Query for Existing Data for Mobile (QEDm), published by IHE Patient Care Coordination Technical Committee. This is not an authorized publication; it is the continuous build for version 0.0.1-current). This version is based on the current content of https://github.com/IHE/QEDm/ and changes regularly. See the Directory of published versions

1:X Query for Existing Data for Mobile (QEDm)

The Query for Existing Data for Mobile (QEDm) Profile supports dynamic queries for clinical data elements, including observations, allergy and intolerances, problems, diagnostic results, medications, immunizations, procedures, encounters and provenance by making the information widely available to other systems within and across enterprises to support provision of better clinical care. It defines a transaction used to query a list of specific data elements, persisted as FHIR resources.

QEDm is functionally equivalent to the QED Profile (based on HL7v3), but QEDm is better suited for implementation by application on mobile devices or where the http/REST technology is preferred. The term “mobile” must be understood in a wide sense: it refers not only to applications on devices used for mobility that are resource- and platform-constrained. (e.g., tablets, smartphones, and embedded devices including home-health devices), but also to larger systems deployed in environments where interoperability requirements are simple, such as pulling the latest summary for display.

The QEDm Profile defines a standardized interface to health (HTTP-based RESTful APIs) suited for deployment of mobile applications on resource-constrained devices with simple programming environment (e.g., JavaScript), simple protocol stack (e.g., HTTP), and simple display functionality (e.g., HTML browser). The goal is to limit required additional libraries that are often necessary to process SOAP, MIME-Multipart, MTOM/XOP Web Services.

The QEDm Profile uses the already defined actors Clinical Data Consumer and Clinical Data Source, for which it specifies option and a transaction to be used for querying a list of specific data elements, persisted as FHIR resources. The current version of Supplement doesn’t consider the reconciliation of the fine-grained data elements gathered by the Clinical Data Source and/or Clinical Data Consumer Actors. In order to perform reconciliation a grouping with RECON Reconciliation Agent should be considered.

The QEDm Profile may also be deployed in conjunction with document sharing profiles such as MHD or XDS Profiles. The Document Provenance Option in QEDm is used in particular by the mXDE Profile to address the combined deployment of QEDm for access to fine-grained data element with links to source documents accessible through the MHD or XDS Profiles.

1:8.1 QEDm Actors, Transactions, and Content Modules

This section defines the actors, transactions, and/or content modules in this implementation guide. Further information about actor and transaction definitions can be found in the IHE Technical Frameworks General Introduction Appendix A: Actors and Appendix B: Transactions.

Figure 8.1-1 shows the actors directly involved in the QEDm Profile and the relevant transaction between them.

Figure: 1:8.1-1: QEDm Actor Diagram

Table 1:8.1-1 lists the transactions for each actor directly involved in the QEDm Profile. To claim compliance with this profile, an actor shall support all required transactions (labeled “R”) and may support the optional transactions (labeled “O”).

Table 1:8.1-1: QEDm Integration Profile - Actors and Transactions

Actors	Transactions	Optionality	Reference
Clinical Data Source	Mobile Query Existing Data [PCC-44]	R	PCC TF-2: 3.44
Clinical Data Consumer	Mobile Query Existing Data [PCC-44]	R	PCC TF-2: 3.44

1:8.1.1 Actor Descriptions and Actor Profile Requirements

1:8.1.1.1 Clinical Data Source

The Clinical Data Source in this profile responds to FHIR-based queries for one or more fine-grained data elements (FHIR resources) defined by the options listed in Section 8.2.

FHIR Capability Statement for Server

1:8.1.1.2 Clinical Data Consumer

The Clinical Data Consumer in this profile sends FHIR-based queries to the Clinical Data Source for one or more fine-grained data elements (FHIR resources) defined by the options listed in Section 8.2. Rendering or further processing of the data is not defined by this profile.

FHIR Capability Statement for Client

1:8.2 QEDm Actor Options

Options that may be selected for each actor in this profile, if any, are listed in the Table 1:8.2-1. Dependencies between options when applicable are specified in notes.

Table 1:8.2-1: QEDm - Actors and Options

Actor	Option Name	Reference
Clinical Data Source	Simple Observations (Note 1)	Section 1:8.2.1.1
	Allergies and Intolerances (Note 1)	Section 1:8.2.1.2
	Conditions (Note 1)	Section 1:8.2.1.3
	Diagnostic Results (Note 1)	Section 1:8.2.1.4
	Medications (Note 1)	Section 1:8.2.1.5
	Immunizations (Note 1)	Section 1:8.2.1.6
	Procedures (Note 1)	Section 1:8.2.1.7
	Encounters (Note 1)	Section 1:8.2.1.8
	Document Provenance (Note 1)	Section 1:8.2.1.9
	Occuupational Data for Health (Note 1)	Section 1:8.2.1.10
Clinical Data Consumer	Simple Observations (Note 1)	Section 1:8.2.2.1
	Allergies and Intolerances (Note 1)	Section 1:8.2.2.2
	Conditions (Note 1)	Section 1:8.2.2.3
	Diagnostic Results (Note 1)	Section 1:8.2.2.4
	Medications (Note 1)	Section 1:8.2.2.5
	Immunizations (Note 1)	Section 1:8.2.2.6
	Procedures (Note 1)	Section 1:8.2.2.7
	Encounters (Note 1)	Section 1:8.2.2.8
	Document Provenance (Note 1)	Section 1:8.2.2.9
	Occuupational Data for Health (Note 1)	Section 1:8.2.2.10

Note 1: At least one of these options shall be supported by the related actor.

1:8.2.1 Clinical Data Consumer Options

1:8.2.1.1 Simple Observations Option

A Clinical Data Consumer that implements the Simple Observations Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Simple Observations in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.1.

1:8.2.1.2 Allergies and Intolerances Option

A Clinical Data Consumer that implements the Allergies and Intolerances Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Allergies and Intolerances in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.2.

1:8.2.1.3 Conditions Option

A Clinical Data Consumer that implements the Conditions Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Conditions in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.3.

1:8.2.1.4 Diagnostic Results Option

A Clinical Data Consumer that implements the Diagnostic Results Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Diagnostic Results in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.4.

1:8.2.1.5 Medications Option

A Clinical Data Consumer that implements the Medications Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Medications in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.5.

1:8.2.1.6 Immunizations Option

A Clinical Data Consumer that implements the Immunizations Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Immunizations in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.6.

1:8.2.1.7 Procedures Option

A Clinical Data Consumer that implements the Procedures Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Procedures in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.7.

1:8.2.1.8 Encounters Option

A Clinical Data Consumer that implements the Encounters Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Encounters in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.8.

1:8.2.1.9 Document Provenance Option

This option is different than the above options that allow the selection of appropriate clinical content to query. It provides a means to extend the traceability of information used for clinical decisions: when a data element is accessed by a Clinical Data Consumer, identifiers from that data element can be retrieved to enable access to one or more documents in which this data element was originally recorded, providing a valuable broader clinical context.

A Clinical Data Consumer that implements the Document Provenance Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Provenance in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.9.

1:8.2.1.10 Occupational Data for Health Option

A Clinical Data Consumer that implements the Occupational Data for Health Option performs the Mobile Query Existing Data transaction using the vocabulary specified for Occupational Data for Health in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.10.

1:8.2.2 Clinical Data Source Options

1:8.2.2.1 Simple Observations Option

A Clinical Data Source that implements the Simple Observations Option responds to the message semantics specified for Simple Observations in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.1.

1:8.2.2.2 Allergies and Intolerances Option

A Clinical Data Source that implements the Allergies and Intolerances Option responds to the message semantics specified for Allergies and Intolerances in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.2.

1:8.2.2.3 Conditions Option

A Clinical Data Consumer that implements the Conditions Option responds to the message semantics specified for Conditions in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.3.

1:8.2.2.4 Diagnostic Results Option

A Clinical Data Source that implements the Diagnostic Results Option responds to the message semantics specified for Diagnostic Results in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.4.

1:8.2.2.5 Medications Option

A Clinical Data Source that implements the Medications Option responds to the message semantics specified for Medications in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.5.

1:8.2.2.6 Immunizations Option

A Clinical Data Source that implements the Immunizations Option responds to the message semantics specified for Immunizations in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.6.

1:8.2.2.7 Procedures Option

A Clinical Data Source that implements the Procedures Option responds to the message semantics specified for Procedures in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.7.

1:8.2.2.8 Encounters Option

A Clinical Data Source that implements the Encounters Option responds to the message semantics specified for Encounters in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.8.

1:8.2.2.9 Document Provenance Option

This option is different than the above options that allow the selection of appropriate clinical content to query. It provides a means to extend the traceability of information used for clinical decisions: when a data element is accessed by a Clinical Data Consumer, identifiers from that data element can be provided to the Clinical Data Consumer to enable access to one or more documents in which this data element was originally recorded, providing a valuable broader clinical context.

A Clinical Data Source that implements the Document Provenance Option responds to the message semantics specified for Provenance in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.9.

1:8.2.2.10 Occupational Data for Health Option

A Clinical Data Source that implements the Occupational Data for Health Option responds to the message semantics specified for Occupational Data for Health in [PCC-44] in PCC TF-2: 3.44.4.1.2.1.10 with the profiled content specified in the Reference link location.

1:8.3 QEDm Required Actor Groupings

Table 1:8.3-1: QEDm - Required Actor Groupings

QEDm Actor	Actor to be grouped with	Reference
Clinical Data Consumer	None	-
Clinical Data Source	None	-

1:8.4 QEDm Overview

1:8.4.1 Concepts

The QEDm Profile supports a broad set of the QED use cases and functionality while keeping the implementation as simple as possible.

1:8.4.2 Use Cases

1:8.4.2.1 Use Case #1: Discovery and Retrieval of Existing Data Elements

1:8.4.2.1.1 Discovery and Retrieval of Existing Data Elements Description

In this use case, the patient, by using a mobile device, needs access to existing data elements. For example, a mobile application involved in a workflow needs to discover all the current Observations and Medications.

1:8.4.2.1.2 Discovery and Retrieval of Existing Data Elements Process Flow

The Mobile Query Existing Data transaction is used to provide parameterized queries that result in a list of returned data elements.

Figure 1:8.4.2.1.2-1: Use Case #1 Process Flow in QEDm Profile

1:8.4.2.2 Use Case #2: Discovery and Retrieval of Existing Data Elements with Source Document Links

1:8.4.2.2.1 Discovery and Retrieval of Existing Data Elements with Source Document Links Description

In this use case, the physician, by using a mobile device, needs to access all existing data elements and eventually to retrieve and consume the source documents, if any.

For example, a mobile application involved in a workflow needs to discover all Encounters which the patient has participated in and, for those of interest, it needs to retrieve and show the related document where the Encounter was originally specified.

1:8.4.2.2.2 Discovery and Retrieval of Existing Data Elements with Source Document Links Process Flow

The Mobile Query Existing Data [PCC-44] transaction is used to provide parameterized queries that result in a list of returned data elements. One of the query options specifies that provenance information must be included in the result to obtain the links to source documents, if any.

The mobile application implements The Clinical Data Consumer to perform the query.

The mobile application also implements an MHD Document Consumer and retrieves the document from the MHD Document Responder by using the related returned document link.

Figure 1:8.4.2.2.2-1: Use Case #2 Process Flow in QEDm Profile

1:8.5 QEDm Security Considerations

See ITI TF-2: Appendix Z.8 “Mobile Security Considerations”.

The QEDm Profile provides an API for accessing Data Element level details that are identifiable to a specific Patient. Thus, all the data communicated, including the query parameters, should be considered Patient Identifiable data. The grouping with IUA, or some similar User Authentication and Authorization solution, is critical to enforcing Privacy and Security. All accesses to this data should be recorded as audit log for security surveillance and Privacy reporting. These topics are discussed in Appendix Z.8 with recommendations.

The Document Provenance Option adds an additional protection against Data Integrity and Data Authenticity risks. The Provenance record associated with a Data Element returned by the Clinical Data Source would indicate the source of the data. In the case where Provenance is specific to a Document, grouping with MHD Document Consumer or XDS Document Consumer enables the retrieval of that source Document. The mXDE Profile ITI TF-1: 45.5 Security Considerations includes further discussion on the specific Security Considerations of bridging between a Document Sharing environment and a Data Element access model.

1:8.6 QEDm Cross-Profile Considerations

ITI mXDE – Mobile Cross-Enterprise Document Data Element Extraction

A Clinical Data Source may be grouped with a Data Element Extractor which requires the addition of necessary provenance information to ensure consistency within each returned data element.

This grouping allows the extraction of data elements and the addition of references to data origins (e.g., Documents) used in generating the result.

A Clinical Data Consumer may be grouped with a Data Element Provenance Consumer to extract the identifiers (provenance information) that consistently link the returned data elements to the related data origin.

ITI PIX - Patient Identity Cross Referencing and ITI PDQ - Patient Demographics Query

A Clinical Data Consumer may be grouped with a Patient Identifier Cross-reference Consumer or a Patient Demographics Consumer to resolve patient identifiers prior to submitting queries to a Clinical Data Source.

Within an enterprise, the need to cross-reference patient identifiers may not be necessary. However, once enterprise boundaries are crossed, these identifiers will need to be resolved. In that case profiles such as PIX, PIXm, PDQ and/or PDQm may be used.

ITI MHD – Mobile Health Documents

A Clinical Data Source may be grouped with an MHD Document Responder. Data gathered from clinical documents submitted to the Document Responder can be a source of information returned by the Clinical Data Source. It may include references to documents used in generating the QEDm returned data-elements, by using the FHIR Provenance Resource.

A Clinical Data Consumer may be grouped with an MHD Document Consumer. The Clinical Data Consumer may use the references to access the source documents.

ITI XDS - Cross-Enterprise Document Sharing

A Clinical Data Source may be grouped with an XDS Document Repository. Data gathered from clinical documents submitted to the Document Repository can be a source of information returned by the Clinical Data Source. Information returned by the Clinical Data Source may include references to all documents used in generating the results, by using the FHIR Provenance Resource.

Content Integration Profiles

A Content Creator may be grouped with a Clinical Data Consumer to obtain some or all of the information necessary to create a Medical Summary based on information found in a Clinical Data Source.

A Content Creator may be grouped with a Clinical Data Source. When grouped with a Content Creator, the Clinical Data Source shall respond to queries containing the relevant vocabulary codes used by the Content Creator.