IHE ITI Mobile access to Health Documents (MHD) - Document Consumer (client).

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with no declared Options or all declared Options.

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with Comprehensive declared Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with Generate Metadata declared Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with ITI-65 FHIR Documents Publish declared Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with Simplified Publish declared Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with UnContained declared Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Responder (server).

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with no declared Options or all declared Options.

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with Comprehensive Metadata Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with ITI-65 FHIR Documents Publish Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with UnContained Option.

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with the Generate Metadata declared Options and may also declare other Options.

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with the Simplified Publication declared Options and may also declare other Options.

The $generate-metadata Operation defintion.

This operation is needed as the $generate in FHIR R4 is not properly defined, and thus has incorrect parameters. The MHD $generate-metadata should be replaced when MHD is upgraded to FHIR R5. This MHD $generate-metadata is modeled after the expected changes in FHIR R5, and follows the example given in FHIR R4:

Input:

• Binary 0..1 the document in Binary Resource format. Usually used with CDA documents.
• Bundle 0..1 the document in FHIR-Document form of a Bundle of kind Document Output:
• reference to a DocumentReference with metadata generated from the document

Search Parameter extension enabling clients to search on the DocumentReference.content.attachment.creation element

This SearchParameter enables finding Lists by the SourceId of a submissionSet.

This SearchParameter enables finding Lists by the designationType code in a submissionSet or folder.

Defines constraints on the AuditEvent Resource to record when a Find Document Lists Transaction happens, as recorded by the Document Responder.

• Build off of the IHE BasicAudit PatientQuery event
• add the ITI-67 as a subtype
• client is Document Consumer
• server is Document Responder
• entity slices for query, and patient are required
• entity slice for transaction is available

Defines constraints on the AuditEvent Resource to record when a Find Document Lists Transaction happens, as recorded by the Document Consumer.

• Build off of the IHE BasicAudit PatientQuery event
• add the ITI-67 as a subtype
• client is Document Consumer
• server is Document Responder
• entity slices for query, and patient are required
• entity slice for transaction is available

Defines constraints on the AuditEvent Resource to record when a Find Document References Transaction happens, as recorded by the Document Consumer.

• Build off of the IHE BasicAudit PatientQuery event
• add the ITI-67 as a subtype
• client is Document Consumer
• server is Document Responder
• entity slices for query, and patient are required
• entity slice for transaction is available

Defines constraints on the AuditEvent Resource to record when a Find Document References Transaction happens, as recorded by the Document Responder.

• Build off of the IHE BasicAudit PatientQuery event
• add the ITI-67 as a subtype
• client is Document Consumer
• server is Document Responder
• entity slices for query, and patient are required
• entity slice for transaction is available

Defines constraints on the AuditEvent Resource to record when a Generate Metadata ITI-106 Transaction happens at the Recipient.

• Build off of the IHE Basic Audit Patient Create event
• add the ITI-106 as a subtype
• client is the Document Source
• Server is the Document Recipient
• may have user, app, organization agent(s)
• shall have a patient entity
• shall have a documentReference identity entity

Defines constraints on the AuditEvent Resource to record when a Generate Metadata ITI-106 Transaction happens at the Soure.

• Build off of the IHE Basic Audit Create event
• add the ITI-106 as a subtype
• client is the Document Source
• Server is the Document Recipient
• may have user, app, organization agent(s)
• shall have a document uri
• note the Document Source may add a patient if it knows it.

Defines constraints on the AuditEvent Resource to record when a Provide Bundle Transaction happens at the Recipient.

• Import event
• shall have source of itself
• shall have a document source agent
• shall have a document recipient agent
• may have user, app, organization agent(s)
• shall have a patient entity
• shall have a submission set identity entity

Defines constraints on the AuditEvent Resource to record when a Provide Bundle Transaction happens at the Source.

• Export event
• shall have source of itself
• shall have a document source agent
• shall have a document recipient agent
• may have user, app, organization agent(s)
• shall have a patient entity
• shall have a submission set identity entity

Defines constraints on the Document Consumer AuditEvent Resource to record when a Retrieve Document Transaction happens, as recorded by the Document Consumer.

• Build off of the IHE BasicAudit PatientRead event
• add the ITI-68 as a subtype
• client is Document Consumer
• server is Document Responder
• entity slices for data, and patient are required
• entity slice for transaction is available

Defines constraints on the Document Responder AuditEvent Resource to record when a Retrieve Document Transaction happens, as recorded by the Document Responder.

• Build off of the IHE BasicAudit PatientRead event
• add the ITI-68 as a subtype
• client is Document Consumer
• server is Document Responder
• entity slices for data, and patient are required
• entity slice for transaction is available

Defines constraints on the AuditEvent Resource to record when a Simplified Publish ITI-105 Transaction happens at the Recipient.

• Build off of the IHE Basic Audit Patient Create event
• add the ITI-105 as a subtype
• client is the Document Source
• Server is the Document Recipient
• may have user, app, organization agent(s)
• shall have a patient entity
• shall have a documentReference identity entity

Defines constraints on the AuditEvent Resource to record when a Simplified Publish ITI-105 Transaction happens at the Soure.

• Build off of the IHE Basic Audit Patient Create event
• add the ITI-105 as a subtype
• client is the Document Source
• Server is the Document Recipient
• may have user, app, organization agent(s)
• shall have a patient entity
• shall have a documentReference identity entity

The Input Parameters for the $generate-metadata operation

• Input: binary, bundle

The Output Parameters for the $generate-metadata operation

• Output: DocumentReference reference

A profile on the Bundle transaction for ITI-65 Provide Document resources with Comprehensive Metadata for MHD.

• Comprehensive Metadata: https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Comprehensive.ProvideBundle
  • this is otherwise known as XDS-on-FHIR
  • shall be a Transaction Bundle
  • all resources shall be compliant with comprehensive constraints, they may be marked comprehensive
  • shall create a SubmissionSet type List that is either minimal, comprehensive, or unContained
  • may create one or more DocumentReference that is either minimal, comprehensive, or unContained
    • with a document as a Binary
    • or, when implementing the ITI-65 FHIR Document Publish option, a FHIR Document Bundle
  • may create/update one or more Folder type List that is either minimal, comprehensive, or unContained
  • may create/update/read one Patient

A profile on the DocumentReference resource for MHD Comprehensive Option with Contained (not UnContained), compatible with XDS-on-FHIR and XCA use.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR DocumentReference implementation of the
• ebRIM implementation at 3:4.2.3.2 Document Entry.
• with use-cases and constraints found in 3:4.3 Additional Document Sharing Requirements

A profile on the DocumentReference resource for MHD with Comprehensive Metadata Option but without a requirement for contained author, authenticator, or sourcePatientInfo.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR DocumentReference implementation of the
• ebRIM implementation at 3:4.2.3.2 Document Entry.
• with use-cases and constraints found in 3:4.3 Additional Document Sharing Requirements

A profile on the DocumentReference resource for MHD with minimal metadata constraints.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR DocumentReference implementation of the
• ebRIM implementation at 3:4.2.3.2 Document Entry.
• with use-cases and constraints found in 3:4.3 Additional Document Sharing Requirements

A profile on the Parameters resource to update the superseded DocumentReference status.

A profile on the DocumentReference resource for MHD Simplified Publish constraints.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR DocumentReference implementation of the
• ebRIM implementation at 3:4.2.3.2 Document Entry.
• with use-cases and constraints found in 3:4.3 Additional Document Sharing Requirements

Simplified Publish

• Similar to Minimal Metadata constraints
  • must be status current
  • must have a patient indicated
• uses attachment.data to carry the document, rather than attachment.url
  • so that the Simplified Publish is a simple POST of the DocumentReference
  • Document Recipient is expected to extract the .data, use .url

A profile on the Find Document Lists Response message for ITI-66

A profile on the Find Document References Comprehensive Response message for ITI-67

A profile on the Find Document References Response message for ITI-67

A profile on the List resource for MHD Comprehensive Metadata Folder. Note UnContained has no impact on Folder.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR List for use as a Folder implementation of the
• ebRIM implementation at 3:4.2.3.4 Folder Attributes.
• with use-cases and constraints found in 3:4.3 Additional Document Sharing Requirements

A profile on the List resource for MHD use as a Folder with minimal metadata constraints.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR List for use as a Folder implementation of the
• ebRIM implementation at 3:4.2.3.4 Folder Attributes.
• with use-cases and constraints found in 3:4.3 Additional Document Sharing Requirements

A profile on the Bundle transaction for ITI-65 Provide Document resources with Minimal metadata for MHD.

• Minimal Metadata: https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Minimal.ProvideBundle
  • shall be a Transaction Bundle
  • all resources shall be compliant with minimal constraints, they may be marked minimal, comprehensive, or unContained
  • shall create a SubmissionSet type List that is either minimal, comprehensive, or unContained
  • may create one or more DocumentReference that is either minimal, comprehensive, or unContained
    • with a document as a Binary
    • or, when implementing the ITI-65 FHIR Document Publish option, a FHIR Document Bundle
  • when DocumentReference replace is used the UpdateDocumentRefs slice is used to indicate the superseded DocumentReference
  • may create/update one or more Folder type List that is either minimal, comprehensive, or unContained
  • may create/update/read one Patient

A profile on the Bundle transaction-response for ITI-65 Provide Document Bundle response.

• shall be a transaction response
• shall have at least 1 entry for each entry in the request, in the same order as received in the request
  • entry response location must be indicated

A profile on the List resource for MHD Comprehensive SubmissionSet.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR List for use as a SubmissionSet implementation of the
• ebRIM implementation at 3:4.2.3.3 SubmissionSet Attributes.
• with use-cases and constraints found in 3:4.3.1 Submission Metadata Attribute Optionality for
  • MHD Comprehensive Option Document Source
  • aka the XDS Document Source requirements
  • aka the XDR Document Source requirements

A profile on the List resource for MHD UnContained Comprehensive SubmissionSet.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR List for use as a SubmissionSet implementation of the
• ebRIM implementation at 3:4.2.3.3 SubmissionSet Attributes.
• with use-cases and constraints found in 3:4.3.1 Submission Metadata Attribute Optionality for
  • MHD Document Source that has implemented both Comprehensive Metadata Option and UnContained References Option

A profile on the List resource for MHD SubmissionSet.

• MHD is based on the IHE Document Sharing model,
• the 3:4.1 Abstract Metadata Model, and
• the use defined here is FHIR List for use as a SubmissionSet implementation of the
• ebRIM implementation at 3:4.2.3.3 SubmissionSet Attributes.
• with use-cases and constraints found in 3:4.3.1 Submission Metadata Attribute Optionality for
  • Document Source implementing not implementing Comprehensive Metadata Option
  • Document Source implementing UnContained Option but not Comprehensive Option
  • equivalent to XDR Document Source implementing Metadata-Limited Option requirements
  • aka the default MHD Document Source

A profile on the Bundle transaction for ITI-65 Provide Document resources with UnContained allowed but requiring Comprehensive Metadata for MHD.

• UnContained Comprehensive Metadata: https://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.UnContained.Comprehensive.ProvideBundle
  • note that Minimal Metadata does not require containment, so UnContained Minimal is the same as Minimal Metadata
  • note that UnContained only applies to DocumentReference and SubmissionSet type Lists; so the following apply
  • shall be a Transaction Bundle
  • all resources shall be compliant with comprehensive unContained constraints, they may be marked comprehensive unContained
  • shall create a SubmissionSet type List that is either minimal, comprehensive, or unContained
  • may create one or more DocumentReference that is either minimal, comprehensive, or unContained
    • with a document as a Binary
    • or, when implementing the ITI-65 FHIR Document Publish option, a FHIR Document Bundle
  • may create/update one or more Folder type List that is either minimal, comprehensive, or unContained
  • may create/update/read one Patient

A profile on the List resource for MHD. Used with both Folder and SubmissionSet.

• MHD adds a codeable Concept to List for use with Folder and SubmissionSet

entryUUID Identifier holding a UUID

uniqueId Identifier

• see Appendix Z

uniqueId Identifier holding a OID

When the author of the SubmissionSet is an Organization, this extension shall be used.

Expresses contentType of submissionSet or the codeList of a Folder. Usually expressed in LOINC or SNOMED.

holds the identity of the organization or person the SubmissionSet is intended. For XDR and eMail (e.g. Direct) this tends to be a Practitioner or Patient with a telecom holding an email, but this is not strictly required.

The globally unique, immutable, identifier of the entity that contributed the SubmissionSet. When a broker is involved in sending SubmissionSets from a collection of client systems, it shall use a different sourceId for submissions from each separate system to allow for tracking. The format of the identifier is an OID.

ValueSet that does not include entered-in-error as that does not map

A ValueSet of the allowed actions in a ITI-65 Provide Document Bundle for the Folder List type Resources. Where Folders are allowed to be Updated in addition to Created.

ValueSet of the MHD List Types allowed

A ValueSet of the allowed actions in a ITI-65 Provide Document Bundle for the Patient type Resource. Where Patient would typically be indicated as a GET (read), but might be created or updated depending on policy.

To use the List resource for two different use-cases we define a code-system with the types of List needed in MHD

map between XDS Association Types and MHD FHIR DocumentReference relatesTo code.

map between XDS ebRIM Status Type Codes and MHD FHIR DocumentReference.status code.

Audit Example for a Simplified Publish Transaction as recorded at the recipient

Audit Example for a Simplified Publish Transaction from source perspective

Audit Example for a Generate Metadata Transaction as recorded at the recipient

Audit Example for a Generate Metadata Transaction from source perspective

Audit Example for a Provide Bundle Transaction as recorded at the recipient

Audit Example for a Provide Bundle Transaction from source perspective

Audit Example for a Find Document Lists Transaction as recorded at the consumer

Audit Example for a Find Document Lists Transaction from responder perspective

Audit Example for a Find Document References Transaction as recorded at the consumer

Audit Example for a Find Document References Transaction from responder perspective

Audit Example for a Find Document References Transaction using POST search as recorded at the responder perspective

Audit Example for a Retrieve Document Transaction as recorded at the consumer

Audit Example for a Retrieve Document Transaction from responder perspective

Example of a Comprehensive DocumentReference resource. This is fully filled for all mandatory elements and all optional elements.

Example of a Comprehensive DocumentReference resource.

• This is fully filled for all mandatory elements and all optional elements.
• This specifies a Delayed Document Assembly Document.
  • Thus the hash is the fixed value da39a3ee5e6b4b0d3255bfef95601890afd80709
  • and the size is explicitly zero
  • and when a Document Consumer retrieves the URL, then the document will be assembled and returned to it
  • and the DocumentReference would be updated with the resulting hash and size thus becoming a static entry

Example of a Comprehensive DocumentReference resource.

• This is fully filled for all mandatory elements.
• This specifies a On-Demand Document.
  • Thus the hash is not provided
  • and the size is not provided
  • and when a Document Consumer retrieves the URL, then a new document will be created and returned to it
  • and a linked snapshot DocumentReference would be created with the resulting hash and size thus becoming a static entry

Example of a Comprehensive DocumentReference resource.

• This is fully filled for all mandatory elements.
• This specifies a Document in a Binary.

Example of a comprehensive DocumentReference resource beeing replaced

Example of a UnContained References Option with Comprehensive DocumentReference resource. This is fully filled for all mandatory elements and optional elements.

Example of a Comprehensive DocumentReference resource. This is minimally filled for all mandatory elements.

Example of a minimal DocumentReference resource. This is very unlikely to be acceptable anywhere, but it is the minimum required.

Example of a minimal DocumentReference resource. This has minimal metadata plus an encounter and custodian.

Example of a Simplified Publish DocumentReference resource. This has minimal metadata plus an encounter and custodian.

For Bundling Example binary that

• holds "Hello World"
• size 11
• hash 0a4d55a8d778e5022fab701977c5d840bbc486d0
• base64 of the hash MGE0ZDU1YThkNzc4ZTUwMjJmYWI3MDE5NzdjNWQ4NDBiYmM0ODZkMA==

Dummy Bundle with a DocumentReferenece and Binary

• with 1 documentReference
• with 1 document Binary

Dummy Device example for completeness sake. No actual use of this resource other than an example target

Dummy DocumentReference 2 example for completeness sake. No actual use of this resource other than an example target

Dummy DocumentReference example for completeness sake. No actual use of this resource other than an example target

Dummy Encounter example for completness sake. No actual use of this resource other than an example target

Dummy List example for completeness sake. No actual use of this resource other than an example target

Dummy Organization example for completeness sake. No actual use of this resource other than an example target

Dummy patient example for completeness sake. No actual use of this resource other than an example target

Dummy Practitioner example for completeness sake. No actual use of this resource other than an example target

SubmissionSet in List resource conforming Comprehensive metadata with an intendedRecipient

Folder in List resource conforming only to Comprehensive metadata

SubmissionSet in List resource conforming fully to Comprehensive metadata. This has all elements fully populated.

SubmissionSet in List resource conforming minimally to Comprehensive metadata

An example of a searchset Bundle with one DocumentReference

Folder in List resource conforming only to Minimal metadata

An example of a Provide Bundle with a single DocumentReference pointing at a FHIR-Document Bundle

SubmissionSet in List resource conforming fully to UnContained References Option and Comprehensive Metadata Option. This has all elements fully populated.

Example binary that holds just Hello World

• size 11
• hash 0a4d55a8d778e5022fab701977c5d840bbc486d0
• base64 of the hash MGE0ZDU1YThkNzc4ZTUwMjJmYWI3MDE5NzdjNWQ4NDBiYmM0ODZkMA==

An example of a FHIR-Document Bundle

Example of a Find Documents List Response Bundle witha folder

Example of a Find Document References Bundle Search Set with a single DocumentReference

Example of a comprehensive Provide Document Bundle for a publication.

• The bundle contains
  • SubmissionSet - identifies the documentReference(s)
  • DocumentReference - First DocumentReference
  • Binary - the first document
  • DocumentReference - Second DocumentReference
  • Binary - the second document
  • the Patient is contained in the DocumentReference
  • the Patient is also a reference to a PIXm/PDQm retrieved Resource.

Example of a comprehensive Provide Document Bundle for a publication.

• The bundle contains
  • SubmissionSet - identifies one documentReference
  • DocumentReference - One DocumentReference
  • Binary - the document
  • the Patient is contained in the DocumentReference
  • the Patient is also a reference to a PIXm/PDQm retrieved Resource.

Example of a comprehensive Provide Document Bundle for a publication which replaces another document.

• The bundle contains
  • SubmissionSet - identifies one documentReference
  • DocumentReference - Two DocumentReferences, an update to the old DocumentReference and the new DocumentReferences relates to the old DocumentReference
  • Binary - the document
  • the Patient is contained in the DocumentReference
  • the Patient is also a reference to a PIXm/PDQm retrieved Resource.

Example of a minimal Provide Document Bundle for a push to an email intended recipient.

• The bundle contains
  • SubmissionSet - identifies to whom this is going and one documentReference
  • DocumentReference - One DocumentReference
  • Binary - the document
  • the Patient, as this is a push to a recipient that does not share a patient directory

Example of a minimal Provide Document Bundle for a push to an email intended recipient.

• The bundle contains
  • SubmissionSet - identifies to whom this is going and one documentReference
  • DocumentReference - One DocumentReference
  • Binary - the document
  • the Patient is contained in the DocumentReference. This would be more classic XDR/XDM model. Note there is no mention of the patient in the SubmissionSet in this case (hence minimal metadata), and if multiple documents were sent they would implicitly be the same patient, presumably with the same contained Patient; but given it is a contained Patinet there is no way to computably prove this beyond exact comparison of the contained object.

Example of a complete comprehensive Provide Document Bundle for a publication.

• The bundle contains
  • SubmissionSet - identifies one documentReference
  • Folder - identifies one documentReference
  • DocumentReference - One DocumentReference
  • Binary - the document
  • the Patient is contained in the DocumentReference
  • the Patient is also a reference to a PIXm/PDQm retrieved Resource.

Example of a complete uncontained comprehensive Provide Document Bundle for a publication.

• The bundle contains
  • SubmissionSet - identifies one documentReference
  • Folder - identifies one documentReference
  • DocumentReference - One DocumentReference
  • Binary - the document
  • the Practitioner and Organization are references
  • the Patient is also a reference to a PIXm/PDQm retrieved Resource.

Example of a comprehensive Provide Document Bundle for a publication and added to an existing folder.

• The bundle contains
  • SubmissionSet - identifies one documentReference
  • Folder - existing Folder to be updated
  • DocumentReference - One DocumentReference
  • Binary - the document
  • the Patient is contained in the DocumentReference
  • the Patient is also a reference to a PIXm/PDQm retrieved Resource.

Response bundle example given ex-minimalProvideDocumentBundleSimple

• for every entry in order given
  • successful create of SubmissionSet
  • successful create of DocumentReference
  • successful create of Binary
  • successful create of Patient

Note that in the case of the Patient, it is likely this successful create is just a fake success, as it was more likely to have been matched to a patient that already existed and THAT id was returned. (Alternative could have been a 303)

Response bundle example given ex-minimalProvideDocumentBundleSimpleContained

• for every entry in order given
  • successful create of SubmissionSet
  • successful create of DocumentReference
  • successful create of Binary

Response bundle example given ex-comprehensiveProvideDocumentBundleMultiple

• for every entry in order given
  • successful create of SubmissionSet
  • successful create of DocumentReference - classic XDS static document
  • successful create of Binary

Response bundle example given ex-comprehensiveProvideDocumentBundleSimple

• for every entry in order given
  • successful create of SubmissionSet
  • successful create of DocumentReference - classic XDS static document
  • successful create of Binary

Response bundle example given ex-comprehensiveProvideDocumentBundleComplete

• for every entry in order given
  • successful create of SubmissionSet
  • successful create of Folder
  • successful create of DocumentReference - classic XDS static document
  • successful create of Binary

Response bundle example given ex-unContainedComprehensiveProvideDocumentBundleComplete

• for every entry in order given
  • successful create of SubmissionSet
  • successful create of DocumentReference - classic XDS static document
  • successful create of Binary

Example of a minimal submissionSet in List resource.

example Parameters with a binary

example output from GenerateMetadata