Design Principles

Below are principles that have guided the CodeX HL7 FHIR Accelerator Community and in the design, planning, development, testing, adoption, and value of FHIR-based data standards, including mCODE. These principles guide and are elaborated upon in the Playbook Tracks and Case Studies.

---

If additional specialties follow these principles, the resulting standards are more likely to be developed efficiently, to be compatible across specialties as part of each patient's life-time health, to be adopted in practice, and to provide value for patients and all stakeholders.

1. A dedicated and diverse community is essential to the design and execution of a health data standards project.
   • Each use case needs committed representation from all stakeholders needed to drive the use case (e.g., patients, providers, health systems, Gov’t agencies, vendors, payers, and others).
2. Compelling use cases are the foundation upon which solutions are designed and driven.
   • Define each use case as a project that addresses a single, important, narrowly focused problem.
   • Build a use case plan that is end-to-end - including the scope, resources, data requirements, and a pragmatic strategy for how standards will be adopted and provide value in the real world.
   • Prioritize use cases that address salient challenges. However, start with simpler (not simple) use cases that have commitment from all the community members needed to succeed.
   • Prioritize use cases that improve collection and sharing of quality, core, standardized data related to patient care and outcomes should be the top priority.
3. Clinical information requirements are a first priority for each use case.
   • Build consensus within a diverse team of clinical experts on the minimal data requirements needed to address core use case requirements.
   • Define clinical requirements as discrete observations and actions (e.g., patient birth date = 11/04/1989 vs. patient is 34 years old).
   • If previous work in the space exists, seek to work with the other initiatives and adapt their work rather than re-do.
4. How clinical requirements are represented in FHIR Implementation Guides (IGs) influence their useability, and their interoperability across specialties.
   • Develop first a single, core IG that represents the minimal clinical requirements for small set of use cases concepts common within the specialty. This core IG can be improved upon as use cases are executed and supplemented within related IGs when data requirements are important for just a small subset of the community.
   • Leverage government-backed interoperability standards whenever possible, e.g., United States Core Data for Interoperability (USCDI), Fast Healthcare Interoperability Resources (FHIR), US Core FHIR Implementation Guide for core patient data, and others.
   • Leverage the available tools (see the Resources page) for modeling and IG development, to produce higher-quality FHIR IGs that are more coherent across specialties, use cases, and projects.
   • Leverage global code systems and terminology standards (e.g., LOINC, SNOMED CT, CPT, and other systems).
   • Standardize work through an open, royalty-free health standards development organization, preferably Health Level Seven (HL7).
5. Build use cases within a vision of a coherent lifetime Standard Health Record for every patient.
   • Enable standardized data to become the basis for every patient's health record and standard of care.
   • Empower patients to be engaged with and have control of their health data.
   • Collect patient data once (generally around the encounter) and reuse it for future patient encounters and multiple use cases.
   • Enable consistent representation of health data concepts that could be used across specialties, subspecialties, and use cases.