IHE ACDC Implementation Guide
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IHE ACDC Implementation Guide, published by Integrating the Healthcare Enterprise (IHE). This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of https://github.com/IHE/ACDC/ and changes regularly. See the Directory of published versions

3.72 [PCC-72] Request Assessment Transaction

This section corresponds to Transaction PCC-72 of the IHE PCC Technical Framework. Transaction PCC-72 is used by the Assessment Requester and Assessor Actors.

3.72.1 Scope

The Request Assessment transaction is used to request the assessment defined in a Questionnaire resource. The result of this transaction is the display of, and interaction with a user in order to complete an assessment.

3.72.2 Actor Roles

Figure 3.72.2-1: Use Case Diagram

Table 3.72.2-1: Actor Roles

Table 3.72.2-1: Actor Roles
ActorRole
Assessment Requestor Requests an assessment be performed using the specified FHIR Questionnaire Resource for the patient and encounter in the current context.
Assessor Responds to request, by creating a FHIR QuestionnaireResponse Resource for the patient and encounter in the current context representing the execution of the assessment instrument provided.

3.72.3 Referenced Standards

Table 3.72.3-1: Referenced Standards
StandardName
HL7 FHIRHL7® FHIR#174 standard R4
IETF RFC 2616 Hypertext Transfer Protocol - HTTP/1.1
IETF RFC 7540 Hypertext Transfer Protocol - HTTP/2
IETF RFC 3986 Uniform Resource Identifier (URI): Generic Syntax
IETF RFC 4627 The application/json Media Type for JavaScript Object Notation (JSON)
IETF RFC 6585 Additional HTTP Status Codes

3.72.4 Interaction Diagram

3.72.4.1 Establish Context message

When the EHR Launch option is not used, the EHR system or user will establish the context for performing the assessment through a mechanism not specified in this profile. This may be by placing an order, launching and configuring a web application for the patient being assessed, or through some other mechanism.

When the Assessment Requester actor implements the EHR Launch option, this message uses a SMART on FHIR EHR Launch sequence to establish the context and launch the assessment for a given patient with the specified Questionnaire resource.

3.72.4.1.1 Trigger Events

An assessment is requested for a patient.

3.72.4.1.2 Message Semantics

When used without the EHR Launch option, the user or system that launches the Assessor instrument must first establish the patient and encounter context with the Assessor.

When used with the EHR Launch option, the patient context is established with a SMART on FHIR application through the EHR launch sequence. The Assessment Requester actor corresponds to the EHR actors described in SMART on FHIR. The Assessor actor corresponds to the App actor described in SMART on FHIR. The questionnaire to use for the assessment is recorded in the context returned by the EHR Authorization Server in the SMART on FHIR Authorization Sequence.

3.72.4.1.3 Expected Actions

The Assessment Requester and Assessor actors establish a context in which they agree upon the assessment instrument, the patient, the encounter and the user performing the assessment, and the assessment is ready to be performed.

When the EHR Launch option is used, the Assessment Requester shall launch the Assessor as specified by the SMART on FHIR EHR Launch sequence.

3.72.4.2 Assess Patient Activity message

This is a user interface action performed by the assessor to capture the assessment data from the user and to provide additional assessment information.

3.72.4.2.1 Trigger Events

This message is triggered by launching the Assessor.

3.72.4.2.2 Semantics

The user or patient (or patient representative) is provided with a series of prompts or questions and responds to them. The user responses are collected in a FHIR QuestionnaireResponse resource.

3.72.4.2.3 Expected Actions

The Assessor will display enough context information to ensure patient safety and data integrity (e.g., the patient name, gender, birthdate, and MRN, the encounter, et cetera), and will display the title of the assessment and user interface to capture data needed for the assessment.

The assessor will prompt the user (e.g., provider or patient) and enables them to respond.

The user completes the assessment.

Upon completion the Assessor will transmit the results by performing the PCC-73 transaction.

3.72.4.4 Capability Statement Resource

Assessor and Assessment Requester actors implementing this transaction shall provide a CapabilityStatement Resource as described in ITI TF-2x: Appendix Z.3.

When the EHR Lauch option is support, this capability statement shall provide the required information to support a SMART on FHIR EHR Launch.

3.72.5 Security Considerations

The posted content contains PHI and potentially III that shall be protected. See the general Security Considerations in PCC TF-1: 15.5.

3.72.5.1 Security Audit Considerations

When the EHR Launch option is used and the actors are grouped with the Secure Node or Secure Application actor, the Assessment Requestor and Assessor actors both generate an Application Start Audit Event consistent with ATNA. The message shall comply with the following pattern:

  • Event
    • EventID = EV 110100, Application Activity, “Audit event: Application Activity has taken place.”)
    • EventTypeCode = EV(110120, Application Start, “Audit event: Application Entity has started.”)
    • EventActionCode = “X” (Execute)
  • Application Launcher (1..1)
    • UserID = The Assessment Requestor actor system identity
    • RoleIDCode = EV(110151, DCM, “Application Launcher”)
  • Patient (1..1)
    • The identity of the patient being assessed.
  • Human Requestor (0..n) -> one for each known User
    • UserID = Identity of the human that initiated the transaction.
    • RoleIDCode = Access Control role(s) the user holds that allows this transaction
    • Application (1..1)
    • Asessor actor system identity
    • RoleIDCode = EV(110150, DCM, “Application”)
  • Audit Source (1..1)
    • not specified

When the assessment is complete, the Assessor shall issue an Application Stop audit event. The message shall comply with the following pattern:

  • Event
    • EventID = EV 110100, Application Activity, “Audit event: Application Activity has taken place.”)
    • EventTypeCode = EV(110121, Application Stop, “Audit event: Application Entity has stopped.”)
    • EventActionCode = “X” (Execute)
  • Application Launcher (1..1)
    • UserID = The Assessment Requestor actor system identity
    • RoleIDCode = EV(110151, DCM, “Application Launcher”)
  • Patient (1..1)
    • The identity of the patient being assessed.
  • Human Requestor (0..n) -> one for each known User
    • UserID = Identity of the human that initiated the transaction.
    • RoleIDCode = Access Control role(s) the user holds that allows this transaction
    • Application (1..1)
    • Asessor actor system identity
    • RoleIDCode = EV(110150, DCM, “Application”)
  • Audit Source (1..1)
    • not specified