Project Summary:

The project presented here is HSPCs pilot project, the development of the Office of Population Affairs (OPA) family planning annual reporting (FPAR) process in collaboration with American College of Obstetricians and Gynecologists (ACOG). The goal is to complete the models, standard content, and FHIR profiles (knowledge assets) required for the FPAR and utilize this project to develop processes for creating additional knowledge assets. The principal investigator (PI) for this study, Dr. Steve Hasley, is the ACOG CMIO, and has a close working relationship with OPA. He also has numerous contacts within the vendor community, as well as with HSPC.

The OPA administers Title X funding for family planning clinics across the US.  There were 7.2 million encounters for Title X in 2014, distributed over 4000 care delivery sites. In order to understand their clientele, and the services provided to those clients, OPA has requested that the Title X sites report data about their activities. The first version of this Family planning Annual Report (FPAR 1.0) requested only summative data from the sites (How many visits, how many PAP tests, etc.). A new specification (FPAR 2.0) has been developed, and requests data at the individual patient visit level, so that more detailed and sophisticated analysis can be performed. ACOG has been awarded the contract to develop FPAR 2.0 and is subcontracting with Intermountain Healthcare to develop information models mapped to standard terminologies and HL7’s Fast Healthcare Interoperability Resource (FHIR®) profiles. 

Many of the Title X sites have an Electronic Health Record (EHR) capable of recording discrete patient data, some do not. Of the sites with an EHR, there are over one hundred different vendors represented. Custom fitting a data extraction tool to all of these vendors so that they can submit FPAR 2.0 data is not feasible.  As per the 2015 CEHRT rule, vendors are now obligated to provide an open API so patient data can be viewed, transmitted, and downloaded. If a standard format for the FPAR 2.0 data elements could be constructed and distributed to these vendors, this would eliminate the need for custom mapping, and result in a uniform data stream to OPA. 

FHIR provides a framework for this type of standardization. Mapping the data elements in the FPAR 2.0 specification to a FHIR standard will provide a template for the vendors currently supplying those sites.

Operationalizing this standard across the Title X sites is an opportunity to demonstrate HSPC’s provider-vendor collaboration and FHIR’s utility in a production environment on a large scale.

For the purpose of this project, to demonstrate use of FHIR standard profiles to transmit the FPAR 2.0 dataset, we hope to use test FHIR servers established by Intermountain, several vendors, as well as independent entities to validate and measure the reliability and accuracy of data transmission.

Intermountain and ACOG have initiated the analysis of the FPAR data elements and mapped them to the Logical Observations Names and Codes (LOINC) and SNOMED Clinical Terms (SNOMED CT). Both parties also participated in a kick-off meeting with OPA. Stakeholders include OPA, ACOG, HL7, numerous EHR vendors, as well as the Title X sites and the clients they serve.

Intermountain IT departments that will be impacted by this effort include:

• Stan Huff’s team
• Naveen Maram’s modeling team

We propose to map the FPAR 2.0 dataset to a FHIR standard, and to demonstrate, across some FHIR test servers, that this data could be transmitted to a central server. We intend to measure the accuracy and reliability of this data transfer. This effort is part of a larger joint effort between OPA and the American College of Obstetricians and Gynecologists (ACOG) to operationalize FPAR 2.0 data collection into a central registry for analysis.

OPA wants this project to succeed so that they can get better data to support their mission. This project will demonstrate HL7 FHIR’s utility in a widespread, cross-platform production system. Finally, ACOG wants this to project to be a success because it serves a basic healthcare need for the women of the US. This project has alignment of goals among all the stakeholders, and yet is limited enough in complexity (data elements) that it is doable in a relatively small amount of time.

If the pilot is successful, we will move forward with additional use cases such as skin and wound assessment modeling with the VA

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