Overview
Within the OpenHIE project there are two major functions that a Shared Health Record should perform:
- The SHR should receive and store clinical documents for patients and respond to queries to retrieve a patients clinical documents.
- The SHR should be able to respond to queries for existing data about a patient that was received from the clinical documents.
Standards and Workflows
A core principle of the OpenHIE architecture is to allow the various infrastructure services (such as the SHR) to be interchangeable. Thus, the SHR must support some standard interfaces such that different implementation that are developed can be swapped in as needed. Various standards have been evaluated and the SHR community has decided that the core standards that an OpenHIE SHR must support are as follows:
- The interface standard: IHE's XDS.b profile - (technical specifications) and , Query for Existing Data (QED) (technical specifications) and the FHIR-based Mobile Health Documents profile (MHD) (technical specifications)
- The document standard: HL7 CDA release 2 content modules - (technical specifications)
- The document content standards: IHE's PCC profiles - (technical specifications)
The context in which an SHR should use the above standard profiles is described in the OpenHIE workflows that an SHR is required to support. Each of these workflows describes a particular interaction that an SHR must support. To be OHIE SHR component, the SHR application must be able to support the OHIE workflows listed below. Implementations may support only the workflows needed to support their use case:
Requirements
In addition to the above an SHR should closely match the requirements defined by OpenHIE as can be found here.
Support of OpenHIE Non-functional Requirements
An OpenHIE component should consider the following OpenHIE Non-Functional Requirements - Draft
Additional levels of support
The above forms the base standards that an OpenHIE SHR must support. A number of those standards contain many different profiles that a SHR implementation may choose to support for a variety of use cases. OpenHIE SHRs may be built incrementally to support additional profiles. These different categories of support have been broken down into different phases. These phases are listed below:
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At a bare minimum an OpenHIE SHR must support the following profiles:
XDS.b's provide and register document and query for documents
- HL7 CDA release 2.0 at level 2
Phase 1
SHR Level 1 - (at least one content profile + query for existing data)
A phase 1 OpenHIE SHR must support implement the following:
- XDS.b's provide and register document and query for documents, stored query and retrieve document transactions
At least one of the Patient Care Coordination CDA content profiles Support for the Antepartum History & Physical (APHP) and Antepartum Summary (APS) PCC profiles, which profile the CDA Continuity of Care Document (CCD) specification to specifically support maternal care use cases.
- The Support for the Query for Existing Data (QED) profile
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SHR Level 2 - (all PCC content profiles + query for existing data + referrals)
A phase 2 OpenHIE SHR must support implement the following:
- XDS.b's provide and register document and query for documents, stored query and retrieve document transactions
ALL of the Patient Care Coordination CDA content profiles which profile the CDA Continuity of Care Document (CCD) specification.
The Emergency Department Referral (EDR) Support for the Antepartum Record (APR) PCC profile which specified a number of document types and for the EDR PCC profile which supports referrals
- Support for the The Query for Existing Data (QED) profile
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SHR Level 3 - (clinical documents + query for existing data + referrals + some form of data export - [perhaps lab and drug profiles])
A phase 3 OpenHIE SHR must support implement the following:
- XDS.b's provide and register document and query for documents
Support for the Antepartum Record (APR) and EDR PCC profiles, plus other PCC and QRPH profiles as needed to support specific care workflows
- , stored query and retrieve document transactions
- ALL of the Patient Care Coordination CDA content profiles which profile the CDA Continuity of Care Document (CCD) specification.
The Emergency Department Referral (EDR) PCC profile which supports referrals
- The Support for the Query for Existing Data (QED) profile
A to-be-determined mechanism to export data for reporting purposes