Co-author: Robin Williams, RN

Trifolia (https://trifolia.lantanagroup.com/) is a web-based tool for standards development work. Trifolia produces HL7 Clinical Document Architecture (CDA) templates and Fast Healthcare Interoperability Resources (FHIR) profiles. Trifolia helps users rapidly develop standards-compliant electronic documents for cost-effective standards implementation. See https://www.lantanagroup.com/resources/trifolia/ for a full description of Trifolia and its existing features.

What’s New?

Trifolia release 3 provides substantial new functionality in the following areas:

• FHIR DSTU 2 Support
• Terminology
• Security

FHIR DSTU 2 Support

Since FHIR’s first draft on September 9, 2012, it has gained a great deal of attention and interest. The FHIR specification has now had two DSTU revisions and 11 Connectathons. It is clear that implementers and industry leaders are fond of the FHIR specification and that the industry will be moving towards using the FHIR specification for interoperability in the near future.

“C-CDA on FHIR” is an HL7 project to create a FHIR representation of Consolidated CDA R2 (C-CDA). This involves creating FHIR profile equivalents of the CDA templates in the C-CDA implementation guide. One of the goals of this project is to demonstrate tooling compatibility by interchanging these FHIR profiles and CDA templates between multiple design tools. Trifolia is one of the tools being used to create “C-CDA on FHIR” profiles.

New FHIR features in Trifolia release 3:

• One of the features that so many like about FHIR is the ability to define extensions to the standard when the standard does not represent what you need. Now Trifolia allows you to define an extension and easily re-use the extension in other profiles.
• The user interface uses FHIR-friendly terms such as “slice” (instead of “branch”) and “discriminator” (instead of “branch identifier”) within the context of FHIR profiles.
• The REST API allows users to use CRUD operations (Create, Retrieve, Update, and Delete) on profiles stored in Trifolia. The _format parameter allows users to retrieve profiles and other resources in either XML or JSON.
• The Trifolia UI also shows both XML and JSON representations of a profile in separate tabs, so users need not resort to the REST API to retrieve the computable representation of FHIR profiles.

Terminology

With Trifolia being used by over 800 users, we are seeing terminology come up as a question more often. Some value sets such as the C-CDA Problem value set have thousands of codes within them. The previous release of Trifolia did not provide good support for managing large value sets, so we have made some improvements to ease the pain. The screens for viewing and editing value sets now support paging and searching. This should make it a great deal easier to view/edit large value sets.

Security

Commercial users of Trifolia enter their credentials directly in Trifolia. Upon reviewing the audit logs, our network administrators have found attempts to hack Trifolia by guessing username/password combinations repeatedly. To address this, we have added a “Human Verification” step (i.e. a captcha) to the commercial user login page, to ensure that the user is not a robot trying to guess passwords.

Conclusion

Trifolia release 3 is a substantial update. Existing users will benefit from the terminology and security enhancements, and new users of both Trifolia and FHIR will benefit from the increased FHIR support.