EU Health Data API, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/bvdh/jwg-api/ and changes regularly. See the Directory of published versions

Document Exchange

Overview

Document exchange using IHE MHD (Mobile Health Documents) transactions. This IG inherits MHD transactions as-is, with constraints specific to EEHRxF content.

Actors

• Document Producer (client): Publishes documents using MHD Document Source
• Document Access Provider (server): Receives and serves documents using MHD Document Recipient + Document Responder
• Document Consumer (client): Queries and retrieves documents using MHD Document Consumer

See Actors and Transactions for detailed actor groupings.

IHE MHD Transactions

This IG uses the following IHE MHD transactions:

ITI-68 Scope Note: The required scope depends on the document format. For non-FHIR documents (PDF), use system/Binary.r. For FHIR Documents (IPS, laboratory reports as FHIR Bundles), use system/Bundle.r. See FHIR Documents vs Binary below.

Sequence Diagram

sequenceDiagram
    participant Consumer as Document Consumer
    participant Provider as Document Access Provider

    rect rgb(255, 248, 240)
    Note over Consumer,Provider: Find Document References (MHD ITI-67)
    Consumer->>Provider: GET /DocumentReference?patient=...&type=...
    Provider-->>Consumer: Bundle of DocumentReferences
    end

    rect rgb(255, 245, 238)
    Note over Consumer,Provider: Retrieve Document (MHD ITI-68)
    Consumer->>Provider: GET [attachment.url from DocumentReference]
    Provider-->>Consumer: Document content
    end

FHIR Documents vs Binary

ITI-68 retrieves the document from the URL specified in DocumentReference.content.attachment.url. The URL format depends on the document type:

This follows MHD Section 2:3.65.4.1.2.1, which specifies the FHIR Document Publish Option: when the DocumentReference.content.attachment.url points at a FHIR Document Bundle, that Bundle is retrieved directly without Binary encoding.

Implementation Note: FHIR Documents do not require base64 encoding into a Binary resource. The document Bundle is stored and retrieved as a native FHIR Bundle resource.

Document Search Strategy

This IG follows the IHE Document Sharing approach:

1. category (coarse search): Broad classification based on EHDS priority categories
2. type (clinical precision): Specific document types, typically LOINC codes

Category Values (EHDS Priority Categories)

The EHDS priority categories are defined by Article 14 of the EHDS Regulation. We define codes specifically for EEHRxF that map directly to these regulatory categories.

See EEHRxFDocumentPriorityCategoryCS for the complete list.

Type Values (LOINC)

See EEHRxFDocumentTypeVS for the complete list.

Examples

The examples below show queries using both category (EHDS priority category) and type (LOINC document type). Either can be used depending on your use case.

Patient Summary

By type (LOINC):

GET [base]/DocumentReference?patient=Patient/123&type=http://loinc.org|60591-5&status=current

By category (EHDS priority):

GET [base]/DocumentReference?patient=Patient/123&category=http://hl7.eu/fhir/euridice-api/CodeSystem/eehrxf-document-priority-category-cs|Patient-Summaries&status=current

Medical Test Results (Laboratory)

By type (LOINC):

GET [base]/DocumentReference?patient=Patient/123&type=http://loinc.org|11502-2&status=current

By category (EHDS priority):

GET [base]/DocumentReference?patient=Patient/123&category=http://hl7.eu/fhir/euridice-api/CodeSystem/eehrxf-document-priority-category-cs|Laboratory-Reports&status=current

Imaging Reports and Manifests

By type (LOINC - imaging reports only):

GET [base]/DocumentReference?patient=Patient/123&type=http://loinc.org|68604-8&status=current

By category (EHDS priority - includes both reports and manifests):

GET [base]/DocumentReference?patient=Patient/123&category=http://hl7.eu/fhir/euridice-api/CodeSystem/eehrxf-document-priority-category-cs|Medical-Imaging&status=current

Note: The Medical-Imaging category includes both imaging reports and imaging manifests. To distinguish between them, use the type code or formatCode. See Imaging Manifest for details.

Hospital Discharge Reports

By type (LOINC):

GET [base]/DocumentReference?patient=Patient/123&type=http://loinc.org|18842-5&status=current

By category (EHDS priority):

GET [base]/DocumentReference?patient=Patient/123&category=http://hl7.eu/fhir/euridice-api/CodeSystem/eehrxf-document-priority-category-cs|Discharge-Reports&status=current

Document Publication (ITI-65)

Document Producers publish documents by POSTing a transaction Bundle:

POST [base]
Content-Type: application/fhir+json

The Bundle contains DocumentReference + Binary resources. See IHE MHD ITI-65 for details.

Open Issue #3: We are seeking input on MHD publication transaction options. See MHD Publication Transaction Options for discussion.

References

• IHE MHD Specification
• IHE Document Sharing
• Actors and Transactions