Brontekst bekijken van MedMij:V2018.04 FHIR MedicationInstruction

#REDIRECT [[MedMij:V2018.04_FHIR_MedicationInformation]]

{{#customtitle:MedMij FHIR use case Medication Information}}
{{IssueBox|Work in progress  - See offical publication here: https://informatiestandaarden.nictiz.nl/wiki/MedMij:Vcurrent_FHIR_IG .}}

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__TOC__

=Introduction=
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This page technically describes how a client, e.g. a PHE, should retrieve medication information from a server, maintained by [https://www.cbg-meb.nl/ College ter Beoordeling Geneesmiddelen (CBG)].  This use case makes use of the IHE MHD profile and PDF/A use case, which are described in detail [[MedMij:V2018.04_FHIR_PDFA| here.]]

'''Note''': this page is part of the [https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2018.04_FHIR_IG MedMij FHIR Implementation Guide] and is a technical representation of the functional design published on this [[MedMij:V2018.04_Ontwerpen| wiki page]].

=Retrieve Medication information by patients=
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This section summarizes the IHE MHD profile to exchange PDF/A documents in a MedMij context. 

{{FHIR-IG-Afsprakenstelsel-Note}}

==Actors and transactions involved==
Table 1 shows the relevant actors, systems and FHIR capability statements in a MedMij context. The capability statements demonstrate the minimum requirements to be conformant to the Medication Information use case specification.
{| class="wikitable"
! colspan="2" style="text-align:left;" | Actors
! colspan="2" style="text-align:left;" | Systems
! colspan="2" style="text-align:left;" | FHIR Capability Statements
|-
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
! style="text-align:left;" |Name
! style="text-align:left;" |Description
|-
| Patient
| The user of a personal healthcare environment.
| PHR
| Personal health record
|[[Bestand: Verwijzing.png| 20px]] [https://simplifier.net/NictizSTU3/medicationinforamtion-clientcapabilities CapabilityStatement: Client]
| FHIR Client requirements 
|-
| College ter Beoordeling Geneesmiddelen (CBG)
| The owner of the medication information 
| XIS
| Healthcare information system
|[[Bestand: Verwijzing.png| 20px]] [https://simplifier.net/NictizSTU3/medicationinformation-servercapabilities CapabilityStatement: Server]
| FHIR Server requirements 
|} 
<font size = "1">'''Table 1. Actors, systems and FHIR capability statements'''</font>

Table 2 shows the MHD actors and transactions in perspective of the systems used in a MedMij context.
{| class="wikitable"
! style="font-weight: bold; text-align:left;" | Actors
! style="font-weight: bold; text-align:left;" | System
! style="font-weight: bold; text-align:left;" | MHD Actors
! style="font-weight: bold; text-align:left;" | MHD Transactions
|-
| rowspan="5" | Patient
|-
| rowspan="4" | PHR
|-
| rowspan="3" | Document Consumer
|-
| Find Document Reference
|-
| Retrieve Document
|-
| rowspan="5" | College ter Beoordeling Geneesmiddelen (CBG)
|-
| rowspan="4" | XIS
|-
| rowspan="3" | Document Responder
|-
| Find Document Reference
|-
| Retrieve Document
|}
<font size = "1">'''Table 2. MHD actors and transactions in perspective of systems in a MedMij context and the medication information use case.'''</font>

===Transactions in scope===
* Find Document References – This transaction is used to issue parameterized queries that result in a list of Document Reference resources.
* Retrieve Document – This transaction is used to get documents.

==Find and retrieve medication information document==

===Find medication information document===
Discovery of medication information documents is done with the MHD defined transaction Find Document Reference. The Find Document Reference retrieves FHIR DocumentReference Resources that represents a single reference to document per resource, for example one PDF/A file containing the medication information. 

The Document Consumer requests DocumentReference, matching a set of criteria, from the Document Responder. The Document Responder returns DocumentReference or DocumentManifest Resources that match the search criteria provided by the Document Consumer.

====Request message====
'''Search'''

The Document Consumer executes an HTTP GET conform to the FHIR [http://hl7.org/fhir/http.html RESTfull] and [http://hl7.org/fhir/search.html search] specification. A search query would have the following format.
 
<pre>
GET [base]DocumentReference?[parameters]{&_format=[mime-type]}
</pre>

'''Search Parameters'''
The Document Consumer may supply, and the Document Responder shall be capable of processing, all query parameters listed below. These search parameters are a selection of the defined search parameters by the HL7 FHIR specification (search parameters: [http://hl7.org/fhir/STU3/documentreference.html#search DocumentReference]). 
{| class="wikitable"
! colspan="3" style="font-weight: bold; text-align:left;" | DocumentReference
|-
| style="font-weight: bold;" | Name
| style="font-weight: bold;" | Type
| style="font-weight: bold;" | Description
|-
| type
| token
| Kind of document. This element is used to specifically search for the right document based on the G-Standard (ZI-nummers or HPK)
|-
| class
| token
| Categorization of document. The relevant categories for this use case are: patient's Instructions, scientific information, additional risk minimization information and assessment reports.
|-
|}

Example queries to search for DocumentReferences containing medication information.

<pre>
1. GET [base]/DocumentReference?class=http://example.system.com|patientinstructions&type=urn:oid:2.16.840.1.113883.2.4.4.8|14668157
2. GET [base]/DocumentReference?class=http://example.system.com|patientinstructions&type=urn:oid:2.16.840.1.113883.2.4.4.7|01474707
3. GET [base]/DocumentReference?class=http://example.system.com|patientinstructions&type=urn:oid:2.16.840.1.113883.2.4.4.1|081140

1. Search on class (Patient Instructions) and type (ZI number for PARACETAMOL/CODEINEFOSFAAT RP TABLET 500/50MG (30 ST)).
2. Search on class (Patient Instructions) and type (HPG number for PARACETAMOL/CODEINEFOSFAAT RP TABLET 500/50MG).
3. Search on class (Patient Instructions) and type (GPK number for PARACETAMOL/CODEINE TABLET 500/50MG).</pre>

====Response message====
The Document Responder shall process the query to discover the DocumentReference entries that match the search parameters given. The Document Responder returns a HTTP Status code appropriate to the processing as well as a Bundle including the matching DocumentReference Resources. When the Document Responder needs to report an error or warning, it shall use HTTP error response codes and should include a FHIR [http://hl7.org/fhir/STU3/operationoutcome.html OperationOutcome] with more details on the failure or warning. If the request message is processed successfully, whether or not any DocumentReference or DocumentManifest Resources are found, the HTTP status code shall be 200. 

The Document Responder shall place into the ''''DocumentReference.content.attachment.url'''' element a full URL that can be used by the Document Consumer to retrieve the document using Retrieve Document transaction.

'''Example of a response message''' 
<pre><Bundle>
    <id value="021aeba5-1d9d-4c06-92cd-d7c037bbcc" />
    <meta>
        <lastUpdated value="2018-02-16T14:57:34+00:00" />
    </meta>
    <type value="searchset" />
    <total value="1" />
    <link>
        <relation value="self" />
        <url value="http://test.fhir.org/r3/DocumentReference?class=http://example.system.com|patientinstructions&type=urn:oid:2.16.840.1.113883.2.4.4.8|14668157" />
    </link>
    <entry>
        <fullUrl value="http://test.fhir.org/r3/DocumentReference/example" />
        <resource>
            <DocumentReference>
                <id value="example" />
                <meta>
                    <versionId value="1" />
                    <lastUpdated value="2017-11-28T08:30:39+00:00" />
                </meta>
                <contained>
                    <Practitioner>
                        <id value="a2" />
                        <name>
                            <family value="Smitty" />
                            <given value="Gerald" />
                        </name>
                    </Practitioner>
                </contained>
                <masterIdentifier>
                    <system value="urn:ietf:rfc:3986" />
                    <value value="urn:oid:1.3.6.1.4.1.21367.2005.3.7" />
                </masterIdentifier>
                <identifier>
                    <system value="urn:ietf:rfc:3986" />
                    <value value="urn:oid:1.3.6.1.4.1.21367.2005.3.7.1234" />
                </identifier>
                <status value="current" />
                <docStatus value="preliminary" />
                <type>
                    <coding>
                        <system value="urn:oid:2.16.840.1.113883.2.4.4.8" />
                        <code value="14668157" />
                        <display value="PARACETAMOL/CODEINEFOSFAAT RP TABLET 500/50MG (30 ST)" />
                    </coding>
                </type>
                <class>
                    <coding>
                        <system value="http://example.system.com" />
                        <code value="patientsinstructions" />
                        <display value="Patient Medication Instructions" />
                    </coding>
                </class>
                <subject>
                    <reference value="Patient/xcda" />
                </subject>
                <created value="2005-12-24T09:35:00+11:00" />
                <indexed value="2005-12-24T09:43:41+11:00" />
                <author>
                    <reference value="Practitioner/xcda1" />
                </author>
                <author>
                    <reference value="#a2" />
                </author>
                <authenticator>
                    <reference value="Organization/f001" />
                </authenticator>
                <custodian>
                    <reference value="Organization/f001" />
                </custodian>
                <relatesTo>
                    <code value="appends" />
                    <target>
                        <reference value="DocumentReference/example" />
                    </target>
                </relatesTo>
                <description value="Patients Medication Instruction for " />
                <content>
                    <attachment>
                        <contentType value="application/hl7-v3+xml" />
                        <language value="en-US" />
                        <url value="http://example.org/xds/mhd/Binary/07a6483f-732b-461e-86b6-edb665c45510" />
                        <size value="3654" />
                        <hash value="2jmj7l5rSw0yVb/vlWAYkK/YBwk=" />
                    </attachment>
                </content>
            </DocumentReference>
        </resource>
        <search>
            <mode value="match" />
        </search>
    </entry>
</Bundle></pre>

===Retrieve medication information document(s)===
After obtaining the location of the medication information document in the DocumentReference.content.attachment.url, the Document Consumer requests the document from the Document Responder. The Document Responder sequentially serves the document to the Document Consumer. The context that was established in the initial request shall also apply when retrieving/serving the document contents.

====Request Message====
This message is an HTTP GET request to retrieve the document. See an example below.

<pre>GET http://example:9556/svc/fhir/Binary/1e404af3-077f-4bee-b7a6-a9be97e1ce32</pre>

The Document Consumer may provide a HTTP Accept header, according to the semantics of the HTTP protocols (see RFC2616, Section 14.1). The only MIME type assured to be returned is the MIME type indicated in the DocumentReference.content.attachment.contentType'. The HTTP If-Unmodified-Since header shall not be included in the GET request.

====Response Message====
The Document Responder shall process the request message. The Document Responder returns a HTTP Status code appropriate to the processing as well as a Bundle with the medication information in a FHIR [http://hl7.org/fhir/STU3/binary.html Binary] Resource. Binary resources behave slightly differently to all other resources on the RESTful API. Specifically, when a read request is made for the binary resource that doesn't explicitly specify the FHIR content types "application/fhir+xml" or "application/fhir+json", then the content should be returned using the content type stated in the resource. e.g. if the content type in the resource is "application/pdf", then the content should be returned as a PDF directly.[http://hl7.org/fhir/STU3/binary.html#rest]

When the Document Responder needs to report an error or warning, it shall use HTTP error response codes and should include a [http://hl7.org/fhir/STU3/operationoutcome.html OperationOutcome] with more details on the failure or warning. If the Retrieve Document message is processed successfully the HTTP status code shall be 200.

'''Example of a response message''' 
<pre> 
<Bundle xmlns="http://hl7.org/fhir">
    <id value="5905e2ee-8505-4f13-8701-63b33b531291" />
    <meta>
        <versionId value="f80e4263-f7ef-4a6f-9996-95ee7607f553" />
        <lastUpdated value="2017-10-25T12:24:26.69+00:00" />
    </meta>
    <type value="searchset" />
    <total value="1" />
    <link>
        <relation value="self" />
        <url value="http://example:9556/svc/fhir/Binary/1e404af3-077f-4bee-b7a6-a9be97e1ce32" />
    </link>
    <entry>
        <fullUrl value="http://example:9556/svc/fhir/Binary/1e404af3-077f-4bee-b7a6-a9be97e1ce32" />
        <resource>
            <Binary>
                <id value="1e404af3-077f-4bee-b7a6-a9be97e1ce32" />
                <meta>
                    <versionId value="948f3653-c9a3-4831-bae5-f629319c194f" />
                    <lastUpdated value="2017-09-20T17:55:14.098+00:00" />
                </meta>
                <contentType value="application/pdf" />
                <content value="JVBERi0xLjUNJeLjz9MNCjU1I........"/>   
            </Binary>
   </entry>
<Bundle>
</pre>

==Interactions, operations, search parameters==

===Interactions===
The following logical interactions are needed for this use case:
* [http://hl7.org/fhir/STU3/http.html#search Search]
* [http://hl7.org/fhir/STU3/http.html#read Read]

===Operations===
There are no defined operations for this use case.

===Search parameters===
The following search parameter types need to be supported for this use case. No search result parameters need to be supported.

Search parameter types:
* [http://hl7.org/fhir/STU3/search.html#token token]
* [http://hl7.org/fhir/STU3/search.html#reference reference]
* [http://hl7.org/fhir/STU3/search.html#date date]
* [http://hl7.org/fhir/STU3/search.html#uri uri]

==List of StructureDefinitions==
The following HL7 FHIR STU3 StructureDefinitions are defined for MHD: 
* [https://simplifier.net/IHEPatientDemographi/IHEMHDQueryComprenensiveDocumentReference http://ihe.net/fhir/StructureDefinition/IHE.MHD.DocumentReference]