Mobile access to Health Documents (MHD)
4.0.1 - normative

This page is part of the IHE Mobile Access to Health Documents (v4.0.1: Trial Implementation) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

Document Consumer (client)

IHE ITI Mobile access to Health Documents (MHD) - Document Consumer (client).

Document Recipient implementing Comprehensive Metadata Option

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with Comprehensive declared Option.

Document Recipient

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with no declared Options or all declared Options.

Document Recipient implementing UnContained References Option

IHE ITI Mobile access to Health Documents (MHD) - Document Recipient - with UnContained declared Option.

Document Responder (server)

IHE ITI Mobile access to Health Documents (MHD) - Document Responder (server).

Document Source (publisher) implementing Comprehensive Metadata Option

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with Comprehensive Metadata Option.

Document Source (publisher)

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with no declared Options or all declared Options.

Document Source (publisher) implementing UnContained References Option

IHE ITI Mobile access to Health Documents (MHD) - Document Source (publisher) - with UnContained Option.

Behavior: Search Parameters

These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources.

search on the DocumentReference.content.attachment.creation element

Search Parameter extension enabling clients to search on the DocumentReference.content.attachment.creation element

search on the IHE defined extension for designationType

This SearchParameter enables finding Lists by the designationType code in a submissionSet or folder.

search on the IHE defined extension for SourceId

This SearchParameter enables finding Lists by the SourceId of a submissionSet.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide

Audit Event for Find Document Lists Transaction by the Document Consumer

Defines constraints on the AuditEvent Resource to record when a Find Document Lists Transaction happens, as recorded by the Document Consumer.

  • Query event
  • shall have the source as itself
  • shall have a document consumer agent
  • shall have a document responder agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a the query parameters
Audit Event for Find Document Lists Transaction at Document Responder

Defines constraints on the AuditEvent Resource to record when a Find Document Lists Transaction happens, as recorded by the Document Responder.

  • Query event
  • shall have the source as itself
  • shall have a document consumer agent
  • shall have a document responder agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a the query parameters
Audit Event for Find Document References Transaction at Document Consumer

Defines constraints on the AuditEvent Resource to record when a Find Document References Transaction happens, as recorded by the Document Consumer.

  • Query event
  • shall have the source as itself
  • shall have a document consumer agent
  • shall have a document responder agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a the query parameters
Audit Event for Find Document References Transaction at Document Responder

Defines constraints on the AuditEvent Resource to record when a Find Document References Transaction happens, as recorded by the Document Responder.

  • Query event
  • shall have the source as itself
  • shall have a document consumer agent
  • shall have a document responder agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a the query parameters
Audit Event for Provide Bundle Transaction at Recipient

Defines constraints on the AuditEvent Resource to record when a Provide Bundle Transaction happens at the Recipient.

  • Import event
  • shall have source of itself
  • shall have a document source agent
  • shall have a document recipient agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a submission set identity entity
Audit Event for Provide Bundle Transaction at Source

Defines constraints on the AuditEvent Resource to record when a Provide Bundle Transaction happens at the Source.

  • Import event
  • shall have source of itself
  • shall have a document source agent
  • shall have a document recipient agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a submission set identity entity
Audit Event for Retrieve Document Transaction at Document Consumer

Defines constraints on the Document Consumer AuditEvent Resource to record when a Retrieve Document Transaction happens, as recorded by the Document Consumer.

  • Import event
  • shall have the source as itself
  • shall have a document consumer agent
  • shall have a document responder agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a document uniqueId (usually a Binary)
Audit Event for Retrieve Document Transaction at the Document Responder

Defines constraints on the Document Responder AuditEvent Resource to record when a Retrieve Document Transaction happens, as recorded by the Document Responder.

  • Export event
  • shall have the source as itself
  • shall have a document consumer agent
  • shall have a document responder agent
  • may have user, app, organization agent(s)
  • shall have a patient entity
  • shall have a document uniqueId (usually a Binary)
MHD DocumentReference Comprehensive

A profile on the DocumentReference resource for MHD Comprehensive Option with Contained (not UnContained), compatible with XDS-on-FHIR and XCA use.

MHD Comprehensive Provide Document Bundle

A profile on the Bundle transaction for ITI-65 Provide Document resources with Comprehensive Metadata for MHD.

  • Comprehensive Metadata: http://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Comprehensive.ProvideBundle
    • this is otherwise known as XDS-on-FHIR
    • shall be a Transaction Bundle
    • all resources shall be compliant with comprehensive constraints, they may be marked comprehensive
    • shall create a SubmissionSet type List that is either minimal, comprehensive, or unContained
    • may create one or more DocumentReference that is either minimal, comprehensive, or unContained
    • may create one or more Binary
    • may create/update one or more Folder type List that is either minimal, comprehensive, or unContained
    • may create/update/read one Patient
MHD Find Document References Comprehensive Response message

A profile on the Find Document References Comprehensive Response message for ITI-67

MHD Find Document References Response message

A profile on the Find Document References Response message for ITI-67

MHD Find Document Lists Response Message

A profile on the Find Document Lists Response message for ITI-66

MHD Folder Minimal

A profile on the List resource for MHD use as a Folder with minimal metadata constraints.

MHD Folder Comprehensive

A profile on the List resource for MHD Comprehensive Metadata Folder. Note UnContained has no impact on Folder.

MHD common List with designationType

A profile on the List resource for MHD. Used with both Folder and SubmissionSet.

  • MHD adds a codeable Concept to List for use with Folder and SubmissionSet
MHD DocumentReference Minimal

A profile on the DocumentReference resource for MHD with minimal metadata constraints.

MHD Minimal Provide Document Bundle

A profile on the Bundle transaction for ITI-65 Provide Document resources with Minimal metadata for MHD.

  • Minimal Metadata: http://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.Minimal.ProvideBundle
    • shall be a Transaction Bundle
    • all resources shall be compliant with minimal constraints, they may be marked minimal, comprehensive, or unContained
    • shall create a SubmissionSet type List that is either minimal, comprehensive, or unContained
    • may create one or more DocumentReference that is either minimal, comprehensive, or unContained
    • may create one or more Binary
    • may create/update one or more Folder type List that is either minimal, comprehensive, or unContained
    • may create/update/read one Patient
MHD Provide Document Bundle Response

A profile on the Bundle transaction-response for ITI-65 Provide Document Bundle response.

  • shall be a transaction response
  • shall have at least 1 entry for each entry in the request, in the same order as received in the request
    • entry response location must be indicated
MHD SubmissionSet Minimal

A profile on the List resource for MHD SubmissionSet.

MHD SubmissionSet Comprehensive

A profile on the List resource for MHD Comprehensive SubmissionSet.

MHD SubmissionSet Comprehensive UnContained

A profile on the List resource for MHD UnContained Comprehensive SubmissionSet.

MHD DocumentReference Comprehensive UnContained References Option

A profile on the DocumentReference resource for MHD with Comprehensive Metadata Option but without a requirement for contained author, authenticator, or sourcePatientInfo.

MHD UnContained Comprehensive Provide Document Bundle

A profile on the Bundle transaction for ITI-65 Provide Document resources with UnContained allowed but requiring Comprehensive Metadata for MHD.

  • UnContained Comprehensive Metadata: http://profiles.ihe.net/ITI/MHD/StructureDefinition/IHE.MHD.UnContained.Comprehensive.ProvideBundle
    • note that Minimal Metadata does not require containment, so UnContained Minimal is the same as Minimal Metadata
    • note that UnContained only applies to DocumentReference and SubmissionSet type Lists; so the following apply
    • shall be a Transaction Bundle
    • all resources shall be compliant with comprehensive unContained constraints, they may be marked comprehensive unContained
    • shall create a SubmissionSet type List that is either minimal, comprehensive, or unContained
    • may create one or more DocumentReference that is either minimal, comprehensive, or unContained
    • may create one or more Binary
    • may create/update one or more Folder type List that is either minimal, comprehensive, or unContained
    • may create/update/read one Patient

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide

Author organization of the SubmissionSet

When the author of the SubmissionSet is an Organization, this extension shall be used.

Clinical code of the List

Expresses contentType of submissionSet or the codeList of a Folder. Usually expressed in LOINC or SNOMED.

Intended recipient of the SubmissionSet

holds the identity of the organization or person the SubmissionSet is intended. For XDR and eMail (e.g. Direct) this tends to be a Practitioner or Patient with a telecom holding an email, but this is not strictly required.

Publisher organization identity of the SubmissionSet

The globally unique, immutable, identifier of the entity that contributed the SubmissionSet. When a broker is involved in sending SubmissionSets from a collection of client systems, it shall use a different sourceId for submissions from each separate system to allow for tracking. The format of the identifier is an OID.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide

MHD List Types ValueSet

ValueSet of the MHD List Types allowed

MHD Folder List Types ValueSet

A ValueSet of the allowed actions in a ITI-65 Provide Document Bundle for the Folder List type Resources. Where Folders are allowed to be Updated in addition to Created.

MHD Patient Types ValueSet

A ValueSet of the allowed actions in a ITI-65 Provide Document Bundle for the Patient type Resource. Where Patient would typically be indicated as a GET (read), but might be created or updated depending on policy.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide

MHD List Types

To use the List resource for two different use-cases we define a code-system with the types of List needed in MHD

Terminology: Concept Maps

These define transformations to convert between codes by systems conforming with this implementation guide

AssociationType vs RelatesTo

map between XDS Association Types and MHD FHIR DocumentReference relatesTo code.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like

DocumentReference for Comprehensive fully filled metadata

Example of a Comprehensive DocumentReference resource. This is fully filled for all mandatory elements and all optional elements.

DocumentReference for Comprehensive fully filled metadata for a Deferred Creation

Example of a Comprehensive DocumentReference resource.

  • This is fully filled for all mandatory elements and all optional elements.
  • This specifies a Delayed Document Assembly Document.
    • Thus the hash is the fixed value da39a3ee5e6b4b0d3255bfef95601890afd80709
    • and the size is explicitly zero
    • and when a Document Consumer retrieves the URL, then the document will be assembled and returned to it
    • and the DocumentReference would be updated with the resulting hash and size thus becoming a static entry
DocumentReference for Comprehensive fully filled metadata for a On-Demand document

Example of a Comprehensive DocumentReference resource.

  • This is fully filled for all mandatory elements.
  • This specifies a On-Demand Document.
    • Thus the hash is not provided
    • and the size is not provided
    • and when a Document Consumer retrieves the URL, then a new document will be created and returned to it
    • and a linked snapshot DocumentReference would be created with the resulting hash and size thus becoming a static entry
DocumentReference for Comprehensive fully filled metadata for a document in a Binary

Example of a Comprehensive DocumentReference resource.

  • This is fully filled for all mandatory elements.
  • This specifies a Document in a Binary.
DocumentReference for Minimal metadata

Example of a minimal DocumentReference resource. This is very unlikely to be acceptable anywhere, but it is the minimum required.

DocumentReference for Comprehensive minimally metadata

Example of a Comprehensive DocumentReference resource. This is minimally filled for all mandatory elements.

DocumentReference for Comprehensive minimally filled metadata

Example of a UnContained References Option with Comprehensive DocumentReference resource. This is fully filled for all mandatory elements and optional elements.

Provide Document Bundle with one document to be added to an existing folder

Example of a comprehensive Provide Document Bundle for a publication and added to an existing folder.

  • The bundle contains
    • SubmissionSet - identifies one documentReference
    • Folder - existing Folder to be updated
    • DocumentReference - One DocumentReference
    • Binary - the document
    • the Patient is contained in the DocumentReference
    • the Patient is also a reference to a PIXm/PDQm retrieved Resource.
Audit Example of ITI-66 at Consumer

Audit Example for a Find Document Lists Transaction as recorded at the consumer

Audit Example of ITI-66 at responder

Audit Example for a Find Document Lists Transaction from responder perspective

Audit Example of ITI-67 at Consumer

Audit Example for a Find Document References Transaction as recorded at the consumer

Audit Example of ITI-67 using POST recorded at responder

Audit Example for a Find Document References Transaction using POST search as recorded at the responder perspective

Audit Example of ITI-67 at responder

Audit Example for a Find Document References Transaction from responder perspective

Audit Example of ITI-65 at recipient

Audit Example for a Provide Bundle Transaction as recorded at the recipient

Audit Example of ITI-65 at source

Audit Example for a Provide Bundle Transaction from source perspective

Audit Example of ITI-68 at consumer

Audit Example for a Retrieve Document Transaction as recorded at the consumer

Audit Example of ITI-68 at responder

Audit Example for a Retrieve Document Transaction from responder perspective

Example document that says: Hello World

Example binary that holds just Hello World

  • size 11
  • hash 0a4d55a8d778e5022fab701977c5d840bbc486d0
  • base64 of the hash MGE0ZDU1YThkNzc4ZTUwMjJmYWI3MDE5NzdjNWQ4NDBiYmM0ODZkMA==
Example Comprehensive Email SubmissionSet

SubmissionSet in List resource conforming Comprehensive metadata with an intendedRecipient

Example Comprehensive Folder

Folder in List resource conforming only to Comprehensive metadata

Example Comprehensive Full SubmissionSet

SubmissionSet in List resource conforming fully to Comprehensive metadata. This has all elements fully populated.

Example UnContained Comprehensive Full SubmissionSet

SubmissionSet in List resource conforming fully to UnContained References Option and Comprehensive Metadata Option. This has all elements fully populated.

Example Comprehensive SubmissionSet

SubmissionSet in List resource conforming minimally to Comprehensive metadata

Provide Document Bundle with complete Comprehensive metadata of one document

Example of a complete comprehensive Provide Document Bundle for a publication.

  • The bundle contains
    • SubmissionSet - identifies one documentReference
    • Folder - identifies one documentReference
    • DocumentReference - One DocumentReference
    • Binary - the document
    • the Patient is contained in the DocumentReference
    • the Patient is also a reference to a PIXm/PDQm retrieved Resource.
Provide Document Bundle with Comprehensive metadata of multiple static document(s)

Example of a comprehensive Provide Document Bundle for a publication.

  • The bundle contains
    • SubmissionSet - identifies the documentReference(s)
    • DocumentReference - First DocumentReference
    • Binary - the first document
    • DocumentReference - Second DocumentReference
    • Binary - the second document
    • the Patient is contained in the DocumentReference
    • the Patient is also a reference to a PIXm/PDQm retrieved Resource.
Provide Document Bundle with Comprehensive metadata of one document

Example of a comprehensive Provide Document Bundle for a publication.

  • The bundle contains
    • SubmissionSet - identifies one documentReference
    • DocumentReference - One DocumentReference
    • Binary - the document
    • the Patient is contained in the DocumentReference
    • the Patient is also a reference to a PIXm/PDQm retrieved Resource.
Dummy Device example

Dummy Device example for completeness sake. No actual use of this resource other than an example target

Dummy DocumentReference example

Dummy DocumentReference example for completeness sake. No actual use of this resource other than an example target

Dummy DocumentReference 2 example

Dummy DocumentReference 2 example for completeness sake. No actual use of this resource other than an example target

Example of a Find Document Lists Response Message with a folder

Example of a Find Documents List Response Bundle witha folder

Example of a Find Document References Response Message

Example of a Find Document References Bundle Search Set with a single DocumentReference

Dummy List example

Dummy List example for completeness sake. No actual use of this resource other than an example target

Example Minimal Folder

Folder in List resource conforming only to Minimal metadata

Provide Document Bundle with Minimal metadata of one document

Example of a minimal Provide Document Bundle for a push to an email intended recipient.

  • The bundle contains
    • SubmissionSet - identifies to whom this is going and one documentReference
    • DocumentReference - One DocumentReference
    • Binary - the document
    • the Patient, as this is a push to a recipient that does not share a patient directory
Provide Document Bundle with Minimal metadata of one document with sourcePatientInfo

Example of a minimal Provide Document Bundle for a push to an email intended recipient.

  • The bundle contains
    • SubmissionSet - identifies to whom this is going and one documentReference
    • DocumentReference - One DocumentReference
    • Binary - the document
    • the Patient is contained in the DocumentReference. This would be more classic XDR/XDM model. Note there is no mention of the patient in the SubmissionSet in this case (hence minimal metadata), and if multiple documents were sent they would implicitly be the same patient, presumably with the same contained Patient; but given it is a contained Patinet there is no way to computably prove this beyond exact comparison of the contained object.
SubmissionSet for Minimal metadata

Example of a minimal submissionSet in List resource.

Dummy Organization example

Dummy Organization example for completeness sake. No actual use of this resource other than an example target

Dummy Patient example

Dummy patient example for completeness sake. No actual use of this resource other than an example target

Dummy Practitioner example

Dummy Practitioner example for completeness sake. No actual use of this resource other than an example target

Response to fully populated Provide Document Bundle with one document with sourcePatientInfo

Response bundle example given ex-comprehensiveProvideDocumentBundleComplete

  • for every entry in order given
    • successful create of SubmissionSet
    • successful create of Folder
    • successful create of DocumentReference - classic XDS static document
    • successful create of Binary
Response to Provide Document Bundle with multiple documents with sourcePatientInfo

Response bundle example given ex-comprehensiveProvideDocumentBundleMultiple

  • for every entry in order given
    • successful create of SubmissionSet
    • successful create of DocumentReference - classic XDS static document
    • successful create of Binary
Response to Provide Document Bundle with one document with sourcePatientInfo

Response bundle example given ex-comprehensiveProvideDocumentBundleSimple

  • for every entry in order given
    • successful create of SubmissionSet
    • successful create of DocumentReference - classic XDS static document
    • successful create of Binary
Response to Provide Document Bundle with Minimal metadata of one document

Response bundle example given ex-minimalProvideDocumentBundleSimple

  • for every entry in order given
    • successful create of SubmissionSet
    • successful create of DocumentReference
    • successful create of Binary
    • successful create of Patient Note that in the case of the Patient, it is likely this successful create is just a fake success, as it was more likely to have been matched to a patient that already existed and THAT id was returned. (Alternative could have been a 303)
Response to Provide Document Bundle with Minimal metadata of one document with sourcePatientInfo

Response bundle example given ex-minimalProvideDocumentBundleSimpleContained

  • for every entry in order given
    • successful create of SubmissionSet
    • successful create of DocumentReference
    • successful create of Binary
Response to fully populated Provide Document Bundle with one document with sourcePatientInfo

Response bundle example given ex-unContainedComprehensiveProvideDocumentBundleComplete

  • for every entry in order given
    • successful create of SubmissionSet
    • successful create of DocumentReference - classic XDS static document
    • successful create of Binary
Provide Document Bundle with complete UnContained Comprehensive metadata of one document

Example of a complete uncontained comprehensive Provide Document Bundle for a publication.

  • The bundle contains
    • SubmissionSet - identifies one documentReference
    • Folder - identifies one documentReference
    • DocumentReference - One DocumentReference
    • Binary - the document
    • the Practitioner and Organization are references
    • the Patient is also a reference to a PIXm/PDQm retrieved Resource.