Stream: implementers
Topic: why US-core doesn't support bundle for documents
frank cao (Aug 11 2021 at 13:32):
Is there a reason that US-core does not support bundle for clinical documents? It seems that bundle is a better approach to support documents with discrete data.
Lloyd McKenzie (Aug 11 2021 at 13:47):
US-core is focused on what most EHRs in the U.S. are capable of doing. And converting CDA documents to FHIR documents isn't (yet?) one of those things.
frank cao (Aug 11 2021 at 14:10):
Thanks Lloyd. If we were to implement a non-US document repository that includes diagnostic reports, clinical notes such as discharge summaries, would you recommend to stick to US-core or also support document bundles? We may not have a need for CDA but the idea of document bundles is to support discrete data, which US-core doesn't support, correct?
John Moehrke (Aug 11 2021 at 14:13):
The DocumentReference resource is supported in US-Core. Not clear to me why this could not be describing a FHIR-Document (bundle). US-Core does not provide guidance on how to specify other kinds of documents, but does not (as far as I can tell) forbid others.
John Moehrke (Aug 11 2021 at 14:17):
a more general and international implementation guide on the use of DocumentReference is the IHE-MHD -- https://profiles.ihe.net/ITI/MHD/
John Moehrke (Aug 11 2021 at 14:21):
The IHE also has an Implementation Guide showing how to convey the IPS (FHIR-Document) using Document Sharing, including MHD. (nothing too special, Composition maps to DcumentReference (just like found in FHIR core) and the FHIR-Document (Bundle holding the Composition and stuff) is pointed to by the attachment.url
frank cao (Aug 11 2021 at 14:36):
Thanks a lot. I will take a look. For diagnostic related reports, should I use document bundle or DiagnosticReport? Both can support discrete data and I like that DiagnosticReport instance is smaller than a bundle.
John Moehrke (Aug 11 2021 at 15:02):
should start a new stream for a new topic.
Yunwei Wang (Aug 11 2021 at 15:06):
You can take a look at International Patient Summary IG https://build.fhir.org/ig/HL7/fhir-ips/ which is document based. @frank cao
Brendan Keeler (Aug 11 2021 at 17:58):
Isn't composition the right resource here
frank cao (Aug 11 2021 at 18:03):
Yunwei Wang said:
You can take a look at International Patient Summary IG https://build.fhir.org/ig/HL7/fhir-ips/ which is document based. frank cao
I'm aware of the IPS. If I need to support discharge summary that may contain discrete data, I think IPS or bundle is a better fit. However if US-core IG doesn't support it, does that mean most vendors cannot support the discrete data format? I also looked at MHD and I think it could be the long term solution for document exchange with FHIR.
John Moehrke (Aug 11 2021 at 19:56):
Note that the definition of 'document' in the context of DocumentReference (and IHE-MHD) is the broad definition used for document in http. It does not need to meet the principles of a Document popularized by CDA. These principles are best-case, but not minimally important. Thus a DocumentReference (and IHE-MHD) can be used for anything that can be described with the metadata elements in the DocumentReferenence resource, and has a stream of bytes.
Michele Mottini (Aug 11 2021 at 20:00):
The US core way to support discrete data is to make it available in the server - as separate resources, and then the client can get them if it wants them
John Moehrke (Aug 11 2021 at 20:01):
Michele Mottini said:
The US core way to support discrete data is to make it available in the server - as separate resources, and then the client can get them if it wants them
Im unclear what your point is... US-Core does include DocumentReference
Michele Mottini (Aug 11 2021 at 20:13):
That if as a client I want to find out things about a patient that has been discharged I use searches like ../AllergyIntolerance?patient=xxxx, ../Observation?patient=xxxx etc
Michele Mottini (Aug 11 2021 at 20:14):
Servers might return documents via DocumentReference resource, but they are usually C-CDAs - that a FHIR client cannot really interpret
frank cao (Aug 12 2021 at 14:08):
But if we look at discrete data as part of a document, current US-core does not support it. I understand that from a minimum requirement perspective, but I think it does hinder interoperability to a certain degree if vendors just take the easy way by sending document without any discrete data even if they can.
Lloyd McKenzie (Aug 12 2021 at 14:13):
For a lab report, if you want to limit yourself to US Core and you actually have a FHIR document (congrats!), then post the document as a DocumentReference and also post the DiagnosticReport and individual Observations as distinct resources without the Composition wrapper.
Michele Mottini (Aug 12 2021 at 14:18):
US Core is not based on 'sending' - it makes the data available and the client query it, and so all discrete data is available
Last updated: Apr 12 2022 at 19:14 UTC
