Mobile Care Services Discovery (mCSD)
3.8.0 - Trial-Implementation
Mobile Care Services Discovery (mCSD)
3.8.0 - Trial-Implementation
This page is part of the IHE ITI Mobile Care Services Discovery (v3.8.0: Public-Comment) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions 
IHE welcomes New Issues from the GitHub community. For those without GitHub access, issues may be submitted at ITI Public Comments.
As issues are submitted they will be managed on the mCSD GitHub Issues, where discussion and workarounds may be found. These issues, when critical, will be processed using the normal IHE Change Proposal management and balloting. It is important to note that as soon as a Change Proposal is approved, it carries the same weight as a published Implementation Guide (i.e., it is testable at an IHE Connectathon from the time it is approved, even if it will not be integrated until several months later).
These issues were known as part of the publication, and IHE invites comments.
mCSD_7. Should there be additional required search parameters? Should we also require any reverse chaining (_has) options for the search? Should we require any reverse includes (_revinclude)? These would add complexity to the server and most will have similar options through include and normal chaining.
In [ITI-90], we’ve added a number of required search parameters to support queries for OrganizationAffiliation and Endpoint. Is it sustainable to require this many search parameters? Should we move some to SHOULDs or MAYs? Note that the main use case is locating an Organization based on its business, not network, attributes (already covered elsewhere in mCSD), then checking its Endpoints. Further, recursively searching parents and affiliations for Endpoints is likely an edge case, not one we need to try to do in a single request.
mCSD_10. Section 1:46.8 mCSD Endpoint Usage Considerations, describes how to populate and use an endpoint directory. Given that this IG is more about how to deploy and use directories than what to put in them, would this content be better as a white paper instead? And could this content be generalized to allow usage with mCSD as well as other directory IGs like https://hl7.org/fhir/uv/vhdir/?
mCSD_11. Should we assume federation of (i.e., connectivity to) child organizations when related by .partOf? Currently the IG does (see Section 1:46.8.2), and we believe this is what is done in practice. The downside is that there is no way to represent a hierarchical relationship that does not imply routing.
mCSD_12. Should we specify details of addressing to federated recipients, at least for some profiles (see Section 1:46.8.2)? For example, with MHD [ITI-65] we could pass the Organization.identifier in the intendedRecipient field. There is already an IG for passing a Direct address in an XDR [ITI-41].
mCSD_14. Consider doing something similar to what HL7 UDAP Security did, and describe mCSD within the larger family of directory IGs, making clear where compatibility is assured as well as what each IGs focus is. For example, https://hl7.org/fhir/uv/vhdir/ covers maintenance and validation of the content of directories, while mCSD covers how to represent and search complex structures.
mCSD_15. In Section 1:46.8, we mention the US TEFCA RCE maintaining a consolidated directory spanning multiple networks. Can we identify an international example?
mCSD_16. In Section 1:46.8.2, we say that a hierarchy formed by Organization.partOf implies federation of (i.e., connectivity to) child organizations. Should we? We believe this is what is done in practice. The downside is that there would be no way to represent a hierarchical relationship that does not imply routing. An alternative proposed design would require OrganizationAffiliation with a code of “DocShare-federate” to be explicitly related to any parent-child relationship to imply connectivity. We did not choose this because its impact on existing directory structures would be substantial.
mCSD_18. Should we specify details of addressing federated recipients, at least for some profiles (see Section 1:46.8.2)? For example, with MHD [ITI-65] we could pass the Organization.identifier in the intendedRecipient field. There is already an IG for passing a Direct address in an XDR [ITI-41].
mCSD_20. There is minimal usage guidance for REST endpoints. Figure 1:46.8.3-1 shows connectionType = hl7-fhir-rest and extension:specificType = MHD-Recipient-ProvideReg. Is this necessary? Couldn’t clients discover anything they need to know about REST from the CapabilityStatement?
mCSD_21. This profile says very little about home community ID, yet it is called out in mCSD issue #2. Section 1:46.8.2 talks about “identifiers of type Home Community ID”. The profile on Endpoint for Document Sharing says to put the HCID in the Endpoint.identifier. The Example of an mCSD XCA Query Endpoint shows an Endpoint.identifier.type with coding for a HCID. But this is not specified normatively anywhere.
We have seen directories add a custom code “HCID” that shows that an identifier is a HCID, and have seen them use the system of “urn:ietf:rfc:3986” and a URN-encoded OID. In committee discussions, we walked this through, and the general consensus was that for identifying an organization to meet the MHD to a Federation use cases (i.e., to determine connectivity), whether or not an identifier happened to be a HCID was not significant. If we were to get into more detail about addressing federated recipients (see issue 15 in this list), we might need to make decisions like whether HCID must be a specific identifier type and whether it should be URN-encoded.
mCSD_23. In the Resource Profile: mCSD Endpoint for Document Sharing, to indicate that the endpoint is not constrained, should payloadType and payloadMimeType be empty, or fully populated?
mCSD_24. In the Resource Profile: mCSD Endpoint for Document Sharing, should payloadType and payloadMimeType be required to be the same for Endpoints that reflect grouped actors (i.e., XCA/XDS/MHD Query and XCA/XDS/MHD Retrieve), thus replicating the capability at both endpoints?
mCSD_25. In the Resource Profile: mCSD Endpoint for Document Sharing, should payloadType and payloadMimeType be specified for an XCA Query endpoint? It did not seem right that Query be indicated with a mimeType of ebRegistry as that is not helpful to the use-case.
mCSD_26. In the Resource Profile: mCSD Endpoint for Document Sharing, would a Proxy service that is supporting OrgAff be a good example of NOT putting a homeCommunityId in the endpoint.identifier?
mCSD_27. Need to align and flesh out the examples better with the guidance in Section 1:46.8.2. For example, could we see an example for an organization accessible via two different exchanges?
mCSD_28. Grouping of actors is mentioned in Section 1:46.8.3. Does Karen’s Cross apply here? If so, how? Should OrganizationAffiliation be required?
Karen’s Cross (see 3.0 Interaction Patterns. Also described here) is a mapping table defined by the Direct Project (not by IHE), that tells how to get to and from different flavors of IHE Document Sharing “Push” (XDR, XDM) and the Direct Protocol. It was done at a “whiteboard” level of detail, and resulted in specific requirements for transforming messages more or less isomorphically from one flavor to another. Later, additional requirements were added for encoding Direct addresses in XDR SubmissionSet.intendedRecipient. It should be noted that the Cross is incomplete; neither Direct nor IHE has any analogous requirements for transforming, say, an XCA Query and Retrieve response into an XDM file. XCDR and MHD Push and Pull are also missing. That said, IHE Document Sharing profiles (not counting Direct) are generally considered similar enough that transformations should be obvious.
So, when would Karen’s Cross (or an expanded version) apply? Potentially anywhere two systems need to translate between different Doc Sharing actors, but it’s really only needed if transformations are not obvious. Maybe it needs to be documented by IHE (especially if it’s between IHE actors). We’ll look into this in a second.
But first, OrganizationAffiliation shouldn’t be required, because it’s orthogonal to whether translation is needed. For example: In the directory, Org A has two Endpoints: an MHD Document Responder and an XDS Document Registry/Repository. Behind the scenes, the MHD actor is an adapter over the XDS actors. This is simply two APIs to the same organization. The HCID and any other organization or author identifiers are simply copied; there is no translation needed.
Now let’s consider the other cases where there’s federation to other organizations/entities not directly reachable. OrganizationAffiliation is just one case:
In these cases, there might be a translation layer behind the exposed Endpoint to get to those other entities, or there might be some other proprietary mechanism: internal EHR messaging, direct DB access, etc.
So would Karen’s Cross (or an expanded version) potentially apply? Yes, but likely only in making sure that addressing of federated organizations/entities is clear. We have that as issue mCSD_18.
mCSD_29. Is OrganizationAffiliation sufficiently mature to base this profile on? Is it appropriate to say the .organization is the “parent-like” org that rolls up content from .participatingOrganization orgs? There is a .network field; should that be used instead?
We believe we are using it appropriately, but there are a couple of issues we are tracking:
mCSD_30. Currently there is one code in mCSD Organization Affiliation Types. Should there be at least two, one for transparent federation vs opaque federation? The expectations would be different: with transparent federation, federated identifiers would be preserved in responses and respected in requests. With opaque federation, identifiers would be consolidated/overwritten with the identifiers of the “parent” organization.
Probably, but the implications of opaque federation are complex. Some aspects may be consolidated (e.g., golden patient record) while others are not (separate documents). Perhaps we could limit scope to whether federated communities (Organizations with an ID of type HCID) are addressable in requests and responses. Seeking input from reviewers.
mCSD_31. Currently, only synchronous XDS/XCA/XDR and MHD Push are supported. This scope was limited for the public-comment deadline. After public comment, we plan to add in asynchronous (WS-A and AS4) and full MHD. One area that needs work is Digital Certificates to support async end-to-end security (Not needed for sync that uses TLS).
mCSD_32. In mCSD Endpoint, rather than managingOrganization 1..1, create an invariant so that either managingOrganization or contact must be populated.
mCSD_33. FHIR R5 will allow Endpoint.connectionType to be greater than 1, so we can use the IHE-defined codes in addition to the HL7 ones. We won’t need Endpoint.extension:specificType anymore. See Issue 89.
mCSD_34. Should we add a subscription model for receiving updates instead of or in addition to [ITI-91] for resource updates?
These issues have been decided and documented in the publication.
mCSD_1. Should we include the FreeBusy transaction and use cases or just remove them?
*mCSD_2. Should we include the aggregate reporting use case from Care Services Discovery (CSD) or remove with a reference to Aggregate Data Exchange (ADX) in cross profile considerations? This use case would define options for the actors in this use case to return aggregate data. *
*mCSD_3. How do we capture data about community health workers? In some environments, there are community health workers that are associated with a facility but don’t actually work there. Such a worker might have a set area of villages that they rotate through providing community-based care. The villages are within the catchment area of a Health facility, and the supervisor of the community health worker may be based at that facility. *
Not quite sure the best way to capture this when looking at:
http://build.fhir.org/location.html#bnr
*It is clear that we have a hierarchy of locations to capture the geographic hierarchy (jurisdictions): *
The health facility in question would be situated at a location above the village level, say at the county or district level - this we can capture in the parent-child relationship “partOf” in the location resource
The community health worker is providing services at several villages - this we can capture through the location data field of the role in the practitioner resource
The community health worker is associated to a health facility - again we can capture this through the location field but perhaps we would use a different role to indicate that they’re community health worker associated to this facility but not directly providing services at the facility, only its catchment area
In case a community health worker is reporting to a supervisor - that’s not captured anywhere that I can see in FHIR. I think this is a larger that exists beyond the community health worker context
Perhaps the best way to model this is to define each village as a location, and associate that worker with each location they rotate through. Each village is a partOf the health district. The facility is also a location that is partOf the district. The practitioner is related to the village locations with a “delivers care to” role; and to the facility with a “based out of” role.
mCSD_4. Do we need to include more geospatial data (such as polygons or more complex geometry types) stored with Locations and how? This would be so jurisdictions (such as districts or counties) could include that data instead of just a position (latitude/longitude). CP#13391 has been opened for this.
As per the request, FHIR has added a standard extension to address this: https://www.hl7.org/fhir/extension-location-boundary-geojson.html
mCSD_5. With a federated deployment, data may come from multiple sources and there can be an issue with resolving duplicate records and maintaining the mapping. Patient has a link field and we have opened a CP for Organization, Location, and Practitioner. CP GF#13264 has been opened for this. There is also the Linkage resource, but it is maturity level 0.
FHIR has closed the issued with the recommendation to use the Linkage resource to handle this.
mCSD_6. We need a way to deprecate identifiers. For now we can use period and we have created a CP to add an entry to the use field: GF#13265.
FHIR has added an additional Identifier.use code of “old” for this case.
mCSD_8. IHE has updated mCSD to add support for organizational facilities. As part of this revision of mCSD, we have removed the “Organization Option”, “Location Option”, “Practitioner Option”, and “Healthcare Services Option”. These options existed to enable servers to focus only on a small subset of the resources. The actual burden to support all resources is small and set of options seems to add unnecessary complexity. The result would be that servers shall support all of the FHIR Resources, the clients can use the FHIR Resources in the way defined. If there is concern with the removal of these options, please submit a Public Comment.
No comments received so changes are being kept, but any additional comments are welcome.
mCSD_9. We have added a requirement to include a meta.profile tag for all compliant resources. This is so that in a mixed server that has these resources as well as others, a Care Services Selective Consumer can limit the results of Find Matching Care Service [ITI-90] to only mCSD resources using the _profile parameter. Since this type of parameter isn’t allowed for the _history transaction for Request Care Services Updates [ITI-91] the Care Services Update Consumer may have to filter results if required. Is this a common configuration and is this step necessary?
Removed the references to meta.profile.
mCSD_13. Section 1:46.8 mCSD Endpoint Usage Considerations, describes how to populate and use an endpoint directory. Given that this IG is more about how to deploy and use directories than what to put in them, would this content be better as a white paper instead? And could this content be generalized to allow usage with mCSD as well as other directory IGs like https://hl7.org/fhir/uv/vhdir/?
Duplicate of mCSD_10
mCSD_17. In Section 1:46.8.2, we say that a hierarchy formed by the mCSD Additional Hierarchies extension does not imply federation of (i.e., connectivity to) child organizations. Should it?
Extension has been removed.
mCSD_19. In Section 1:46.8.2, why do we use OrganizationAffiliation for an organization’s membership in an HIE, as opposed to the mCSD Additional Hierarchies extension? Because we don’t wish to constrain the use of resources that define organizational structure, rather just reflect how best to use Endpoints in these structures. OrganizationAffiliation is already used in other use cases, and in fact, shows HIE/HIO membership as one of its examples.
Extension has been removed.
mCSD_22. In [ITI-90], we’ve added a number of required search parameters to support queries for OrganizationAffiliation and Endpoint. Is it sustainable to require this many search parameters? Should we move some to SHOULDs or MAYs? Note that the main use case is locating an Organization based on its business, not network, attributes (already covered elsewhere in mCSD), then checking its Endpoints. Further, recursively searching parents and affiliations for Endpoints is likely an edge case, not one we need to try to do in a single request.
Combined into related open issue 7.
http://profiles.ihe.net/ITI/mCSD/StructureDefinition/IHE.mCSD.OrganizationHierarchy
IG © 2022+ IHE IT Infrastructure Technical Committee. Package ihe.iti.mcsd#3.8.0 based on FHIR 4.0.1. Generated 2022-08-12
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