Joe Amlung and Rafal Korytkowski from the OCL team recently participated in the HL7 FHIR Connectathon in September, 2024 in Atlanta, Georgia, USA! This event provided an excellent opportunity to engage with the FHIR community, assess our current capabilities, and chart our course for future development.

 

 

Our Objectives

We came to the Connectathon with clear goals in mind:

1. 1. Strengthen OCL’s engagement with the FHIR community
   2. Evaluate OCL’s FHIR support through rigorous testing
   3. Inform a strategic roadmap for future FHIR integration into OCL
   4. Share OCL’s unique global health perspectives and use cases

Putting OCL to the Test

A significant part of our participation involved testing OCL’s FHIR terminology services using the Canonical Resource Management Infrastructure (CRMI) Postman tests. The CRMI tests represent emerging requirements for the next generation of tools to facilitate the content management lifecycle of FHIR resources. The FHIR Connectathon provided the opportunity for OCL and other organizations to test their progress toward meeting the new CRMI requirements.

Test Results and Insights

We’re pleased to report that OCL passed approximately 45% of the CRMI tests, marking a notable improvement from our 34% pass rate in May 2024 at the last (and OCL’s first ever) FHIR Connectathon. Since CRMI represents requirements for the next generation of tools, this pass rate represents a solid foundation from which to build further FHIR capabilities, and also aligns with the results of some of the other terminology servers that were tested.

Areas of Strength

OCL demonstrated competence in several key areas, which demonstrated our compliance and capabilities with FHIR R4:

• Handling GET requests for CodeSystems and ValueSets
• Returning appropriate CodeSystem and ValueSet attributes
• Executing base FHIR searches and filtering
• Performing the $lookup operation
• Partial success with the GET $expand operation

Opportunities for Improvement

We also identified areas where OCL can enhance its FHIR support:

• Addressing minor issues like missing attributes and unexposed operations
• Completing partially implemented operations (e.g., $validate-code)
• Enhancing search capabilities for identifiers and CRMI attributes
• Implementing Library and Manifest functionalities
• Optimizing performance for large ValueSets

Charting the Course: Next Steps for OCL

Based on our Connectathon experience, we’ve outlined some initial thoughts that can inform our roadmap to enhance OCL’s FHIR Core:

1. Immediate Improvements

• Resolve identified bugs in OCL FHIR services
• Complete and deploy FHIR Baseline content to Production

2. Core Enhancements

• Develop a comprehensive FHIR Terminology Services test suite
• Integrate HAPI libraries for improved resource validation
• Align with IG Publisher terminology server requirements

3. Advanced FHIR Compatibility

• Implement CRMI-specific parameters and extensions
• Develop support for large expansions through pagination or asynchronous responses

4. Future Considerations

• Explore basic Library support for terminology resources
• Investigate Manifest recognition and FHIR package returns
• Consider potential synergies between Naming System and our Canonical URL Registry

These improvements are particularly important for supporting WHO SMART Guidelines use cases for terminology management and usage.

Community Insights

Our participation also yielded valuable insights into broader FHIR community trends:

• FHIR R4 remains the primary focus. Industry is waiting until R6 to implement further FHIR support, with limited adoption of R5.
• HAPI libraries are widely used to simplify FHIR development in other FHIR-compatible software, though the full HAPI server is less common in complex implementations.
• There’s growing interest in leveraging existing extensions to terminology resources, rather than creating and managing new extensions to terminology resources.
• ConceptMap support is somewhat limited among major terminology servers, which may be a particularly good opportunity for OCL to support the community.

Looking Ahead

The HL7 FHIR Connectathon was an invaluable experience for the OCL team. It allowed us to benchmark our progress, identify areas for growth, and gain insights into community best practices. This Connectathon showed us how OCL can improve its capabilities and community engagement, and that’s where the OCL community comes in!

If this blog post inspired you to think about how OCL can better support FHIR capabilities, let us know on OCL Chat! We are developing OCL’s 2025 roadmap, which will include enhancements in our FHIR service; we hope to hear your voice and make sure this roadmap represents your ideas. We also are contemplating creating a test set of terminology content to ensure OCL content meets current and future requirements, whether it’s for OCL’s proprietary API or FHIR Core. If you have your own ideas related to testing, either for individual tests or a broad testing approach, we want to hear it! You could propose or create one of the first automated tests to live in a public Postman collection to make sure OCL is running at its best! We will share more details on OCL Chat as they develop.