Stream: ihe
Topic: MHD bundled vs. contained Patient
Simone Heckmann (Sep 10 2021 at 12:55):
If I read the current MHD spec correctly, a provide document Bundle can either contain a Patient Resource in DocumentReference.contained or simply reference an external Patient (uncontained option). Does MHD also consider the option of having a bundled Patient Resource (Reference to the fullUrl of another entry in the same Bundle?
John Moehrke (Sep 10 2021 at 13:02):
yes. And there are examples. The use-case for this model is mostly PUSH, not so much for publication to a Registry. When publishing to a Registry the expectation is that you use PIXm or PDQm to find the patient id to use in the Registry.
John Moehrke (Sep 10 2021 at 13:04):
https://profiles.ihe.net/ITI/MHD/Bundle-ex-minimalProvideDocumentBundleSimple.html
Simone Heckmann (Sep 10 2021 at 13:52):
Great, thanks! Is this considered "contained" oder "uncontained" option? Or neither?
Simone Heckmann (Sep 10 2021 at 13:55):
..or is this outside of the scope of ITI-65?
Simone Heckmann (Sep 10 2021 at 13:58):
Ah. Is this what I'm looking for?
"Patient would typically only be allowed by the Document Recipient in PUSH interaction situations, but may be accepted for other reasons at the discretion of the Document Recipient actor policy."
https://profiles.ihe.net/ITI/MHD/ITI-65.html#23654121-bundle-resources
"Patient" meaning "A Patient as entry in a Bundle"...?
John Moehrke (Sep 10 2021 at 13:58):
it has nothing to do with contained or uncontained. This is related to persistence of historic values. If you have infrastructure that can persist the persons name and address as it was 20 years ago, then use that system (uncontained), if not then you place the current details inside (contained)
John Moehrke (Sep 10 2021 at 13:59):
Simone Heckmann said:
Ah. Is this what I'm looking for?
"Patient would typically only be allowed by the Document Recipient in PUSH interaction situations, but may be accepted for other reasons at the discretion of the Document Recipient actor policy."
https://profiles.ihe.net/ITI/MHD/ITI-65.html#23654121-bundle-resources"Patient" meaning "A Patient as entry in a Bundle"...?
yes
John Moehrke (Sep 10 2021 at 14:02):
The main reason for one or the other is based on doing early alignment of patient identity, or late alignment. In Publication settings, one should likely make sure you have a Patient identity that the registry agrees with, where if one can't be found then a patient identity likely needs to be created.
Push settings, one could lookup the patient identity at the destination, but push tends to be more a situation where the recipient needs to just figure it out.
Simone Heckmann (Sep 10 2021 at 14:02):
John Moehrke said:
yes
Great thanks!
I also found the Patient slice on the Bundle now: https://profiles.ihe.net/ITI/MHD/StructureDefinition-IHE.MHD.Minimal.ProvideBundle.html
I suppose, I was looking at the wrong Bundle the first time around, because it seemed to me that adding a Patient resource wasn't allowed there.
All good now :big_smile:
John Moehrke (Sep 10 2021 at 14:04):
now that you figured it out... I would love to hear your recommendations for improving the specification. Feel free to enter a github issue
Simone Heckmann (Sep 14 2021 at 09:22):
I think some explanation as to what exactly constitutes a "PUSH interaction situation" and how this relates to the IHE defined Transactions would be helpful...
Simone Heckmann (Sep 15 2021 at 12:40):
Issue added: https://github.com/IHE/ITI.MHD/issues/89
Last updated: Apr 12 2022 at 19:14 UTC
