Query Patient-level Clinical Data Workflow
**The transaction queries for previously stored clinical data for a specific patient. The following sequence diagram shows the steps involved in this transaction.
Workflow Maturity
Mature
  • One or more OpenHIE implementations of this workflow exist in one or more countries
  • Workflow is defined and ARB approved
  • Workflow is supported by mature standards
Standards*
  • XDS.b with the on-demand document option
  • CDA documents profiled by IHE PCC
  • CSD - Find matching services - ITI-73
  • PIX Query - ITI-9
  • Optionally, the MHD profile can be supported (in addition or instead of XDS.b) to enable PoC systems to query clinical content using a simpler and more modern FHIR-based approach. This option may be supported in two ways:
    • The SHR itself may support the required MHD transactions.
    • (recommended) The IL can provide an adapter to convert incoming MHD transactions to XDS.b transactions for the SHR to process as normal.
Assumptions and Prerequisites
  • The PoS system must ensure the patient they are querying clinical information about already exists. It can do this by querying for the patient (Query patients workflow).
  • The PoS system is a trusted application known by the HIE and it is registered with the interoperability layer to be able to send and receive data securely (Common message security workflow).
The SHR MUST be able to generate on-demand documents in the XDS-MS format using the data it stored in the save patient-level clinical data workflow. Optionally, any other sections that have been discretely imported and are deemed useful may be added to the generated XDS-MS document.
Actors
  • PoS - The point of care system that captures a patient's clinical encounter, it is responsible for sending clinical data on to the HIE.
  • IL - Mediates the transactions between the PoS system and the infrastructure services to facilitate easier interoperability.
  • CR - The source of truth for patient demographic and identifier detail. It is able to be queried using an identifier to find the enterprise identifier for a particular person.
  • FR - The source of truth for facility information. It is able to be queried for details about a particular facility by ID.
  • SHR - Stored patients clinical information. It is able to receive and store patient clinical documents.

Interaction Description

The following is a description of the interaction steps.
#
Interaction
Data
Transaction Options
1
Query for clinical documents by patient ID and/or date
XDS.b/MHD metadata
Option 1 (must be supported): XDS.b Registry Stored Query (ITI-18) - Find Documents query
OR
Option 2 (may additionally choose to support): MHD Find document references (ITI-67) - RESTful query
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, 4.3If supporting the MHD Option: MHD profile supplement
2
Resolve client identifier
HL7 QBP^Q23 message
PIX Query (ITI-9) IHE IT Infrastructure
Vol. 1 - Section 5
Vol. 2 - Sections 3.9
3
Return person record
HL7 RSP^K23 message
4
Extract ECID and enrich message with ECID
5
Query for clinical documents by ECID
XDS.b/MHDmetadata
XDS.b Registry Stored Query (ITI-18) - Find Documents query
and optionally (only if SHR support MHD directly)
MHD Find document references (ITI-67) - RESTful query
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, 4.3MHD: MHD profile supplement
6
Return list of document IDs
XDS.b Registry Stored Query response - list of document IDs
or optionally (only if SHR support MHD directly)
MHD Find document references response - list of document IDs
7
Return list of document IDs
XDS.b Registry Stored Query response - list of document IDs
or optionally
MHD Find document references response - list of document IDs
8
Request the content of the document by document ID
XDS.b/MHDmetadata
XDS.b Retrieve Document Set (ITI-43)
and optionally
MHD Retrieve document (ITI-68)
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, 4.3MHD: MHD profile supplement
9
Request the content of the document by document ID
XDS.b/MHDmetadata
XDS.b Retrieve Document Set (ITI-43)
and optionally (only if SHR support MHD directly)
MHD Retrieve document (ITI-68)
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, 4.3MHD: MHD profile supplement
10
If this document is a static document retrieve it
else if it is an on-demand document generate it
11
Return clinical document
XDS.b/MHDresponse - with CDA document content
12
Return clinical document
XDS.b/MHDresponse - with CDA document content
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