FHIR Implementation Guide for Stroke: A dual focus on the patient's clinical pathway and value-based healthcare

Autores da FMUP

• Ricardo João Cruz Correia

  Autor

Participantes de fora da FMUP

• Leandro, GD
• Moro, CMC
• Santos, EAP

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background: Stroke management requires a coordinated strategy, adhering to clinical pathways (CP) and valuebased healthcare (VBHC) principles from onset to rehabilitation. However, the discrepancies between these pathways and actual patient experiences highlight the need for ongoing monitoring and addressing interoperability issues across multiple institutions in stroke care. To address this, the Fast Healthcare Interoperability Resource (FHIR) Implementation Guide (IG) standardizes the information exchange among these systems, considering a specific context of use. Objective: Develop an FHIR IG for stroke care rooted in established stroke CP and VBHC principles. Method: We represented the stroke patient journey by considering the core stroke CP, the International Consortium for Health Outcomes Measurement (ICHOM) dataset for stroke, and a Brazilian case study using the Business Process Model and Notation (BPMN). Next, we developed a data dictionary that aligns variables with existing FHIR resources and adapts profiling from the Brazilian National Health Data Network (BNHDN). Results: Our BPMN model encompassed three critical phases that represent the entire patient journey from symptom onset to rehabilitation. The stroke data dictionary included 81 variables, which were expressed as questionnaires, profiles, and extensions. The FHIR IG comprised nine pages: Home, Stroke-CP, Data Dictionary, FHIR, ICHOM, Artifacts, Examples, Downloads, and Security. We developed 96 artifacts, including 7 questionnaires, 27 profiles with corresponding example instances, 3 extensions, 18 value sets, and 14 code systems pertinent to ICHOM outcome measures. Conclusion: The FHIR IG for stroke in this study represents a significant advancement in healthcare interoperability, streamlining the tracking of patient outcomes for quality enhancement, facilitating informed treatment choices, and enabling the development of dashboards to promote collaborative excellence in patient care.

Keywords

• Brazil; Critical Pathways; Electronic Health Records; Health Information Interoperability; Humans; Stroke; Value-Based Health Care; Information systems; Information use; Patient rehabilitation; Patient treatment; Clinical pathways; Clinical value; Health outcomes; Healthcare information system; Healthcare Interoperability; Implementation guides; International consortium; Stroke; Stroke care; Value-based; Article; artifact; book; cerebrovascular accident; clinical pathway; comorbidity; emergency ward; Fast Healthcare Interoperability Resources; fibrinolytic therapy; follow up; hemicraniectomy; home care; human; long term care; nomenclature; nursing home; patient transport; process model; questionnaire; stroke patient; subacute care; therapeutic index; thrombectomy; value-based care; Brazil; data interoperability; electronic health record; therapy; value-based care; Interoperability