---
title: FHIR EHR
tags: fhir-project
---

<font color="red">FHIR</font> Electronic Health Record (EHR)
===
###### tags: `fhir-project` `ehr`

## Table of Contents
[TOC]

## Introduction
In the EHR scenario, each healthcare organization's will have their own EMR system where the patient's medical record **cannot** be shared with other healthcare organization. For example, patient's record in **Oxford Hospital** EMR system cannot be integrate accessed by **Harvard Hospital** practitioner. The patient’s record might still need to be printed out and delivered by mail to the Harvard Hospital.
Therefore, EMR provides a RESTful API that only allows practitioner of their own organization to access the patient's medical record under the organization.

:::info
:bulb: **Q&A**
Q: Is it possible to share patient's record across different hospital's EMR system digitally?
A: Absolutely YES! Check the [**Patient Portal**](https://hackmd.io/@victoriatjia/patientportal) page
:::

## Features
In this scenario, the EHR provider:
- Provides the practitioner with a login that identifies them
- Authenticates the practitioner using an appropriate OAuth server for the login and restricts the practitioner to viewing records associated with the specific patient
- Allow the practitioner to generate patient's medical record

## Required FHIR Resources
The EHR exposes a FHIR server that supports the CRUD (Create, Read, Update, Delete) operations on the following resources:
- Organization
- Person
- Practitioner + PractitionerRole
- **Patient**: In order to provide demographics to the client. When a client searches patients with no search criteria, they get a list of all patients they have access to
- Observation, Immunization, DiagnosticReport: Clinical data
- AuditEvent
- Composition
- **Bundle**: for the purpose of general patient report documents in the form of PDFs etc. (PDFs are preferred)

## System Description
1. Login System
<center>*Example of user module diagram in Radiotherapy EHR System*</center>

We're going to use below scenario for the detailed example.
**Scenario #1** Oxford Hospital is going to develop an EHR system, with practitioner listed below:

| No. | Department | Role | Name|
| -------- | -------- | -------- |-------- |
| 1| General Medicine| General physician |Dr. Elon Musk |

<!--| 2| IT| IT Admin |Victoria| -->

### **Step-by-step**:
1. Create Organization for Oxford Hospital:
:::spoiler [Organization/2863475](https://hapi.fhir.org/baseR4/Organization/2863475)

{
  "resourceType": "Organization",
  "active": true,
  "type": [ {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/organization-type",
      "code": "prov",
      "display": "Healthcare Provider"
    } ]
  } ],
  "name": "Oxford Hospital",
  "telecom": [ {
    "system": "phone",
    "value": "911"
  } ],
  "address": [ {
    "text": "21, Washington Street"
  } ],
  "contact": [ {
    "name": {
      "text": "Victoria"
    },
    "telecom": [ {
      "system": "email",
      "value": "[e-mail]"
    }, {
      "system": "phone",
      "value": "0812345678"
    } ]
  } ]
}

:::
2. Create Organization for General Medicine Department
:::spoiler [Organization/2916249](https://hapi.fhir.org/baseR4/Organization/2916249)

{
  "resourceType": "Organization",
  "active": true,
  "type": [ {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/organization-type",
      "code": "dept",
      "display": "Hospital Department"
    } ]
  } ],
  "name": "General Medicine",
  "partOf": {
    "reference": "Organization/2863475"
  }
}

:::

<!-- 4. Create Organization for IT Department: [Organization/2916250](https://hapi.fhir.org/baseR4/Organization/2916250) -->

3. Create Person for Dr. Albert Einstein's account username and password
:::spoiler [Person/2865781](https://hapi.fhir.org/baseR4/Person/2865781)

{
  "resourceType": "Person",
  "active": true,  
  "identifier": [ {
    "system": "UserID",
    "value": "[e-mail]"
  }, {
    "system": "Password",
    "value": "NThjYzgzZjViODBjYjUzY2U1Mzg1YWY5NTY0NThmYTllYWVkODk4MjVhZmY3NmE4MjQ5MTAzYzEwZGVlODY3ZQ=="
  }, {
    "system": "HighestEduDegree",
    "value": "Master"
  }, {
    "system": "Institution",
    "value": "Oxford University"
  } ],
  "name": [ {
    "text": "Elon Musk"
  } ],
  "telecom": [ {
    "system": "email",
    "value": "[e-mail]"
  } ]
}

:::
<br>

5. Create Practitioner for Dr. Albert Einstein as a healthcare professional in Oxford Hospital
:::spoiler [Practitioner/2865782](https://hapi.fhir.org/baseR4/Practitioner/2865782)

{
  "resourceType": "Practitioner",
   "active": true,
    "name": [
    {
      "text": [
        "Elon Musk"
      ]
    }
  ]
}

:::
<br>

6. Create PractitionerRole for Dr. Albert Einstein role as General physician in Oxford Hospital
:::spoiler [PractitionerRole/2865783](https://hapi.fhir.org/baseR4/PractitionerRole/2865783)

{
  "resourceType": "PractitionerRole",
  "identifier": [ {
    "system": "PractitionerID",
    "value": "P0002"
  } ],
  "active": true,
  "code": [ {
    "coding": [ {
      "system": "http://hl7.org/fhir/R4/valueset-practitioner-role.html",
      "code": "doctor",
      "display": "Doctor"
    } ]
  } ],
  "practitioner": {
    "reference": "Practitioner/2863581",
    "display": "Elon Musk"
  },
  "organization": {
    "reference": "Organization/2916249",
    "display": "General Medicine-Oxford Hospital"
  },
  "telecom": [ {
    "system": "email",
    "value": "[e-mail]",
    "use": "work"
  } ]
}

:::
<br>

7. Update FHIR Person to link the Person resource with Practitioner resource
:::spoiler [Person/2865781](https://203.64.84.213:52883/binus/fhir/Person/2865781)

"link": [ {
    "target": {
      "reference": "Practitioner/2865782"
    }
  } ]

:::
<br>