Ring of FHIR Interoperability Testing Event

Ring of FHIR® at IHE NA Connectathon 2019

Michigan Health Information Network (MiHIN) and IHE USA are hosting a collaborative interoperability testing event based on HL7 FHIR® specifications and the MiHIN FHIR PIT and Ring of FHIR implementation. The event will consist of tutorial material and face to face testing at the IHE NA Connectathon 2019. The tutorial will be presented as part of the Innovations in Interoperability - Connectathon 2019 Conference on Wednesday, January 23 (separate registration required), and the Ring of FHIR Interoperability testing event will take place on Thursday, January 24 and Friday, January 25.

Note: Those unfamiliar with FHIR are strongly encouraged to register for the Connectathon Conference in order to be ready to participate in the Ring of FHIR Interoperability Testing Event. See details below.


Event: IHE North American Connectathon 2019 Conference

Date: Wednesday, January 23, 2019

Location: HIMSS Innovation and Conference Center 1 St. Clair NE, Cleveland, OH and The Huntington Convention Center of Cleveland

Overall Format: A highly interactive conference comprised of educational sessions, demonstrations, hands-on workshop and an exclusive tour of the IHE North American Connectathon testing floor and HIMSS Innovation and Conference Center.

Conference registration includes lunch and the FHIR Tutorial: Wednesday, January 23, 12:15 - 1:45pm ET

Innovations in Interoperability: Hands-on Introduction to FHIR - A FHIR PIT Party

Speaker: Wendy Couturier, MPH, FHIR Product Manager, Michigan Health Information Network Shared Services.

This hands-on session is an opportunity for attendees to learn, develop and test Fast Healthcare Interoperability Resources (FHIR®) solutions in a safe, secure environment utilizing Michigan’s FHIR Pilot Interoperability Testbed (the FHIR-PIT).  During the session, you will learn core FHIR basics; FHIR architecture and server standards; FHIR resources, components and bundles; FHIR servers and APIs; and how to leverage FHIR to find just the information needed from a set of health information.

Learning Objectives:

  • Demonstrate use of the “Ring of FHIR” network of servers to learn and practice using FHIR for interoperable software applications
  • Showcase how applications can be created that leverage the power of FHIR via the robust platform populated with synthetic health information


Ring of FHIR Interoperability Testing Event

This hands-on session is an opportunity for attendees to learn, develop and test Fast Healthcare Interoperability Resources (FHIR®) solutions in a safe, secure environment utilizing MiHIN’s FHIR®-PIT (Fast Health Interoperability Resources - Pilot Interoperability Testbed) During the session, you will learn core FHIR basics; FHIR architecture and server standards; FHIR resources, components and bundles; FHIR servers and APIs; and how to leverage FHIR to find just the information needed from a set of health information.


  1. A self-provided laptop to participate in hands-on testing
    1. Ensure you have the most updated version of Google Chrome, the best browser for testing
    2. MiHIN will bring the cloud-based testing environment (FHIR-PIT)
  2. MiHIN Terms of Service agreement completed via mihin.org/Connectathon
    1. Upon completion, MiHIN will send you credentials via the email address you provide for access into the environment
  3. Familiarize yourself with this document and the tracks that will be presented
  4. If you plan to participate in the Exploratory track, come prepared with scenarios that you hope to test out

1. Quality Track


Clinical quality measures (CQMs) are measures of healthcare quality generated in a clinical setting by using information such as lab results, vital signs, symptoms, x-rays, etc. When properly utilized, CQMs can help transform healthcare delivery to improve care for patients and help transform healthcare payment to be quality-based instead of volume-based.

Electronic clinical quality measures (eCQMs) are clinical quality measures that are electronically captured or calculated locally in a clinical setting. For example, in a clinic’s electronic health record (EHR) system, and then potentially transported electronically and securely to a centralized repository for analysis and comparison with other clinics.

Reporting certain CQMs is a requirement for Promoting Interoperability for both Medicaid and Medicare EHR incentive programs.


  1. As the HIN, test push of QRDA quality reports to simulated CMS
  2. Acting as a Provider, you may submit files to Payer organizations via the HIN
  3. Upon receiving provider files, the Payer will calculate provider scores and provide feedback to the providers.
  4. Simulated CMS (Centers for Medicare & Medicaid Services) will be the recipient of quality reports

Example: Upon receiving QRDA quality reports from providers, the HIN will then push those files simulating a submission to CMS to show provider performance on quality measures


The FHIR®-PIT will allow participants to explore and evaluate a mechanism for bulk quality measure querying and calculation via FHIR.

Expected Outcome

To explore and evaluate a mechanism for bulk read and write quality measure querying via FHIR, the solution will apply the following Integrating the Healthcare Enterprise (IHE) profiles:

  • Query for Existing Data for Mobile (QEDm) which “supports queries for clinical data elements, including observations, allergy and intolerances, conditions, diagnostic results, medications, immunizations, procedures, encounters and provenance”[1] allowing real-time access to various CQMs.
  • Aggregate Data Exchange (ADX), which defines a mechanism for aggregate data exchange. The track will explore the use of Measure and MeasureReport to define and perform aggregate data exchange.[2]

In the future, this may allow organizations to generate and/or access population-level data sets for the purposes of CQM reporting in near real-time, simplifying providers’ and a payer’s workflow, and removing burdens from the process of reporting quality of care. In addition, since the ADX profile is used in public health, this process will provide an opportunity to align with and learn from public health reporting capabilities.

2. Consent Track


Several laws and regulations put forth by the federal and state governments mandate patient consent prior to accessing or sharing patient information for the purposes of treatment, payment, and coordination of care. Patient consent is required for access to both mental and behavioral health information.

There are currently many inefficiencies in this paper-based system. There is no widespread adoption of a statewide standard consent form, no centralized location to store consent preferences, and patients fill out new consent forms at each new provider’s office.

Keeping in mind federal and state laws, the FHIR®-PIT offers a simulated environment of interoperability between various providers and HIEs (health information exchanges), whereby developers can test access and disclosure of consent forms across organizations.


  1. The HIN will broker requests to pull patient consent forms from the Active Care team.
  2. The Provider Organization will receive queries for patient consent forms and, if found, share them with the HIN
  3. During a patient visit, a Provider will check for existing patient consent forms from the Active Care team via the HIN.


The purpose of this track is to develop and test various consent methods to determine the most efficient practices for granular consent.

  • Objective 1:  Develop and test various consent methods using synthetic data
  • Objective 2:  Incorporate multiple consent forms to allow for granular choice
  • Objective 3:  Incorporate privacy tags or other methods for routing messages accordingly to check for consent

There are two dominant methods for electronic consent currently: FHIR Consent Resource and FHIR Contract Resource. Each of these methods function differently and can serve different capabilities.

This track encourages participants to test both of these consent models, as well as additional consent models, to determine which consent methods are better for different capabilities.

Expected Outcome

During this track, participants will explore a standardized, shared way to manage consent forms and consent-related information, keeping in mind the minimum necessary information needed to access and confirm patient consent and proceed with patient care. This track will provide the ability to test out consent resources and contract resources for specific use cases deemed appropriate by the participant. The following FHIR resources are utilized:

  • The FHIR Consent Resource conveys access control policies which permit or deny a use or disclosure request made by a sending or receiving system (push/pull). The Consent Resource provisions are not equivalent to the terms of a contract, because they must be stated as obligations to do or not do some act for a consenting grantor to “agree” or “disagree.”
  • The FHIR Contract Resource is different because it is an electronic version of a legally binding paper contract. The Contract Resource can use the FHIR QuestionnaireResponse to include statements and question/answer formats like the way they would be seen on a paper form. This method would be preferential for capabilities where a copy of the consent form is needed on file, can be easily edited, and can be signed legally by a consumer.

3. Exploratory Track


MiHIN’s FHIR-PIT simulates a healthcare network of providers, practices, and hospitals with a large population of patients who experience changes in their health status. In conjunction with PatientGen™, a FHIR-compatible test data generator that produces realistic patient histories involving clinically relevant patient encounters, developers are encouraged to explore.

Participants can test against a rich data set, explore and discover what questions or comments arise.

Get exploring, utilizing:

    • Fully pre-configured turn-key FHIR server
    • Populated with realistic synthetic test data based on PatientGen and MiHIN personas resources
    • Resembles clinical protected health information (PHI)
  • Test with more than 300,000 pre-generated FHIR resources including patients, practitioners, organizations, conditions, procedures, encounters, etc.
  • Wide variety of “safe” test data for discovering opportunities in the exchange of health information

Expected Outcome

  • Questions and comments are documented to allow for future track planning and enhancements to the FHIR-PIT.
  • Provides developers an opportunity to test applications in simulated environment.


Contact information



Innovations in Interoperability - Connectathon 2019 Conference: $100 | More details on this event.

Ring of FHIR Testing Event: $200


How to Register:

Participants in the Ring of FHIR Testing Event and Innovations in Interoperability Educational Session will need to register through the Cvent Registration Portal. Ring of FHIR Participants will need to select their testing track during registration.

Register Today!




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