_FHIR_Resource_Proposal
Are there any other options ?
Great question. I work on the FHIR team at Epic and from a FHIR perspective we are having a similar problem identifying the appropriate place in FHIR to return notes. The proposal you have linked is a starting artifact in defining a new resource for that purpose. Until we determine in the FHIR community if a new spec should be created or an existing FHIR resource should be used, we do not have a FHIR specification to develop support against.
Outside of FHIR, today there are multiple ways to get notes into Epic such as HL7 v2, document based exchange, or something more Epic defined (these are just the ones I'm aware of). Without knowing more about your use case, it is hard to say what option may or may not meet your needs. I recommend you reach out through the contact us at https://open.epic.com/. From this email group they can dive into what integrations would meet your specific scenario and you will have input from a full gamut of integration experts.
And if you are interested in the standards side of things and getting notes in the FHIR specification, I'd encourage you to get involved on chat.fhir.org or any of the HL7 FHIR meetings to provide input on the specification!
*Edited to point to website instead of email.

How to reduce redundancy in a service implemented using multilayer architecture while maintaining consistency across the system?

Currently our service is implemented using a multilayer architecture dividing the whole service into three:
API
Business
Persistence
However this introduces a lot of redundancy within our system. A common adage in the industry is "DRY" (Don't Repeat Yourself). The redundancy has increased the development time, and made the system more fragile and cluttered our code with "copy" methods.
To give a better idea, say we have a Person service. This would require the following:
Person entity - JPA annotated class for ORM
Repository service request - contains field values to be persisted of the Person domain object with additional persistence options
Repository service response - contains field values of the Person entity
Person - class with business logic, domain fields and computed fields
Domain service request - contains field values of Person resource and additional business options
Domain service response - contains field values of Person business object excluding those that shouldn't be visible to API users
Person resource - class representing what should be viewable to the API users
And things get worse when taking nested objects into consideration.
The current design facilitates difference between concerns (business, API, persistence), however:
Currently, the differences are very small. This is causing us to have
very similar classes with only minor differences
Services returning
service response objects with fields instead of just the objects
itself hampers other services from depending on other services
Questions:
Is it worth it to go through with this design?
What are our alternatives?
What could we change to improve our situation?
I know where you're coming from. My shortest advice would be: read "Domain Driven Desing - Tackling Complexity Inside the Heart of Software" by Eric Evans.
A central part of the DDD is the domain: POJOs containing majority of the business logic.
The building blocks are more or less what you've already mentioned.
There are three kinds of services:
Application Services that are responsible for orchestration, transaction management and authorization
Domain Services contain business logic that doesn't fit other domain building blocks: entities, policies, factories, value objects. Create them only if you can't use other domain mechanisms.
Infrastructure Services. The most common are repositories which are responsible for persistence of root aggregates (this role play some of the entities), and only them. This is contrast with DAOs which are created for any entity. Other infrastructure services might be for instance clients of Web Services that are being used by the application.
This richness of different kinds of services together with the idea of pushing the logic down as far as possible, because the logic in the domain is the most easily reusable, gives the developers tools they need to build comprehensive and maintainable complex software. Note that DDD might be too heavy for simple CRUD apps.
The entry points to the system are either Web Services endpoints or controllers (for Web apps where UI is generated on the backend like in case of JSPs of JSFs).
For the middle sized systems I like to use approach inspired by CQRS, that is, in order to avoid inevitable slowness when loading multiple root aggregates for displaying purposes (read side) I write dedicated query services that return DTOs straight from the DB, in case of JPA using select new mechanism.

ETL of Human Resource data from Taleo

My company needs to migrate data from a Taleo system to a new HR system.
A little research suggests that traditional ETL may not work against the Taleo cloud based system, but I don't know enough about the setup and am trying to learn.
Does anyone have experience migrating HR data from Taleo to another system, and, if so, how did you do it, and was traditional ETL an option?
Thanks
How you access Taleo depends as much on your platform as theirs.
Example: I'm using Windows:
not sure if this is my mistake ~~ vs2010 Add Service Reference fails
Taleo has just released a new version that as has killed a number of companies temporarily.*
Whether your ETL is one time or continous, Taleo provides a .PDF version of their API that works as follows for employee records (I'm only grabbing their employee records). Other records appear to use the same paradigm.
Employee records have two types of fields: fixed and user defined. The fixed fields which I work with in c# are like simple properties of a class and can be accessed with standard .name notation such as taleoItem.ManagerId. The user defined names are in list of "beans" ... for each bean, one looks first at its name ( *foreach (var taleoItem in taleoEmployeeBean.flexValues) ... if (taleoItem.fieldName == "Social Club Member") { ... ). * currently I'm getting zero of the 50+ flexbeans that I normally get and two flexbeans that I've never before seen. as can be expected, until Taleo fixes this breakage, all that I can to is twiddle my thumbs
When Taleo works properly, retrieving data generally works like this.
access a fixed url to get a url for your company;
authenticate via the url retrieved from step 1 to get a session token.
use the session token from step 2 to invoke the various Taleo API methods.
Warning: the Taleo API has documentation errors. Also, the test cases will not necessarily work.
I'm not familiar with Taleo, but according to their website they have features that allow integration via "XML, Web Services, reusable components, and standard APIs". There are many ETL tools on the market that can interface with web services as a source, or you could optionally write your own.
Taleo provides a PDF which described all the calls that can be made. Basically Taleo uses SOAP as web-service for accessing their data.
For a detailed description visit Taleo Integration in Drupal

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