This specification conforms to FHIR®© R4
Introduction to the Technical specification
Tabel of contents
- 1 Content Overview
- 2 General Messaging Model
- 2.1 MedComMessagingMessage (Bundle)
- 2.2 MedComMessagingMessageHeader
- 2.3 MedComMessagingOrganization
- 2.4 MedComMessagingProvenance
- 2.5 MustSupport
- 2.6 Narrative text
In case of discrepancies between the MedCom Messaging Implementation Guide (IG) and this page, it is the IG which should be followed. Please contact fhir@medcom.dk if you find discrepancies.
1 Content overview
The MedCom Messaging IG describes currently four FHIR profiles, which can be seen in Table 1 .
| Profile | Resource | Description | MustSupport elements |
|---|---|---|---|
| MedComMessagingMessage | Bundle | Acts as a container for the content of the message. The type of the Bundle shall always be 'message'. | Message id Message type Timestamp Entry (Reference to all included profiles) |
| MedComMessagingMessageHeader | MessageHeader | The header of a message. This profile holds references to the fundamental information in a message such as sender, receiver, and the content of the message. | MessageHeader id Narrative text eventCoding (Type of message) Sender Organization Receiver Organization Carbon Copy Receiver of the receipt |
| MedComMessagingOrganization | Organization | Information usefull to identify a messaging organization | Identifier (SOR-id) Identifier (EAN/GLN-number) Name |
| MedComMessagingProvenance | Provenance | Information about the activity of the current message and which organization has triggered the message. Further it describes the history of message activities. | Text (Narrative text) Target (Targets the MessageHeader) occuredDateTime(Timestamp) Recorded Activity of the message Agent Sender organization Entity.role (If the message is a response to a previous message) |
2 General messaging model
The Figure 1 illustrates the general messaging model, which all MedCom FHIR messages will comply to.
As shown below in the diagram there are four MedCom profiled FHIR resources involved in a MedCom FHIR Message:
- A MedComMessagingMessage is a Bundle resource of type “message”, which is a container for a collection of other resources:
- The MedComMessagingMessage’s first resource is a MedComMessagingMessageHeader, which is a MessageHeader resource
- The MedComMessagingMessageHeader points to at least two organizations for the MedComMessagingMessage:
- a source organisation called a MedComMessagingOrganization, which is an Organization resource
- a destination organisation called a MedComMessagingOrganization, which too is an Organization resource
- The MedComMessagingMessage points to MedComMessagingProvenance, which is a Provenance resource
Below you will find a thorough explanation of the MedCom profiled FHIR resources involved in a MedCom FHIR Message.
2.1 MedComMessagingMessage (Bundle)
The MedComMessagingMessage is a base resouruce in all messages. This resource is of type Bundle. This means that the MedComMessagingMessage collects resources together into a single instance containing context. These resource bundles are useful for a variety of reasons, including sending a set of resources as part of a message exchange.
| Links for MedComMessagingMessage |
|---|
| Detailed specification for MedComMessagingMessage in MedComMessagingMessage IG |
| Detailed specification for Bundle in FHIR R4 |
2.1.1 MedComMessagingMessage Identifiers
The identifiers are often used in FHIR to connect content in resources to external content fx when creating, sending and receiving a message. A MedComMessagingMessage contains two identifiers:
- the Bundle.id and
- the MessageHeader.id
The MessageHeader.id identifier is uniqe identifier that is assigned to a new created message. Each time a new message is sent, the Bundle.id will be changed to a new value. When a receiver receives and processes the MedComMessagingMessage, it will respond with a new MedComMessagingMessage, and therfore with a new identifier, wrapped in a bundle which also has a new id. The response message will also quote the request MessageHeader.id in MessageHeader.response.identifier so that the source system can relate the response to its request.
2.1.2 MedComMessagingMessage Timestamps
The Timestamps in FHIR represents the date/time that the bundle was assembled. A MedComMessagingMessage has 2 important timestamps:
- Bundle.timestamp: the time the message was sent
- Bundle.meta.lastUpdated: the last time the message was updated (either by storing, or by modification)
2.2 MedComMessagingMessageHeader
The MedComMessageHeader profile that is used in all MedCom FHIR Messages. The message header contains information about wheather the message is requesting or responding to an action. Therefore a MedComMessagingMessageHeader includes a sender, receiver and it may include a carbon-copy receiver, however, this depends on the type of standard. Each MedComMessagingMessageHeader includes a globally unique id, which is used to refere the message in the message history from the MedComMessagingProvenance profile.
| Links for MedComMessagingMessageHeader |
|---|
| Detailed specification for MedComMessageHeader in MedComMessagingMessage IG |
| Detailed specification for MessageHeader in FHIR R4 |
2.3 MedComMessagingOrganization
This profile describes the Organization resource that is used in all MedCom FHIR Messages. MedComMessagingOrganization inherits from MedComCoreOrganization as it shall include both a SOR and EAN/GLN identifier. MedComMessagingOrganization is used to describe the sender and receiver organizations of all MedCom FHIR Messages.
| Links for MedComMessagingOrganization |
|---|
| Detailed specification for MedComMessagingOrganization in MedComMessagingMessage IG |
| Detailed specification for Organization in FHIR R4 |
2.4 MedComMessagingProvenance
The MedComMessagingProvenance resource tracks information about the activity that created, revised, deleted, or signed a version of a resource, and describes the entities and agents involved. This information can be used to track the resource origin and thus make it possible to form an assesment about the resource’s quality, reliability, and trustworthiness.
The provenance resources are a record-keeping assertion that gathers information about the context in which the information in a resource was obtained. Provenance resources are prepared by the application that initiates the creation/update etc. of the resource.
2.5 MustSupport
The mustSupport is a boolean property, which meas that it can either be True or False. If the property is true, it means that systems claiming to conform to a given profile must “support” the element because the base FHIR specification is intended to be independent of any particular implementation context, no elements are flagged as mustSupport=true as part of the base specification. This flag is intended for use in profiles that have a defined implementation context.
For this reason, the specification itself never labels any elements as MustSupport. This is done in StructureDefinitions, where the profile labels an element as mustSupport=true. When a profile does this, it must also make clear exactly what kind of “support” is required, as this could involve expectations around what a system must store, display, allow data capture of, include in decision logic, pass on to other data consumers, etc.
In MedCom FHIR Messaging MustSupport denotes the MedCom FHIR Message. While FHIR resources can contain a lot of different elements, a MedCom FHIR Message is defined to be exactly what is outlined by the MustSupport flag in the IG.
2.6 Narrative Texts
A Narrative Text is a human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative encodes all the structured data pointed out by the ∑-symbol and it is required to contain sufficient details to make it “clinically safe” for a human to just read the narrative. Contained resources do not have narrative, but their content must be represented in the ressource container. Narratives contains two sub elements, status and div that are explained below.
2.6.1 The status element
The code system narrative status defines the codes for the status element.
In MedCom FHIR Messages the status of the narrative text shall be “generated”, unless other is specified. This status allows the narrativ text to include structured data and the defined extension in the div element.
A narrative in MedCom FHIR Messages can not be of code: empty.
2.6.2 The div element
The contents of the div element are XHTML fragments that SHALL contain only the basic HTML formatting elements described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained style attributes.
The XHTML content SHALL NOT contain a head, a body element, external stylesheet references, deprecated elements, scripts, forms, base/link/xlink, frames, iframes, objects or event related attributes (e.g. onClick). This is to ensure that the content of the narrative is contained within the resource and that there is no active content. Such content would introduce security issues and potentially safety issues with regard to extracting text from the XHTML. Note that even with these restrictions, there are still several important security risks associated with displaying the narrative.
The div element SHALL have some non-whitespace content (text or an image).
2.6.3 General Narrative Text Rules
- All resources in a MedComMessagingMessage contains a Narrative Text defined by the [resource].Text element
- The Narrative Text SHALL have a status with value “extensions”. Extensions means that the contents of the narrative are entirely generated from the core elements in the content and some of the content is generated from extensions.
- The narrative SHALL reflect the impact of all modifier extensions.
| Links for Narrative Text |
|---|
| Narrative Text description in FHIR R4 |
| NarrativeStatus in FHIR R4 |
| Styling the XHTML in FHIR R4 |
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The version of this documentation is: Version 2.0.3. You can finde the release note of the version here."FHIR® is the registered trademark of HL7 and is used with the permission of HL7. Use of the FHIR trademark does not constitute endorsement of this implementation guide by HL7, nor affirmation that this content is conformant to the various applicable standards"