Finnish Base Profiles
1.0.0-rc2 - ballot Finland flag

Finnish Base Profiles - Local Development build (v1.0.0-rc2). See the Directory of published versions

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Official URL: https://hl7.fi/fhir/finnish-base-profiles/ImplementationGuide/hl7.fhir.fi.base Version: 1.0.0-rc2
Draft as of 2023-02-20 Computable Name: FinnishBaseProfiles

Welcome to the Finnish FHIR Base Profiles Specification

This implementation guide specifies the Finnish FHIR base profiles.

It builds on top of the International Patient Access specification.

The profiles are based on R4, FHIR 4.0.1.

Standard for Trial Use Ballot Feedback

This documentation and set of artifacts are still undergoing development, and they are in DRAFT mode. The working group of HL7 Finland and the different interested parties are working on this specification. This is a DRAFT specification that is currently under review by the members of HL7 Finland. If you are interested in participating to the formal review process, please contact Timo Kaskinen, the chair of the FL7 Finland Technical Committee, or Mikael Rinnetmäki, responsible for publication of this implementation guide.

This version of this implementation guide is frozen and published as a base for the official ballot within HL7 Finland. The p See also the formal announcement in HL7 Finland's website (in Finnish only).

This ballot cycle is considered a Standard for Trial Use ballot in the HL7 Balloting process.

HL7 Finland does not use the HL7 Ballot Desktop or the Jira Ballot Process, rather feedback is gathered through email to timo.kaskinen@nhg.fi and issues in the GitHub repository of the implementation guide.

The main purpose of the ballot cycle is to solicit feedback from the wider FHIR community. The team involved in creating the first versions of the implementation guide have a limited view on the market and the activities of the community.

In the ballot process, the focus is on critical comments. We want to learn of any potential doubts and disagreements the community may have towards the specification created by the smaller core team.

Still, all feedback is welcome and appreciated and will be considered in the further development of the implementation guide. Please do also share positive feedback.

Some questions to trigger thoughts are:

  • Do you find the creation of Finnish FHIR Base Profiles worthwhile?
  • Is the purpose of the implementation guide clear and is the description of the problem domain adequate on this first page of the implementation guide?
  • Is this the right level for base profiles? The global community is still figuring this out. For instance, see the categorization of Base, Baseline, and Core profiles in the Canadian Baseline specification.
  • Are there clear errors or mistakes in the implementation guide? Please don't hesitate pointing these out!
  • Are there ambiguities or is some of the language confusing? Let us konw that too.
  • The selection of the FHIR resources to be profiled was somewhat arbitrary. What resources are missing that should be profiled? Where should the focus of profiling efforts be targeted?
  • Do you know of FHIR resources being used in Finland that are not profiled in this implementation guide? Would the Finnish FHIR community benefit from those resources being profiled? Could the parties using those resources benefit from making the use case more visible through this implementation guide?
  • Would you be able to provide examples from use cases to be included in this implementation guide?
  • Did you happen to learn something useful when reading this implementation guide? :)

We look forward to hearing from you!

Companion Specifications

There is a separate Finnish Implementation Guide for SMART App Launch that describes how the SMART specification is applied in Finland.

Why Do We Need Finnish FHIR Base Profiles?

Better flow of information between systems is one of the key enablers for digitalization and improved efficiency of healthcare systems. Better flow of information is facilitated by interoperability standards. HL7 FHIR® is one of the most important standards for interoperability and exchange of healthcare data.

For many things in healthcare it is hard to achieve a global consensus over what data should be coded and communicated, and how. The base HL7 FHIR standard does an excellent job in defining the global consensus where it exists. At the same time, it specifically allows and encourages smaller communities to come up with more specific profiles and implementation guides.

In many cases, the HL7 FHIR standard allows for several ways to implement a functionality. There are increasing concerns that without a coordinated approach implementers will choose different ways to implement some features, and this will lead to challenges for interoperability. This implementation guide attempts to define a consensus within the Finnish FHIR implementers on which ways we have considered the best fit for use cases in Finland.

In this implementation guide we also describe the code systems and identifiers that are specific to the Finnish healthcare system.

Notable FHIR Implementations in Finland

There are dozens of FHIR enabled systems and applications implemented and in use in Finland. This list does not attempt to be a complete list of all implementations. Rather, it is included here for readers not familiar with the Finnish healthcare system, as a quick glance to some of the most notable implementations at the time of writing of the first version of this guide.

Kanta

Kanta is the Finnish national central registry of health and social welfare information, with many services available for systems, providers, and citizens. Most of both the data and the APIs in Kanta system are based on HL7 V3 standards. However, there is ongoing work to open also FHIR based access to the information.

The part where HL7 FHIR is used the most is the Kanta PHR, a personal health record platform for storing and exchanging health and wellbeing data produced and governed by citizens. This part of Kanta is also the one most open to application developers.

Omaolo

Omaolo is a collection of services developed by DigiFinland, a publicly funded company. Omaolo has a fully HL7 FHIR based personal health record platform as its core.

Terveyskylä / Health Village

Health Village is yet another publicly funded group of services. It has built in HL7 SMART App Launch capability for interacting with third party apps.

Apotti

Apotti is a sizeable Epic installation in Finland. Epic is one of the biggest electronic health record system vendors globally.

CGI

The OMNI360 by CGI Finland is one of the prominent Finnish electronic health record systems and has several native FHIR APIs.

EskoSystems

The Esko APTJ by Esko Systems is also one of the prominent Finnish electronic health record systems. It uses several FHIR APIs internally, and offers a SMART App Launch method to interact with third party systems.

Learn more

The FHIR Demo 2022 showcase presented integrations implemented between a dozen platforms and more than a dozen FHIR apps, all based on HL7 FHIR.

Even that showcase did not cover the full extent to which HL7 FHIR is being used in Finland. There’s a lot going on!

To learn about the current status, please contact HL7 Finland. We’re happy to give you an overview.

Profiling Approach

The base FHIR specification works on a global scope. It is hard to achieve consensus on many things globally. However, smaller regions and jurisdictions are in a better position to agree on tighter constraints.

Local Considerations

For instance, different coding systems and terminologies are used in different parts of the world. In this implementation guide, we document which code systems and terminologies are used in Finland and how they are applied in FHIR.

The FHIR standard also allows implementers to implement many features in several ways. One example is scheduling. Some jurisdictions are working on scheduling API’s based on FHIR operations. In Finland, existing solutions have chosen to go with a more fine grained approach with pure FHIR resources and the REST interface.

International Aspects

Our main intent is still to limit profiling specific to Finland. During the process, we actively monitor other national base profiles. We attempt to harmonize our base profiles with already published base profiles from other Nordic countries, specifically the Danish DK Core, the Norwegian no-basis-Profiles, and the Swedish Base Profiles.

The Finnish FHIR base profiles derive from the International Patient Access (IPA) specification where applicable, and we will keep the specifications conformant. Should we find any constraints in IPA that we can’t adhere to, the main resolution should be to affect the IPA specification and search for wider consensus and shared understanding.

Other notable national base profiles under our radar are the US Core, the Canadian baseline, the Swiss CH Core, and the Australian AU Base.

See also the National IG Implementations page in HL7 International’s Confluence.

Profiles and Examples

We publish profile resources that help implementers validate their implementations.

We also publish examples, as we think they are another good way to interoperability.

Also, where we cannot find consensus and agree on one single approach, we attempt to document all different approaches used.

Governance

The profiling work is performed in a project driven by HL7 Finland. See the announcement (in Finnish), the running memo, and some more details. We warmly welcome new participants to the project. You may even be compensated for your efforts.

The team involved in creating the first version of the specification includes

  • Arto Huusko, CGI Oyj
  • Janne Heikkinen, BCB Medical Oy
  • Jari Kariniemi, Kymenlaakson hyvinvointialue
  • Jari Vuonos, Apotti Oy
  • Joni Hirviniemi, Fujitsu
  • Jyrki Soikkeli, Apotti Oy
  • Marko Kaukonen, BCB Medical Oy
  • Markus Lind, Buddy Healthcare Oy
  • Markus Suonpää, CGI Finland Oyj
  • Mika Jylhä, Esko Systems Oy
  • Mika Lentovaara, HUS
  • Mika Tuomainen, Kela
  • Mikael Rinnetmäki, Sensotrend Oy
  • Tero Pekkola, Esko Systems Oy

Collaboration

We want this implementation guide to be useful for you.

If you are implementing FHIR in a system or application that is meant to be used in Finland and are thinking of some implementation details, you are probably in the right place and this implementation guide should help you with those questions. If this implementation guide in any way fails to give you the answers you are looking for, we’d love to hear about it so we can make it better. Please do be in touch in one of the ways listed below.

Open an Issue in GitHub

The source code of this implementation guide is maintained in a publicly accessible repository in GitHub. Issues opened in that GitHub repo are very welcome. They help the team pick up any proposed changes or additions and to discuss them publicly.

Open a Pull Request in GitHub

Pull requests are even better. If you are in a position to suggest how exactly your proposal should be implemented in the specification, do it! It helps the team maintaining the implementation guide a great deal.

Participate in IG Development and Maintenance

Please also consider joining the development effort. This is the best way to affect the outcome of the profiling work. You may even be compensated for your efforts. Please be in touch with HL7 Finland to discuss options, if this even remotely interesting for you.

The best implementation guide is the one that reflects the views and the consensus of the whole FHIR community!

Safety Considerations

This implementation guide defines data elements, resources, formats, and methods for exchanging healthcare data between different participants in the healthcare process. As such, clinical safety is a key concern. Additional guidance regarding safety for the specification’s many and various implementations is available at https://www.hl7.org/FHIR/safety.html.

Although the present specification does give users the opportunity to observe data protection and data security regulations, its use does not guarantee compliance with these regulations. Effective compliance must be ensured by appropriate measures during implementation projects and in daily operations. The corresponding implementation measures are explained in the standard. In addition, the present specification can only influence compliance with the security regulations in the technical area of standardisation. It cannot influence organisational and contractual matters.

This document is licensed under Creative Commons CC0 1.0 Universal Public Domain Dedication.

HL7®, HEALTH LEVEL SEVEN®, FHIR® and the FHIR ® are trademarks owned by Health Level Seven International, registered with the United States Patent and Trademark Office.

This implementation guide contains and references intellectual property owned by third parties (“Third Party IP”). Acceptance of these License Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.

See also http://hl7.org/fhir/license.html.

Following is a non-exhaustive list of third-party artifacts and terminologies that may require a separate license:

SNOMED Clinical Terms® (SNOMED CT®) This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of SNOMED International (former known as International Health Terminology Standards Development Organisation IHTSDO). All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists. “SNOMED” and “SNOMED CT” are registered trademarks of SNOMED International.

Logical Observation Identifiers Names and Codes LOINC This material contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyright © 1995-2013, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and available at no cost under the license at http://loinc.org/terms-of-use.