The official version of the OHIE workflows can be found in the OpenHIE Architecture Specification.

Overview

Description: This transaction allows a point of service (PoS) system to save patient-level clinical data to the SHR. The transaction is verified and validated against the other registries before it is saved in the SHR. The following sequence diagram shows the steps involved.

Sponsor:  Ryan Crichton (with the IL and SHR communities)

Status: In Progress

Referenced Standards and APIs:

Assumptions and prerequisites

Actors

Validations

The IL should validate the clinical document before it can be saved to the SHR. There are some key validations that are always required and the transaction should fail if these are not met. These are base validation that must always take place:

There are also additional optional validations that may be beneficial for more advanced HIEs where the information is available. Implementation can also come up with other validation that make sense to their environment. These validations should not fail the transaction but rather be logged as warnings for a HIE admin to check up on:


title Save Clinical Encounter
participant PoS
participant IL
participant IL Interlinked Registry InfoMan as IL-IM
participant CR
participant SHR
note over IL-IM
	Pre-initialisation:\nSee the CSD Query for services workflow
end note
PoS->+IL: [1] Submit clinical document
IL->+CR: [2] Resolve client identifier
CR->-IL: [3] Return person record
IL->IL: [4] Extract ECID and enrich message with ECID if patient exists, else error
IL->+IL-IM: [5] Fetch provider details and perform validation\n(see validation options above)
IL-IM->-IL: [6] Return cached details and validation results
IL->+IL-IM: [7] Fetch facility details and perform validation\n(see validation options above)
IL-IM->-IL: [8] Return cached details and validation results
IL->IL: [9] Read validation result and enrich document with EPID and ELID
IL->+SHR: [10] Save clinical document
SHR->SHR: [11] Parse and store certain sections of clinical document discretely
SHR->SHR: [12] Register a CCD on-demand document for this patient
SHR->-IL: [13] Acknowledge encounter saved
IL->-PoS: [14] Acknowledge encounter saved


Technical details


Ensure that the provider is valid and currently practicing, enrich message with EPID

RefInteractionEndpointDataTransaction Specification
1

Submit clinical encounter

XDS.b provide and register document (ITI-41 from the ITI framework) - SOAP web service

and optionally

MHD provide document bundle (ITI-65) - RESTful FHIR interface

CDA document conforming to a particular PCC profile

XDS: IHE IT Infrastructure

  • Vol. 1 - Section 10, Appendix E, J, K
  • Vol. 2a - Sections 3.18
  • Vol. 2b - Sections 3.41, 3.42, 3.43
  • Vol. 2x - Appendix A, B, K, L, M, N, V, W
  • Vol. 3 - Section 4.1, 4.2, 4.3

MHD: MHD profile supplement

2Resolve client identifierPIX Query (ITI-9)

HL7 QBP^Q23 message

IHE IT Infrastructure
  • Vol. 1 - Section 5
  • Vol. 2 - Sections 3.9
3Return person record

HL7 RSP^K23 message

"
4

Extract ECID and enrich message with ECID if patient exists, else error

none

5

Fetch provider details and perform validation

CSD Care Services Request - Find matching services

function urn='urn:ihe:iti:csd:2014:stored-function:provider-search'

IHE ITI CSD Supplement

6

Return cached details and validation results


Return validation results"
7Fetch facility details and perform validationCSD Care Services Request - Find matching servicesfunction urn='urn:ihe:iti:csd:2014:stored-function:facility-search'IHE ITI CSD Supplement
8Return cached details and validation results

"
9

Read validation result and enrich document with EPID and ELID

none

10Save clinical encounter

XDS.b provide and register document (ITI-41 from the ITI framework) - SOAP web service

and optionally

MHD provide document bundle (ITI-65) - RESTful FHIR interface


CDA document conforming to a particular PCC profile 

IHE IT Infrastructure

  • Vol. 1 - Section 10, Appendix E, J, K
  • Vol. 2a - Sections 3.18
  • Vol. 2b - Sections 3.41, 3.42, 3.43
  • Vol. 2x - Appendix A, B, K, L, M, N, V, W
  • Vol. 3 - Section 4.1, 4.2, 4.3

MHD: MHD profile supplement 

11Parse and store certain sections of clinical document discretelyInternal operation

12Register a CCD on-demand document for this patientXDS.b register document set (ITI-42 from the ITI framework) - SOAP web serviceGenerated metadata

IHE IT Infrastructure

  • Vol. 1 - Section 10, Appendix E, J, K
  • Vol. 2a - Sections 3.18
  • Vol. 2b - Sections 3.41, 3.42, 3.43
  • Vol. 2x - Appendix A, B, K, L, M, N, V, W
  • Vol. 3 - Section 4.1, 4.2, 4.3

XDS-MS specification

13Acknowledge encounter saved

ITI-41 SOAP response

and optionally

ITI-65 RESTful response

"
14Acknowledge encounter saved

ITI-41 SOAP response

and optionally

ITI-65 RESTful response


"

Pseudo code for validation logic

// This refers to metadata that comes from the XDS.b evelope
get SubmissionSet.patientId
create PIX query using id and assigningAuthority
do PIX query
if success and assigning authority isn't already ECID
	get ECID from PIX query response
	change SubmissionSet.patientId to ECID
if not success
	reject submission set
for each SubmissionSet.author element
	create CSD query using local IDs from author.authorInstitution and/or author.authorPerson
	do CSD query
	if success
		replace author.authorInstitution/author.authorPerson details with EPID or ELID details
	if not success
		reject submission set
for each CDA document in submission set
	get DocumentEntry.patientId
	create PIX query using id and assigningAuthority
	do PIX query
	if success and assigning authority isn't already ECID
		get ECID from PIX query response
		change DocumentEntry.patientId to ECID
		add ECID to CDA header recordTarget
	if not success
		reject submission set
	for each DocumentEntry.author element
		create CSD query using IDs local from author.authorInstitution and/or author.authorPerson
		do CSD query
		if success
			replace author.authorInstitution/author.authorPerson details with EPID or ELID details
			Add EPID to CDA header author elements
			Add ELID to CDA organisations that apppear
		if not success
			reject submission set