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Making Science Computable with FHIR

The EBMonFHIR Project

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Brian S. Alper, MD, MSPH

® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

May 14, 2025

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Our Team

Computable Publishing LLC

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SCIENCE DID NOT HAVE AN INTEROPERABILITY SOLUTION

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Healthcare Knowledge Ecosystem Today

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Data

Evidence

Guidance

Action

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Healthcare Knowledge Ecosystem Desired

Data Analysis, Synthesis, and Interpretation.

EVIDENCE

Guidelines, Recommendations, Decision Aids, Decision Support

GUIDANCE

Observations and Measurements.

DATA

Healthcare (testing and intervention) decision-making and implementation

ACTION

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Produce guidance

Disseminate guidance

to policy makers, clinicians and patients

Implement guidance and decision support

Synthesize evidence

Produce evidence

Evaluate and

improve practice

Image adapted from MAGIC Foundation

Trustworthy

evidence

Coordination and

support

Common

Methodology

Culture for sharing and innovation

Tools

and

platforms

Digitally

structured

data

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Global standards

The Digital and Trustworthy

Evidence Ecosystem

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Produce guidance

​

Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Produce evidence

Evaluate and improve practice

What are we creating?

Trustworthy

evidence

Coordination and

support

Common

Methodology

Culture for sharing and innovation

Tools

and

platforms

Digitally

structured

data

​

Global standards

The Digital and Trustworthy

Evidence Ecosystem

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Produce guidance

Guidelines, Decision Aids, Clinical Decision Support

​

Disseminate guidance

Implement guidance and decision support

Synthesize evidence

Systematic Reviews

Produce evidence

Research Studies

Evaluate and improve practice

What are we creating?

Trustworthy

evidence

Coordination and

support

Common

Methodology

Culture for sharing and innovation

Tools

and

platforms

Digitally

structured

data

​

Global standards

The Digital and Trustworthy

Evidence Ecosystem

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EBMonFHIR extends HL7 FHIR to EBM data

® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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FHIR EVIDENCE RESOURCE IS THE ATOMIC UNIT FOR SCIENCE

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  • What is FHIR?
  • What is EBMonFHIR?
  • What is the FHIR Evidence Resource?

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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Each variableDefinition instance:

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  • Has a variableRole code
    • e.g. population, exposure, outcome
  • May have observed Reference
    • (Group || EvidenceVariable)
  • May have intended Reference
    • (Group || EvidenceVariable)

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Evidence.statistic

  • statisticType (e.g. odds ratio) and attributeEstimate.type (e.g. p-value) are CodeableConcepts
  • numberAffected and sampleSize elements are unsignedInt values
  • modelCharacteristic can handle complex statistical models

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Anatomy of FHIR Evidence Resource

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New codesystems were created for…

  • Evidence.studyDesign
  • Evidence.statistic.statisticType
  • Evidence.statistic.attributeEstimate.type
  • Evidence.certainty.type
  • Evidence.certainty.rating

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SCIENTIFIC EVIDENCE CODE SYSTEM (SEVCO) – TERMINOLOGY FOR SCIENCE

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Goals

  • Coordinate terminology for evidence communication across many expert groups globally, within and external to HL7
  • Avoid terminology management at the ‘single FHIR Resource’ level of development
  • Provide comprehensive, maintainable approaches for terminology development and maintenance

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Terminology Development Protocol

  • Create an open Expert Working Group
  • Recognize the common uses in current systems – to set the scope
  • Recognize existing ontologies and terminologies (to re-use if suitable)
  • Deliberate on preferred term, alternative terms, definition, and comment for application UNTIL 100% agreement

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Tooling for Terminology Development

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Tooling for Terminology Development

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Tooling for Terminology Development

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SEVCO 2.0 has 486 terms

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EBM-ON-FHIR IG – BROAD SCOPE

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EBMonFHIR IG contains 124 new artifacts

  • 15 Profiles of Evidence
  • 4 Profiles of EvidenceVariable
  • 20 Profiles of Group
  • 9 Profiles of Citation
  • 11 Profiles of ArtifactAssessment
  • 14 Profiles of Composition
  • 15 Profiles of other Resources (ResearchStudy, …)
  • 36 Extensions

® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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StudyEligibilityCriteria Profile

  • Profiles of CohortDefinition used for the inclusion and exclusion criteria of specific definitional groups include

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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EBM-ON-FHIR TOOLING

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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EBM-ON-FHIR ACTIVE DEVELOPMENTS

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Active projects include

  • Working with AWMF in Germany to support a national Guideline Digital Library
  • Working with eBASE Africa in Cameroon to digitize a Malaria Guideline
  • Working with Vulcan UDP and ICH M11
  • Research Study Data Dictionary
  • HEvKA

® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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® Health Level Seven and HL7 are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

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https://fevir.net/HEvKA to join any of these meetings