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Telemedicina HL7 FHIR -
Dr. Mandirola

La Pandemia trajo muchas desgracias y muertes alrededor del mundo. Para la mayoría de los países es la peor tragedia de su historia, ni hablar del desastre económico que provocó en todos los países. Dentro de este panorama trágico, en el cual estamos inmersos, algunas tecnologías se desarrollaron rápidamente y permitieron que la atención llegara a más personas, una de esas tecnologías es la telemedicina. La evolución de la telemedicina abarca mucho más que una simple comunicación entre el paciente y el médico, también requiere interoperar con distintos sistemas para poder acceder y compartir información que le permite al profesional actuante hacer más eficiente su tarea. Hoy en día existen un montón de aplicaciones y aparatos que permiten obtener datos de pacientes, el objetivo es capturar la información en tiempo real de cada sistema de medición, registro, historias clínicas, toma de señales e imágenes que requieren interoperar con una plataforma de telemedicina.

La telemedicina de hoy requiere una integración de la consulta médica con distintos sistemas de registro de Historias Clínicas Electrónicas, sistemas de imágenes y dispositivos de medición, entre otros, que le permitan al médico integrar su trabajo en forma eficiente con la consulta a distancia. Para eso debe contar con una aplicación integrada que le ofrezca un flujo de trabajo eficiente con información que llegue al lugar correcto, en el momento correcto y garantice que la historia completa del paciente permanezca sincronizada con la teleconferencia. Si bien la integración es necesaria para brindar todo el potencial de la telemedicina, el camino hacia la integración no siempre está pavimentado. Para ayudarnos, contamos con HL7, servicios web y ahora FHIR (Fast Healthcare Interoperability Resources). No es de extrañar que los desarrolladores estén luchando por comprender cómo desarrollar mejor sus productos para servir a sus usuarios e integrarlos a la perfección.

Actualmente la mayoría de las soluciones de telemedicina son propietarias, otra de las características es que hay muchos desarrollos específicos para cada enfermedad (control de pacientes diabéticos, hipertensos, chagásicos, etc.), lo que genera un panorama de sistemas heterogéneo y orientado a silos con interoperabilidad limitada. Resolver el problema de la interoperabilidad requiere un fuerte enfoque en la integración y estandarización de datos en las infraestructuras de telemedicina. El objetivo de HL7-FHIR es proveer un estándar que permita que los módulos y programas puedan interoperar para permitir una integración flexible con servicios nuevos, existentes y el uso de estándares internacionales para permitir una alta reutilización de módulos e interoperabilidad.

HL7-FHIR es el estándar más utilizado para el intercambio de información de salud como parte de estas visitas remotas. Será importante ver exactamente qué recursos de HL7-FHIR ofrecen varios proveedores de Historias Clínicas Electrónicas y si son suficientes para ejecutar las necesidades de integración completa de los proveedores de telemedicina. Los flujos de trabajo comúnmente admitidos al final de una visita de telesalud deben incluir:

  • Ordenes de estudios (imágenes, análisis de laboratorio, etc.).
  • Informes de estudios.
  • Agenda de turnos y visitas de seguimiento con especialistas.
  • Dispositivos de captura de señales como electrocardiógrafos, oxímetros, glucómetros, etc.
  • Integración de la documentación del encuentro en el registro de datos del paciente en la Historia Clínica electrónica que pueda verse también en donde el paciente recibe atención principalmente.

La unificación de las aplicaciones con HL7-FHIR permite ampliar la capacidad de interoperar la información, esto permite mejores flujos de trabajo con una más eficiente prestación y mejor calidad de atención a los pacientes. Distintos grupos de trabajo dentro de HL7-FHIR están viendo cómo ayudar a los proveedores de telesalud a ofrecer soluciones optimizadas a través de una integración perfecta con cualquier Historia Clínica Electrónica. Actualmente HL7-FHIR puede satisfacer la mayoría de las necesidades de integración a través de los estándares disponibles, de todas formas, se está mejorando cada día más los flujos de trabajo con HL7-FHIR en distintos entornos de telemedicina. HL7-FHIR está utilizándose cada día más para facilitar las integraciones y se aclarará qué recursos se utilizan con mayor frecuencia para facilitar las crecientes demandas que la telemedicina requiere.

Dr. Humberto F. Mandirola

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