Fast Healthcare Interoperability Resources for Inpatient Deterioration Detection With Time-Series Vital Signs: Design and Implementation Study

Abstract

Background

Vital signs have been widely adopted in in-hospital cardiac arrest (IHCA) assessment, which plays an important role in inpatient deterioration detection. As the number of early warning systems and artificial intelligence applications increases, health care information exchange and interoperability are becoming more complex and difficult. Although Health Level 7 Fast Healthcare Interoperability Resources (FHIR) have already developed a vital signs profile, it is not sufficient to support IHCA applications or machine learning–based models.

Objective

In this paper, for IHCA instances with vital signs, we define a new implementation guide that includes data mapping, a system architecture, a workflow, and FHIR applications.

Methods

We interviewed 10 experts regarding health care system integration and defined an implementation guide. We then developed the FHIR Extract Transform Load to map data to FHIR resources. We also integrated an early warning system and machine learning pipeline.

Results

The study data set includes electronic health records of adult inpatients who visited the En-Chu-Kong hospital. Medical staff regularly measured these vital signs at least 2 to 3 times per day during the day, night, and early morning. We used pseudonymization to protect patient privacy. Then, we converted the vital signs to FHIR observations in the JSON format using the FHIR Extract Transform Load application. The measured vital signs include systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and body temperature. According to clinical requirements, we also extracted the electronic health record information to the FHIR server. Finally, we integrated an early warning system and machine learning pipeline using the FHIR RESTful application programming interface.

Conclusions

We successfully demonstrated a process that standardizes health care information for inpatient deterioration detection using vital signs. Based on the FHIR definition, we also provided an implementation guide that includes data mapping, an integration process, and IHCA assessment using vital signs. We also proposed a clarifying system architecture and possible workflows. Based on FHIR, we integrated the 3 different systems in 1 dashboard system, which can effectively solve the complexity of the system in the medical staff workflow.