MedMij FHIR use case PDF/A - te sturen

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Introduction

MedMij specifies the format PDF/A for exchanging unstructured documents containing health information. MedMij has adopted as much as possible the Mobile access to Health Documents (MHD) profile from Integrating the Healthcare Enterprise (IHE) that defines a RESTful/HTTP interface to an XDS environment using HL7 FHIR STU3 resources. The MHD profile is written to be content agnostic and as such is suitable for much more than PDF/A. For the purposes of this use case we have limited the scope to PDF/A.

MedMij includes the IHE MHD profile as a framework to exchange PDF/A documents. The next section summarizes MHD and contains references to this specification. The following section provides an adaptation of the MHD profile to specify exchange of PDF/A documents in a MedMij context. For example, the MHD actors and transactions are put into perspective of the MedMij actors and systems. The essence of the MHD profile is outlined here and example transaction messages have been added.

IHE MHD specification

Mobile access to Health Documents (MHD) profile defines a simple HTTP interface to an XDS like environment. It defines four transactions:

  1. submit submission sets, folders, new documents, and document metadata from the mobile device to a document receiver (Provide Document Bundle),
  2. find submission sets matching query parameters (Find Document Manifest),
  3. find document entries containing metadata based on query parameters (Find Document Reference),
  4. retrieve a copy of a specific document (Retrieve Document).

These transactions leverage the document content and format agnostic metadata concepts from XDS, but simplify them for access by constrained environments such as mobile devices, or other resource constrained systems. The MHD profile does not replace XDS. It can be used to allow mobile devices, or other resource constrained systems, access to an XDS health information exchange.[1]

Wiki: Mobile acces to Health Document (MHD)

Document: MHD Supplement (Rev 2.3 July 24, 2017)

Additional Supplement: Appendix Z on HL7 FHIR

Underlying Standards:

List of StructureDefinitions

The following HL7 FHIR STU3 StructureDefinitions are defined for MHD:

Exchanging PDF/A documents

This section summarizes the IHE MHD profile to exchange PDF/A documents in a MedMij context.

Each transaction is performed in the context of a specific authenticated patient, for whose context (token) has been established using the authentication mechanisms described in the 'Afsprakenstelsel'. Each XIS Gateway is required to perform filtering based on the patient associated with the context for the request, so only the records associated with the authenticated patient are returned. For this reason search parameters should be passed for patient identification.

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 full MHD specifications.

Persons Systems FHIR Capability Statements
Name Description Name Description Name Description
Patient The user of a personal healthcare environment. PHR Personal health record Verwijzing.png CapabilityStatement: Client PDFA FHIR Client requirements
Healthcare professional The user of a XIS XIS Healthcare information system Verwijzing.png CapabilityStatement: Server PDFA FHIR Server requirements

Table 1. Actors, systems and FHIR capability statements

Table 2 shows the MHD actors and transactions in perspective of the systems used in a MedMij context.

Person System MHD Actors MHD Transactions
Patient
PHR Document Source Provide Document Bundle
Document Consumer Find Document Manifest
Find Document Reference
Retrieve Document
Healthcare Professional
XIS Document Recipient Provide Document Bundle
Document Responder Find Document Manifest
Find Document Reference
Retrieve Document

Table 2. MHD actors and transactions in perspective of systems in a MedMij context

Transaction summary definitions

  • Provide Document Bundle - This transaction is used to transfer documents and metadata.
  • Find Document Manifests – This transaction is used to issue parameterized queries that result in a list of Document Manifest resources.
  • 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 existing PDF/A document(s)

Find PDF/A or PDF/A collection

Discovery of PDF/A documents is done with the MHD defined transaction 'Find Document Reference' or 'Find Document Manifest'. The Find Document Reference retrieves FHIR DocumentReference Resources that represents a single reference to document per resource, for example one PDF/A file. The Find Document Manifest retrieves FHIR DocumentManifest Resources. A DocumentManifest Resourse gathers a set of DocumentReference Resources into a single package together with metadata that applies to the collection.

The Document Consumer requests DocumentReference or DocumentManifest Resources, 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 RESTfull and search specification. A search query would have the following format. 

GET [base]DocumentReference?[parameters]{&_format=[mime-type]}
GET [base]DocumentManifest?[parameters]{&_format=[mime-type]}

Two example queries to search all DocumentReferences and DocumentManifest of a patient whose BSN (Dutch person identification number) is 123456789. 

GET http://example.org/fhir/DocumentReference?patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|123456789
GET http://example.org/fhir/DocumentManifest?patient.identifier=http://fhir.nl/fhir/NamingSystem/bsn|123456789

Example query to search for DocumentReferences of type Discharge summary. 

GET http://example.org/fhir/DocumentReference?type=http://loinc.org|18842-5

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: DocumentReference , DocumentManifest). See also the HL7 FHIR STU3 specification for searching.

DocumentReference DocumentManifest
Name Type Description Name Type Description
patient reference Who/what is the subject of the document patient reference The subject of the set of documents
indexed date When this document reference was created created date When this document manifest created
author reference Who and/or what authored the document author reference Who and/or what authored the manifest
type token Kind of document (LOINC if possible) type token Kind of document set
class token Categorization of document source uri The source system/application/software
status token superseded | entered-in-error status token superseded | entered-in-error
setting token Additional details about where the content was created (e.g. clinical specialty)
period date Time of service that is being documented
facility token Kind of facility where patient was seen
event token Main clinical acts documented
securitylabel token Document security-tags
format token Format/content rules for the document
related-id token Identifier of related objects or events

Response message

The Document Responder shall process the query to discover the DocumentReference or DocumentManifest 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 or DocumentManifest Resources. When the Document Responder needs to report an error or warning, it shall use HTTP error response codes and should include a FHIR 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

Example of a Bundle with 11 DocumentReference Resources. Only the first DocumentReference is displayed. 

 
<Bundle xmlns="http://hl7.org/fhir">
    <id value="c0beb362-efc7-4cb9-b35a-c6cea0742156" />
    <meta>
        <versionId value="1498fcb4-af9c-404f-b445-e6634619df55" />
        <lastUpdated value="2017-10-25T11:25:00.336+00:00" />
    </meta>
    <type value="searchset" />
    <total value="11" />
    <link>
        <relation value="self" />
        <url value="http://vonk.furore.com/DocumentReference" />
    </link>
    <entry>
        <fullUrl value="http://vonk.furore.com/DocumentReference/c4f22730-bb5a-4f12-b4ef-c7bde0784426" />
        <resource>
            <DocumentReference>
                <id value="c4f22730-bb5a-4f12-b4ef-c7bde0784426" />
                <meta>
                    <versionId value="eacd5b87-21bc-42e1-8a4d-d5462b1e7368" />
                    <lastUpdated value="2017-09-22T16:10:22.096+00:00" />
                </meta>
                <masterIdentifier>
                    <system value=" http://www.acme.com/identifiers/patient" />
                    <value value="b19f24b7-e72c-44c0-bdf4-7e45d06db1b6" />
                </masterIdentifier>
                <identifier>
                    <value value="29daadee-26e1-4d6a-9e6a-7f4af9b58877" />
                </identifier>
                <status value="current" />
                <docStatus value="final" />
                <type>
                    <coding>
                        <system value="http://fhir.nhs.net/ValueSet/correspondence-document-type-1" />
                        <code value="861421000000109" />
                        <display value="End of Life Care Coordination Summary" />
                    </coding>
                </type>
                <subject>
                    <reference value="Patient/smart-99912345" />
                </subject>
                <created value="2016-03-08T15:26:00+01:00" />
                <indexed value="2016-03-08T15:26:01+01:00" />
                <author>
                    <reference value="Practitioner/smart-Practitioner-71081332" />
                </author>
                <description value="EOL" />
                <securityLabel>
                    <coding>
                        <system value="http://hl7.org/fhir/ValueSet/security-labels" />
                        <code value="V" />
                        <display value="very restricted" />
                    </coding>
                </securityLabel>
                <content>
                    <attachment>
                        <contentType value="application/pdf" />
                        <url value="http://example:9556/svc/fhir/Binary/1e404af3-077f-4bee-b7a6-a9be97e1ce32" />
                        <size value="1000" />
                        <title value="EPaCCs Place chosen to die summary" />
                    </attachment>
                </content>
                <context>
                    <facilityType>
                        <coding>
                            <system value="http://hl7.org/fhir/ValueSet/c80-facilitycodes" />
                            <code value="83891005" />
                            <display value="Solo practice private office" />
                        </coding>
                    </facilityType>
                </context>
            </DocumentReference>
        </resource>
        <search>
            <mode value="match" />
        </search>
    </entry>
    .......

Retrieve PDF/A document

After obtaining the location of the PDF/A document in the DocumentReference.content.attachment.url, the Document Consumer requests the document from the Document Responder. The Document Responder sequentially serves the PDF/A 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. 

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

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 PDF/A in a FHIR 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.[2]

When the Document Responder needs to report an error or warning, it shall use HTTP error response codes and should include a 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 

 
<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>

Send PDF/A document(s)

The Provide Document Bundle transaction is used to transmit a set of documents and associated metadata from a Document Source to a Document Recipient. This message uses the HTTP POST method on the target Document Recipient FHIR endpoint to convey the metadata and the document(s) as a FHIR transaction.

PDF/A Bundle Message

The Document Source shall initiate a FHIR “transaction” by sending HTTP POST request methods composed of a FHIR transaction Bundle Resource. A transaction interaction is performed by an HTTP POST command as shown: 

POST [base] {?_format=[mime-type]}

The content of the post submission is a Bundle with Bundle.type = transaction. Each entry carries request details (Bundle.entry.request) that provides the HTTP details of the action in order to inform the system processing the transaction what to do for the entry (note: the request is optional, but SHOULD be present). The HTTP command SHALL be a PUT or POST and the entry SHALL contain a resource (Bundle.entry.resource) for the body of the action.

The Bundle contains at Bundle.entry.resource the following resources:

  • one DocumentManifest Resource,
  • one or more DocumentReference Resources,
  • zero or more Binary Resources.

The DocumentReference.content.attachment.url points at the document content, which shall be in the Bundle as a Binary Resource. See FHIR Resolving references in Bundles at http://hl7.org/fhir/STU3/bundle.html#references

All DocumentReference.subject and DocumentManifest.subject values shall be References to FHIR Patient Resources identified by an absolute external reference (URL).

MHD points out that certain information elements within DocumentReference and DocumentManifest should be contained. For example, when sourcePatientInfo is provided, the DocumentReference.context.sourcePatientInfo shall be a reference to a contained Patient Resource. That is, the source patient info is encoded in a Patient Resource that is encoded within the DocumentReference Resource (See http://hl7.org/fhir/STU3/references.html#contained).

Other resources that are identified to be send contained within the DocumentReference or DocumentManifest resource:

  • DocumentReference.authenticator.Reference(Practitioner|Organization)
  • DocumentReference.author.Reference(Practitioner|Organization)
  • DocumentReference.context.sourcePatientInfoReference(Patient)
  • DocumentManifest.author.Reference(Practitioner|Organization)

Example of PDF/A Bundle Message 

<?xml version="1.0" encoding="UTF-8"?>
<Bundle xmlns="http://hl7.org/fhir">
  <meta>
    <lastUpdated value="2017-10-25T11:25:00.336+00:00" />
  </meta>
  <type value="transaction" />
  <entry>
    <fullUrl value="" />
    <resource>
      <DocumentManifest xmlns="http://hl7.org/fhir">
        <id value="example"/> 
        <text> 
          <status value="generated"/> 
          <div xmlns="http://www.w3.org/1999/xhtml">Text</div> 
        </text> 
        <!--   Many XDS systems do not track any id for the author. When systems don't do this, 
    the only option is for the author information to be contained in the Document Reference
     -->
        <contained> 
          <Practitioner> 
            <id value="a1"/> 
            <name> 
              <family value="Dopplemeyer"/> 
              <given value="Sherry"/> 
            </name> 
            <telecom> 
              <system value="email"/> 
              <value value="john.doe@healthcare.example.org"/> 
            </telecom> 
          </Practitioner> 
        </contained> 
        <masterIdentifier>
          <system value=" http://www.acme.com/identifiers/patient" />
          <value value="b19f24b7-e72c-45F0-bdf4-7e45d06db1b6" />
        </masterIdentifier>
        <identifier> 
          <system value="http://example.org/documents"/> 
          <value value="23425234234-2347"/> 
        </identifier> 
        <status value="current"/> 
        <subject> 
          <reference value="http://example.org/fhir/Patient/nl-core-patient-example-1" />
          <display value="Irma Jongeneel-de Haas"/>
        </subject> 
        <created value="2016-03-08T15:26:00+01:00" />
        <author> 
          <reference value="#a1"/> 
        </author> 
        <recipient> 
          <reference value="Practitioner/xcda1"/> 
        </recipient> 
        <source value="urn:oid:1.3.6.1.4.1.21367.2009.1.2.1"/> 
        <description value="End of Life Care Coordination Summary"/> 
        <content> 
          <pReference> 
            <reference value="http://vonk.furore.com/DocumentReference/c4f22730-bb5a-4f12-b4ef-c7bde0784426"/> 
          </pReference> 
        </content> 
      </DocumentManifest> 
    </resource>
    <request>
      <method value="POST"/>
      <url value="DocumentManifest"/> 
    </request>
  </entry>
  <entry>
    <fullUrl value="http://vonk.furore.com/DocumentReference/c4f22730-bb5a-4f12-b4ef-c7bde0784426" />
    <resource>
      <DocumentReference>
        <meta>
          <versionId value="eacd5b87-21bc-42e1-8a4d-d5462b1e7368" />
          <lastUpdated value="2017-09-22T16:10:22.096+00:00" />
        </meta>
        <contained>
          <Practitioner> 
            <id value="a1"/> 
            <name> 
              <family value="Dopplemeyer"/> 
              <given value="Sherry"/> 
            </name> 
            <telecom> 
              <system value="email"/> 
              <value value="john.doe@healthcare.example.org"/> 
            </telecom> 
          </Practitioner> 
        </contained>
        <masterIdentifier>
          <system value=" http://www.acme.com/identifiers/patient" />
          <value value="b19f24b7-e72c-44c0-bdf4-7e45d06db1b6" />
        </masterIdentifier>
        <identifier>
          <value value="29daadee-26e1-4d6a-9e6a-7f4af9b58877" />
        </identifier>
        <status value="current" />
        <docStatus value="final" />
        <type>
          <coding>
            <system value="http://fhir.nhs.net/ValueSet/correspondence-document-type-1" />
            <code value="861421000000109" />
            <display value="End of Life Care Coordination Summary" />
          </coding>
        </type>
        <subject>
          <reference value="http://example.org/fhir/Patient/nl-core-patient-example-1" />
          <display value="Irma Jongeneel-de Haas"/>
        </subject>
        <created value="2016-03-08T15:26:00+01:00" />
        <indexed value="2016-03-08T15:26:01+01:00" />
        <author>
          <reference value="#a1" />
        </author>
        <description value="EOL" />
        <securityLabel>
          <coding>
            <system value="http://hl7.org/fhir/ValueSet/security-labels" />
            <code value="V" />
            <display value="very restricted" />
          </coding>
        </securityLabel>
        <content>
          <attachment>
            <contentType value="application/pdf" />
            <url value="http://example:9556/svc/fhir/Binary/1e404af3-077f-4bee-b7a6-a9be97e1ce32" />
            <size value="1000" />
            <title value="EPaCCs Place chosen to die summary" />
          </attachment>
        </content>
        <context>
          <facilityType>
            <coding>
              <system value="http://hl7.org/fhir/ValueSet/c80-facilitycodes" />
              <code value="83891005" />
              <display value="Solo practice private office" />
            </coding>
          </facilityType>
        </context>
      </DocumentReference>
    </resource>
    <request>
      <method value="POST"/>
      <url value="DocumentReference"/> 
    </request>
  </entry>
  <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="iVBORw0KGgoAAA........."/>   
      </Binary>
    </resource>
      <request>
        <method value="POST"/>
        <url value="Binary"/> 
      </request>
  </entry>
</Bundle>

PDF/A Bundle Response Message

The Document Recipient returns a HTTP Status code appropriate to the processing outcome, conforming to the transaction specification requirements as specified in FHIR transaction specification. To enable the Document Source to know the outcome of processing the transaction, and the identities assigned to the resources by the Document Recipient, the Document Recipient shall return a Bundle, with type set to transaction-response, that contains one entry for each entry in the request, in the same order as received, with the Bundle.entry.response.outcome indicating the results of processing the entry. For a failed transaction, the server returns a single OperationOutcome instead of a Bundle. The Document Recipient shall comply with FHIR http://hl7.org/fhir/STU3/bundle.html#transaction-response and http://hl7.org/fhir/STU3/http.html#transaction-response.

Example of a Response Message 

<Bundle xmlns="http://hl7.org/fhir">
    <id value="154e4175-d61f-4918-af2e-653f0c600164" />
    <meta>
        <versionId value="db4148f2-dfd4-4d3d-a2ad-c1815e29916b" />
        <lastUpdated value="2017-10-30T15:13:35.744+00:00" />
    </meta>
    <type value="transaction-response" />
    <entry>
        <fullUrl value="http://vonk.furore.com/DocumentManifest/6d81acbd-5fd3-4b22-bec5-d1eff1aa2db7/_history/9d3810aa-5c29-4194-8cd9-d0de26477e74" />
        <resource>
            <DocumentManifest>
                <id value="6d81acbd-5fd3-4b22-bec5-d1eff1aa2db7" />
                <meta>
                    <versionId value="9d3810aa-5c29-4194-8cd9-d0de26477e74" />
                    <lastUpdated value="2017-10-30T15:13:35.701+00:00" />
                </meta>
                <text>
                    <status value="generated" />
                    <div xmlns="http://www.w3.org/1999/xhtml">Text</div>
                </text>
                <contained>
                    <Practitioner>
                        <id value="a1" />
                        <meta>
                            <versionId value="9d3810aa-5c29-4194-8cd9-d0de26477e74" />
                            <lastUpdated value="2017-10-30T15:13:35.701+00:00" />
                        </meta>
                        <name>
                            <family value="Dopplemeyer" />
                            <given value="Sherry" />
                        </name>
                        <telecom>
                            <system value="email" />
                            <value value="john.doe@healthcare.example.org" />
                        </telecom>
                    </Practitioner>
                </contained>
                <masterIdentifier>
                    <system value=" http://www.acme.com/identifiers/patient" />
                    <value value="b19f24b7-e72c-45F0-bdf4-7e45d06db1b6" />
                </masterIdentifier>
                <identifier>
                    <system value="http://example.org/documents" />
                    <value value="23425234234-2347" />
                </identifier>
                <status value="current" />
                <subject>
                    <reference value="http://example.org/fhir/Patient/nl-core-patient-example-1" />
                    <display value="Irma Jongeneel-de Haas" />
                </subject>
                <created value="2016-03-08T15:26:00+01:00" />
                <author>
                    <reference value="#a1" />
                </author>
                <recipient>
                    <reference value="Practitioner/xcda1" />
                </recipient>
                <source value="urn:oid:1.3.6.1.4.1.21367.2009.1.2.1" />
                <description value="End of Life Care Coordination Summary" />
                <content>
                    <pReference>
                        <reference value="http://vonk.furore.com/DocumentReference/c4f22730-bb5a-4f12-b4ef-c7bde0784426" />
                    </pReference>
                </content>
            </DocumentManifest>
        </resource>
        <response>
            <status value="201" />
            <location value="http://vonk.furore.com/DocumentManifest/6d81acbd-5fd3-4b22-bec5-d1eff1aa2db7/_history/9d3810aa-5c29-4194-8cd9-d0de26477e74" />
            <lastModified value="2017-10-30T15:13:35.701+00:00" />
        </response>
    </entry>
    <entry>
        <fullUrl value="http://vonk.furore.com/DocumentReference/72b35b5c-5fbe-40c7-a519-1a1c7151b5e1/_history/6b495638-f614-4bbb-9b39-55bb512c6a98" />
        <resource>
            <DocumentReference>
                <id value="72b35b5c-5fbe-40c7-a519-1a1c7151b5e1" />
                <meta>
                    <versionId value="6b495638-f614-4bbb-9b39-55bb512c6a98" />
                    <lastUpdated value="2017-10-30T15:13:35.732+00:00" />
                </meta>
                <contained>
                    <Practitioner>
                        <id value="a1" />
                        <meta>
                            <versionId value="6b495638-f614-4bbb-9b39-55bb512c6a98" />
                            <lastUpdated value="2017-10-30T15:13:35.732+00:00" />
                        </meta>
                        <name>
                            <family value="Dopplemeyer" />
                            <given value="Sherry" />
                        </name>
                        <telecom>
                            <system value="email" />
                            <value value="john.doe@healthcare.example.org" />
                        </telecom>
                    </Practitioner>
                </contained>
                <masterIdentifier>
                    <system value=" http://www.acme.com/identifiers/patient" />
                    <value value="b19f24b7-e72c-44c0-bdf4-7e45d06db1b6" />
                </masterIdentifier>
                <identifier>
                    <value value="29daadee-26e1-4d6a-9e6a-7f4af9b58877" />
                </identifier>
                <status value="current" />
                <docStatus value="final" />
                <type>
                    <coding>
                        <system value="http://fhir.nhs.net/ValueSet/correspondence-document-type-1" />
                        <code value="861421000000109" />
                        <display value="End of Life Care Coordination Summary" />
                    </coding>
                </type>
                <subject>
                    <reference value="http://example.org/fhir/Patient/nl-core-patient-example-1" />
                    <display value="Irma Jongeneel-de Haas" />
                </subject>
                <created value="2016-03-08T15:26:00+01:00" />
                <indexed value="2016-03-08T15:26:01+01:00" />
                <author>
                    <reference value="#a1" />
                </author>
                <description value="EOL" />
                <securityLabel>
                    <coding>
                        <system value="http://hl7.org/fhir/ValueSet/security-labels" />
                        <code value="V" />
                        <display value="very restricted" />
                    </coding>
                </securityLabel>
                <content>
                    <attachment>
                        <contentType value="application/pdf" />
                        <url value="http://example:9556/svc/fhir/Binary/1e404af3-077f-4bee-b7a6-a9be97e1ce32" />
                        <size value="1000" />
                        <title value="EPaCCs Place chosen to die summary" />
                    </attachment>
                </content>
                <context>
                    <facilityType>
                        <coding>
                            <system value="http://hl7.org/fhir/ValueSet/c80-facilitycodes" />
                            <code value="83891005" />
                            <display value="Solo practice private office" />
                        </coding>
                    </facilityType>
                </context>
            </DocumentReference>
        </resource>
        <response>
            <status value="201" />
            <location value="http://vonk.furore.com/DocumentReference/72b35b5c-5fbe-40c7-a519-1a1c7151b5e1/_history/6b495638-f614-4bbb-9b39-55bb512c6a98" />
            <lastModified value="2017-10-30T15:13:35.732+00:00" />
        </response>
    </entry>
    <entry>
        <fullUrl value="http://vonk.furore.com/Binary/0f1a82de-e87b-4a74-9d47-a6ba5ac446ca/_history/8f4ecedc-3650-44cc-90ae-654efb6e8166" />
        <resource>
            <Binary>
                <id value="0f1a82de-e87b-4a74-9d47-a6ba5ac446ca" />
                <meta>
                    <versionId value="8f4ecedc-3650-44cc-90ae-654efb6e8166" />
                    <lastUpdated value="2017-10-30T15:13:35.743+00:00" />
                </meta>
                <contentType value="application/pdf" />
                <content value="iVBORw0KGgoAAA........." />
            </Binary>
        </resource>
        <response>
            <status value="201" />
            <location value="http://vonk.furore.com/Binary/0f1a82de-e87b-4a74-9d47-a6ba5ac446ca/_history/8f4ecedc-3650-44cc-90ae-654efb6e8166" />
            <lastModified value="2017-10-30T15:13:35.743+00:00" />
        </response>
    </entry>
</Bundle>

Interactions, operations, search parameters

Interactions

The following logical interactions are needed for this use case:

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:

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