Query for Existing Data for Mobile (QEDm), published by IHE Patient Care Coordination Technical Committee. This guide is not an authorized publication; it is the continuous build for version 3.0.1-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/PCC.QEDm/ and changes regularly. See the Directory of published versions

2:3.44 Mobile Query Existing Data [PCC-44]

This section corresponds to transaction [PCC-44] of the IHE Technical Framework. Transaction [PCC-44] is used by the Clinical Data Consumer and Clinical Data Source Actors.

2:3.44.1 Scope

The Mobile Query Existing Data transaction is used to query for fine grained clinical data elements that satisfy a set of parameters by using the FHIR framework. The result of the query is a FHIR Bundle containing FHIR clinical data Resources that match the query parameters.

The QEDm Profile assumes that categories and codes referenced by these FHIR Resources need to be defined at the time of deployment. The specification of these FHIR Resources make recommendations on categories and codes that SHOULD be considered.

2:3.44.2 Actor Roles

Table 2:3.44.2-1: Actor Roles

2:3.44.3 Referenced Standards

• HL7 FHIR standard

2:3.44.4 Messages

Figure 2:3.44.4-1: Interaction Diagram

2:3.44.4.1 Mobile Query Existing Data Request message

This message uses the HTTP GET method parameterized query to retrieve FHIR Resources representing clinical data matching search parameters in the GET request.

QEDm does not mandate any additional extended or custom method.

2:3.44.4.1.1 Trigger Events

When the Clinical Data Consumer needs to discover clinical data Resources matching various search parameters it issues a Mobile Query Existing Data message.

2:3.44.4.1.2 Message Semantics

The Clinical Data Consumer executes an HTTP GET against the proper Clinical Data Source’s QEDm URL.

The search target follows the FHIR http specification http://hl7.org/fhir/R4/http.html, addressing the proper FHIR Resource type, according to the supported query options (see Section 2:3.44.4.1.2.1). The syntax of the FHIR query is:

GET [base]/[Resource-type]{?[parameters]}

with the following constraints:

• The [base] represents the Service Base URL
• The [Resource-type] represents the name of the FHIR Resource to consider (each option can involve one or more Resources), as specified in Section 3.44.4.1.2.1
• The [parameters] represents a series of encoded name-value pairs representing the filter for the query, as specified in Section 3.44.4.1.2.1, as well as control parameters to modify the behavior of the Clinical Data Source such as response format, or pagination. See ITI TF-2: Appendix Z.6 for more details on response format.

2:3.44.4.1.2.1 Query Search Parameters

All query parameter values SHALL be appropriately encoded per RFC3986 “percent” encoding rules. Note that percent encoding does restrict the character set to a subset of ASCII characters which is used for encoding all other characters used in the URL.

The FHIR Resource type or types supported by the Clinical Data Consumer and Clinical Data Source are determined by a QEDm named option. An actor claiming named option is required to support the FHIR Resource types listed below. According to the supported option, the Clinical Data Consumer MAY query and the Clinical Data Source SHALL be capable of responding on the Resource types specified in Table 2:3.44.4.1.2.1-1 by processing all the search parameters defined in the following sections.

The Clinical Data Source MAY choose to support additional query parameters beyond the subset defined by the profiling listed below, if done according to the core FHIR specification. Such additional parameters are considered out of scope for this transaction. The Clinical Data Source MAY ignore any additional parameter not specified in this transaction. See http://hl7.org/fhir/R4/search.html#errors.

Sections 2:3.44.4.1.2.1.1 through 2:3.44.4.1.2.1.10 detail the Resource and search parameters combinations to be supported for each of the FHIR Resources designated by a named option.

See ITI TF-2: Appendix Z.10 Profiling conventions for constraints on FHIR for a description of terms used in the Optionality columns.

2:3.44.4.1.2.1.1 Simple Observations Option Search Parameters

When supporting the Simple Observations Option, the Clinical Data Consumer supplies, and the Clinical Data Source SHALL support, the FHIR Observation Resource and be at least capable of processing the search parameters combinations as specified by the following table, according to the related optionality.

GET [base]/Observation?[parameters]

Note 1: The Clinical Data Consumer SHALL support at least one of the search parameters combinations.

2:3.44.4.1.2.1.2 Allergies and Intolerances Option Search Parameters

When supporting the Allergies and Intolerances Option, the Clinical Data Consumer SHALL supply and the Clinical Data Source SHALL support the FHIR AllergyIntolerance Resource and be capable of processing the search parameter as specified by the following table.

GET [base]/AllergyIntolerance?[parameters]

Table 2:3.44.4.1.2.1.2-1: Allergies and Intolerances Option Search Parameters

2:3.44.4.1.2.1.3 Conditions Option Search Parameters

The intended use of FHIR Condition resource includes recording of detailed information about conditions, problems or diagnoses recognized by a clinician. When supporting the Conditions Option, the Clinical Data Consumer supplies and the Clinical Data Source SHALL support the FHIR Condition Resource and be capable of processing all the search parameters combinations as specified by the following table, according to the related optionality.

GET [base]/Condition?[parameters]

Table 2:3.44.4.1.2.1.3-1: Conditions Option Search Parameters

Note 1: The Clinical Data Consumer SHALL support at least one of the search parameters combinations

2:3.44.4.1.2.1.4 Diagnostic Reports Option Search Parameters

When supporting the Diagnostic Reports Option, the Clinical Data Consumer supplies and the Clinical Data Source SHALL support the FHIR DiagnosticReport Resource and be capable of processing all the search parameters combinations as specified by the following table, according to the related optionality.

GET [base]/DiagnosticReport?[parameters]

Table 2:3.44.4.1.2.1.4-1: Diagnostic Reports Option Search Parameters

Note 1: The Clinical Data Consumer SHALL support at least one of the search parameters combinations

2:3.44.4.1.2.1.5 Medications Option Search Parameters

When supporting the Medications Option, the Clinical Data Consumer SHALL supply and the Clinical Data Source SHALL support the FHIR Medication Resource, FHIR MedicationStatement Resource, and FHIR MedicationRequest Resource, and be capable of processing the search parameters as specified by the following tables.

The MedicationStatement and MedicationRequest resources can represent a medication, using an external reference to a Medication resource. If an external Medication Resource is used in a MedicationStatement or a MedicationRequest, it can be retrieved by using the _include search parameter.

There are no search parameters required for the Medication Resource.

For MedicationStatement:

GET [base]/MedicationStatement?[parameters]

Table 2:3.44.4.1.2.1.5-1: MedicationStatement Search Parameters

For MedicationRequest:

GET [base]/MedicationRequest?[parameters]

Table 3.44.4.1.2.1.5-2: MedicationRequest Search Parameters

2:3.44.4.1.2.1.6 Immunizations Option Search Parameters

When supporting the Immunizations Option, the Clinical Data Consumer MAY supply and the Clinical Data Source SHALL support the FHIR Immunization Resource and be capable of processing the search parameter as specified by the following table.

GET [base]/Immunization?[parameters]

Table 2:3.44.4.1.2.1.6-1: Immunizations Option Search Parameters

2:3.44.4.1.2.1.7 Procedures Option Search Parameters

When supporting the Procedures Option, the Clinical Data Consumer supplies and the Clinical Data Source SHALL support the FHIR Procedure Resource and be capable of processing all the search parameters as specified by the following table, according to the related optionality.

GET [base]/Procedure?[parameters]

Table 2:3.44.4.1.2.1.7-1: Procedures Option Search Parameters

Note 1: The Clinical Data Consumer SHALL support at least one of the search parameters combinations

2:3.44.4.1.2.1.8 Encounters Option Search Parameters

When supporting the Encounters Option, the Clinical Data Consumer supplies and the Clinical Data Source SHALL support the FHIR Encounter Resource and be capable of processing all the search parameters as specified by the following table, according to the related optionality.

GET [base]/Encounter?[parameters]

Table 2:3.44.4.1.2.1.8-1: Encounters Option Search Parameters

Note 1: The Clinical Data Consumer SHALL support at least one of the search parameters combinations

2:3.44.4.1.2.1.9 Provenance Option Search Parameters

Clinical Data Consumer supporting this option is enabled to fetch a certain FHIR Resource(s) together with any reference to the original Document from which the Resource(s) has been derived. The FHIR Provenance Resource containing those references can be included by providing the _revinclude parameter in the query.

When supporting the Provenance Option, the Clinical Data Consumer SHALL supply and the Clinical Data Source SHALL be capable of processing the _revinclude parameter, as defined at FHIR Search include

GET [base]/[Resource-type]?_revinclude=Provenance:target&criteria

When supporting the Provenance Option, the Clinical Data Consumer supplies and the Clinical Data Source SHALL support the FHIR Provenance Resource and be capable of processing all the search parameters as specified by the following table, according to the related optionality.

GET [base]/Provenance?[parameters]

Table 2:3.44.4.1.2.1.9-1: Provenance Option Search Parameters

See Section 2:3.44.4.2.2.1 for the specification about the Provenance content.

2:3.44.4.1.2.1.10 Occupational Data for Health Option Search Parameters

When supporting the Occupational Data for Health (ODH) Option, the Clinical Data Consumer SHALL supply and the Clinical Data Source SHALL be capable of supporting Observation Resources compliant with the IHE FHIR Profile: Occupational Data for Health (ODH) - International.

2:3.44.4.1.2.2 Parameter Modifiers

The Clinical Data Source SHALL support the “:exact” parameter modifier on all query parameters of type string. When supplied by the Clinical Data Consumer, the “:exact” parameter modifier instructs the Clinical Data Source that exact matching SHALL be performed.

The Clinical Data Consumer SHOULD not use any additional parameter modifiers listed in the FHIR standard, which are considered out of scope in the context of this transaction.

The Clinical Data Source SHALL reject any search request that contains a search parameter with an unsupported modifier.

2:3.44.4.1.2.3 Populating Expected Response Format

The FHIR standard provides encodings for responses as either XML or JSON. The Clinical Data Source SHALL support both message encodings, whilst the Clinical Data Consumer SHALL support one and MAY support both.

See ITI TF-2: Appendix Z.6 for details.

2:3.44.4.1.3 Expected Actions

The Clinical Data Source SHALL process the query to discover the clinical data FHIR Resource entries (the fine-grained data elements) that match the search parameters given and SHALL use a FHIR Bundle resource to collect the matching entries to be returned.

The Clinical Data Source SHALL respond with a Mobile Query Existing Data Response synchronously (i.e., on the same connection as was used to initiate the request).

When the Provenance Option is specified, the response FHIR Bundle SHALL also contain FHIR Provenance Resource entries that provide consistency of the returned fine-grained data elements with the coarse-grained data origin (e.g., Document). See Section 3.44.4.2.2.1 for the specification about the Provenance content. If the fine-grained data element has not been extracted from a document, the Provenance Resource MAY be absent.

See ITI TF-2: Appendix Z.6 for more details on response format handling. See ITI TF-2: Appendix Z.7 for handling guidance for Access Denied.

3.44.4.2 Mobile Query Existing Data Response message

The Clinical Data Source returns an HTTP Status code appropriate to the processing as well as a list of the matching clinical data FHIR Resources.

3.44.4.2.1 Trigger Events

The Clinical Data Source completed processing of the Mobile Query Existing Data Request message.

3.44.4.2.2 Message Semantics

Based on the query results, the Clinical Data Source will either return an error or success. The guidance on handling Access Denied related to use of 200, 403 and 404 can be found in ITI TF-2: Appendix Z.7.

When the Clinical Data Source needs to report an error, it SHALL use HTTP error response codes and SHOULD include a FHIR OperationOutcome with more details on the failure. See FHIR http://hl7.org/fhir/R4/http.html and http://hl7.org/fhir/R4/operationoutcome.html.

In particular, if a Data Source receives a Mobile Query Existing Data transaction for a resource related to a QEDm Option not supported, it SHALL return an OperationOutcome.issue.code valued as: ‘not-supported’ and SHOULD set OperationOutcome.issue.details valued as: MSG_NO_MATCH No Resource found matching the query “%s”.

If the Mobile Query Existing Data request message is processed successfully, whether or not clinical data Resources are found, the HTTP status code SHALL be 200.

The Mobile Query Existing Data Response message SHALL be a FHIR Bundle Resource containing zero or more clinical data Resources plus optional Provenance Resources (see Section 2:3.44.4.2.2.1). If the Clinical Data Source is sending warnings, the Bundle Resource SHALL also contain an OperationOutcome Resource that contains those warnings.

The response SHALL adhere to the FHIR Bundle constraints specified in ITI TF-2: Appendix Z.1.

See an example of a search set bundle.

2:3.44.4.2.2.1 Provenance Option

A Clinical Data Source that supports the Provenance Option may be grouped with the Mobile Cross-Enterprise Document Data Element Extraction (mXDE) Data Element Extractor Actor and thus will expose mXDE defined Provenance resources.

The Clinical Data Source MAY return Provenance Resources used for other purposes than the one defined here. These would not have the indicated Provenance.policy of urn:ihe:iti:mxde:2023:document-provenance-policy.

2:3.44.4.2.2.2 Resource Bundling

Resource Bundling SHALL comply with the guidelines in ITI TF-2: Appendix Z.1.

The Clinical Data Source SHALL include all resources to be returned as a resource. This means that the query SHALL return resource data in the FHIR Bundle as entries. See an example of a search set bundle.

2:3.44.4.2.3 Expected Actions

The Clinical Data Consumer processes the bundle of resources, received in transaction [PCC-44] according to the capabilities of its application. These capabilities are not specified by IHE.

If a Clinical Data Consumer cannot automatically recover from an error condition, it SHOULD offer a means to make the error accessible to the query initiator (e.g., user, system).

2:3.44.4.2.3.1 Provenance Option

A Clinical Data Consumer that supports the Provenance Option processes the FHIR Provenance resources.

When a Provenance resource is received with Provenance.policy valued at urn:ihe:iti:mxde:2023:document-provenance-policy, the Provenance is compliant with the mXDE defined Provenance. The Provenance.target has a reference for the data element(s) for which a document reference is sought. The Clinical Data Consumer SHALL extract from these Provenance.entity, the reference contained in the Provenance.entity to the document from which the target data-element was extracted. For more detail on interpretation of these Provenance records and accessing the provenance documents, see Mobile Cross-Enterprise Document Data Element Extraction (mXDE).

A Clinical Data Consumer that supports the Provenance Option SHALL process all Provenance resources contained in a bundle returned by a [PCC-44] transaction where each provenance resource MAY include one or more Provenance.target in conjunction with one or more Provenance.entity.

2:3.44.4.3 Conformance Resource

Clinical Data Sources implementing this transaction SHALL provide a Conformance Resource as described in ITI TF-2: Appendix Z.3 indicating the query operation for the Resources have been implemented and SHALL include all the supported query parameters.

2:3.44.5 Security Considerations

The retrieved content contains PHI that SHALL be protected.

See the QEDm Security Considerations.

2:3.44.5.1 Security Audit Considerations

Grouping a Clinical Data Source with an Audit Trail and Node Authentication (ATNA) Secure Node or Secure Application is required. Grouping a Clinical Data Consumer with an ATNA Secure Node or Secure Application is recommended.

The Clinical Data Consumer MAY be considered overburdened to fully implement the requirements of a Secure Node or Secure Application. The Clinical Data Source is likely a more robust service and SHALL generate audit messages.

The AuditEvent resources to be recorded are refinements of the Basic AuditEvent Log Patterns (BALP) for RESTful Execute (search and query) where a Patient is a subject of the search.

2:3.44.5.1.1 Clinical Data Consumer

The Clinical Data Consumer when grouped with ATNA Secure Node or Secure Application Actor SHALL be able to record a Clinical Data Consumer AuditEvent. Audit Example for a QEDm Query transaction from consumer perspective.

2.3.44.5.1.2 Clinical Data Source

The Clinical Data Source when grouped with ATNA Secure Node or Secure Application Actor SHALL be able to record a Clinical Data Source AuditEvent. Audit Example for a QEDm Query transaction from source perspective.