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/euridice-org/eu-health-data-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 and Transactions

This IG defines three document exchange actors. See Actors for detailed actor groupings.

Document Consumption

The primary workflow is query and retrieve: Document Consumers find documents via ITI-67, then retrieve content via ITI-68.

Sequence Diagram

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

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

    rect rgb(240, 255, 240)
    Note over Consumer,Provider: Retrieve Document (ITI-68)
    Consumer->>Provider: GET [attachment.url from DocumentReference]
    Provider-->>Consumer: Document content (FHIR Bundle or Binary)
    end

Document Content

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

ITI-68 retrieves the document directly from the URL. FHIR Documents are returned as Bundle resources when Accept: application/fhir+json is specified.

Authorization Scope: The required scope depends on the document format. For non-FHIR documents (PDF), use system/Binary.read. For FHIR Documents, use system/Bundle.read.

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.

Search 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/eu-health-data-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/eu-health-data-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/eu-health-data-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/eu-health-data-api/CodeSystem/eehrxf-document-priority-category-cs|Discharge-Reports&status=current

Document Publication

When Document Publisher and Document Access Provider are separate systems, the Publisher submits documents using ITI-105 Simplified Publish per the MHD Simplified Publish Option. When they are grouped (co-located), publication is internal.

Document Submission Option

The Document Access Provider MAY support receiving documents from external Publishers by implementing the MHD Simplified Publish Option. This is the Document Submission Option.

Systems implementing this option declare it via EEHRxF-DocumentAccessProvider-SubmissionOption. See Actors - Document Submission Option for actor groupings.

ITI-105 Simplified Publish

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

{
  "resourceType": "DocumentReference",
  "status": "current",
  "type": { ... },
  "subject": { "reference": "Patient/123" },
  "content": [{
    "attachment": {
      "contentType": "application/fhir+json",
      "data": "[base64-encoded document]"
    }
  }]
}

The server validates, extracts, and persists the document, returning the created DocumentReference with server-assigned IDs. See IHE MHD ITI-105 for details.

How ITI-105 handles document content: Per MHD ITI-105 Expected Actions, the Document Recipient extracts the document from attachment.data and persists it such that it is retrievable via attachment.url. This means consumers querying via ITI-67 receive DocumentReferences with URLs pointing to /Bundle/[id] (for FHIR Documents) or /Binary/[id] (for PDFs, DICOM), and ITI-68 retrieval returns the native document format—not base64.

Other Publication Transactions

This IG specifies ITI-105 as the publication mechanism for Document Publishers submitting to external Access Providers. ITI-105 provides a single publication pattern that handles all EHDS content types (FHIR Documents, legacy PDFs, and DICOM manifests) while keeping publisher implementation simple—the Document Access Provider handles normalization on ingest, ensuring consumers always retrieve native document formats via ITI-67/ITI-68.

Member states or local deployments MAY additionally support:

• ITI-65 Provide Document Bundle: For XDS-centric ecosystems requiring explicit SubmissionSet metadata or multi-document submission.
• ITI-106 Generate Metadata: For structured document publishers wanting server-generated DocumentReference.

These are not required for EEHRxF conformance.

References

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