CH EPR FHIR (R4), published by eHealth Suisse. This guide is not an authorized publication; it is the continuous build for version 4.0.1-ballot-2 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/ehealthsuisse/ch-epr-fhir/ and changes regularly. See the Directory of published versions

Update Document Metadata [CH:MHD-1]

This section corresponds to transaction [CH:MHD-1]. Transaction [CH:MHD-1] is used by the Document Source and Document Recipient Actors.

Scope

The Update Document Metadata [CH-MHD-1] transaction is used to update document metadata from the Document Consumer to the Document Responder.

Actor Roles

Actor: Document Source
Role: Prepares and issues an update to a DocumentReference resource
Actor: Document Recipient
Role: Accepts requests for updates to a DocumentReference resource

Referenced Standards

1. Mobile access to Health Documents (MHD), Rev. 4.2.2 – Trial-Implementation, 2024-05-18
2. This MHD Profile is based on Release 4 of the HL7® FHIR® standard.

Messages

Update Document Metadata Request Message

The Update Document Metadata Request Message provides the ability to submit updated attributes for a DocumentReference resource in a community.

Trigger Events

The Update Document Metadata Request Message is triggered when an Document Source needs to transmit updated DocumentReference metadata.

Message Semantics

A Document Source initiates a FHIR request using Update as defined at http://hl7.org/fhir/http.html#update on a DocumentReference Resource.

A Document Source shall send a request for either the JSON or the XML format as defined in FHIR. A Document Recipient shall support the JSON and the XML format.

The Document Source shall be capable of accepting elements specified in profile CH MHD DocumentReference Comprehensive. The DocumentReference elements which are allowed to be updated are defined in Annex 5.1 1.12.1. The Mappings tab, indicates the mapping between DocumentReference elements and the XDS elements defined in Annex 5.1 1.12.1.

Example

PUT [base]/DocumentReference/1c8d1f74-1686-4188-9c35-0c5727c771cc HTTP/1.1
Accept: application/fhir+json
traceparent: 00-0af7651916cd43dd8448eb211c80319c-b7ad6b7169203331-00

{
  "resourceType": "DocumentReference",
  "id": "1c8d1f74-1686-4188-9c35-0c5727c771cc",
  "contained": [
    {
      "resourceType": "Patient",
      "id": "pat",
      "identifier": [
        {
          "use": "usual",
          "type": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code": "MR"
              }
            ]
          },
          "system": "urn:oid:2.16.756.888888.3.1",
          "value": "8734"
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://fhir.ch/ig/ch-epr-fhir/StructureDefinition/ch-ext-deletionstatus",
      "valueCoding": {
        "system": "urn:oid:2.16.756.5.30.1.127.3.10.18",
        "code": "urn:e-health-suisse:2019:deletionStatus:deletionNotRequested"
      }
    },
    {
      "url": "http://fhir.ch/ig/ch-epr-fhir/StructureDefinition/ch-ext-author-authorrole",
      "valueCoding": {
        "system": "urn:oid:2.16.756.5.30.1.127.3.10.6",
        "code": "HCP",
        "display": "Healthcare professional"
      }
    }
  ],
  "masterIdentifier": {
    "system": "urn:ietf:rfc:3986",
    "value": "urn:oid:1.3.6.1.4.1.12559.11.13.2.1.2951"
  },
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:50383ae5-49e5-4dea-b0e6-660cb9e7b91f"
    }
  ],
  "status": "current",
  "type": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "721912009",
        "display": "Medication summary document (record artifact)"
      }
    ]
  },
  "category": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "422735006",
          "display": "Summary clinical document (record artifact)"
        }
      ]
    }
  ],
  "subject": {
    "reference": "http://example.org/Patient/FranzMusterNeedsAbsoluteUrl"
  },
  "date": "2020-06-29T11:58:00+00:00",
  "description": "Changed Description for -MedicationCard",
  "securityLabel": [
    {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "17621005",
          "display": "Normal (qualifier value)"
        }
      ]
    }
  ],
  "content": [
    {
      "attachment": {
        "contentType": "text/xml",
        "language": "de-CH",
        "url": "http://example.com/xdsretrieve?uniqueId=urn:uuid:413eb0f7-aa72-4405-86a4-7793a23fcc27&repositoryUniqueId=2.999.756.42.1",
        "creation": "2020-06-29T11:58:00+00:00"
      },
      "format": {
        "system": "http://ihe.net/fhir/ihe.formatcode.fhir/CodeSystem/formatcode",
        "code": "urn:ihe:pharm:pml:2013",
        "display": "Pharmacy PML"
      }
    }
  ],
  "context": {
    "facilityType": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "264358009",
          "display": "General practice premises (environment)"
        }
      ]
    },
    "practiceSetting": {
      "coding": [
        {
          "system": "http://snomed.info/sct",
          "code": "394802001",
          "display": "General medicine (qualifier value)"
        }
      ]
    },
    "sourcePatientInfo": {
      "reference": "#pat"
    }
  }
}

Expected Actions

The Document Recipient shall provide a CapabilityStatement with the capabilities interaction and indicate that update is available on the DocumentReference.

The Update Responder shall process the Update Document Metadata Request message and return the updated DocumentReference.

Any error that occurs during the processing of the Update Document Metadata Request message shall cause the entire transaction to fail and no change made to the existing DocumentReference. The DocumentReference Responder shall return the status and any error codes incurred during the processing of the request in its response message.

1. Verify the submitted and existing DocumentReference have the same values for the identifiers. If these values are not identical, an OperationOutcome with the error code XDSMetadataIdentifierError should be returned.
2. Verify the submitted and existing DocumentReference reference the same Patient. If these values are not identical, an OperationOutcome with the error code XDSPatientIDReconciliationError should be returned.
3. Check the submitted DocumentReference and determine if it contains only changes to modifiable attributes, as described in Annex 5.1 1.12.1. If not, an OperationOutcome with the error code UnmodifiableMetadataError should be returned.

Federated Cross Community Access Option

With the Federated Cross Community Access option the Document Recipient SHALL identify if a document metadata update targets another community. If this is the case, it SHALL forward the request to the target community, otherwise the request can be handled in the own community. If the remote community cannot be reached an error SHALL be generated by the Document Recipient and the Document Source SHALL process this error.

Response Message

See http://hl7.org/fhir/http.html#update for response.

Security Consideration

The transaction SHALL be secured by Transport Layer Security (TLS) encryption and server authentication with server certificates. Transactions across communities SHALL use mTLS.

The transaction SHALL use client authentication and authorization using extended authorization token as defined in the IUA profile. The extended authorization token SHALL be conveyed as defined in the Incorporate Access Token [ITI-72] transaction.

All Document Recipients except the one with the Federated Cross Community Access Option SHALL be grouped with the Authorization Decision Consumer actor of the CH:ADR profile defined in Extension 2.1 to Annex 5 of the ordinances and perform an Authorization Decision Request [CH:ADR] for every update document metadata [CH:MHD-1] request.

The actors SHALL support the traceparent header handling, as defined in Appendix: Trace Context.

Security Audit Considerations

Document Source Audit

The Document Source shall record an CH Audit Event for [CH:MHD-1] Document Source (example).

Document Recipient Audit

The Document Recipient shall record an CH Audit Event for [CH:MHD-1] Document Recipient (example).