{"type":"doc","content":[{"type":"bodiedExtension","attrs":{"layout":"default","extensionType":"com.atlassian.confluence.macro.core","extensionKey":"excerpt","parameters":{"macroParams":{"name":{"value":"s "}},"macroMetadata":{"macroId":{"value":"dd38856e1e2810941507d74c710b501110143cd85a54cdfa5e168e43e44a9657"},"schemaVersion":{"value":"1"},"title":"Excerpt"}},"localId":"53633a8b-75b3-4745-a915-32a54472709c"},"content":[{"type":"paragraph","content":[{"text":"The eHealth Infrastructure document-query and document-transformation services provide integrations to the Danish national document-sharing infrastructure.","type":"text"}]},{"type":"paragraph","content":[{"text":"This page describes the eHealth infrastructure capabilities for ","type":"text"}]},{"type":"orderedList","attrs":{"order":1},"content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"How to query and retrieve documents from NSP","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"How to upload CDA documents to NSP","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Details on transformations FHIR to CDA Document ","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Details on transformations CDA Document to FHIR ","type":"text"}]}]}]}]},{"type":"heading","attrs":{"level":1},"content":[{"text":"Content","type":"text"}]},{"type":"extension","attrs":{"layout":"default","extensionType":"com.atlassian.confluence.macro.core","extensionKey":"toc","parameters":{"macroParams":{"minLevel":{"value":"1"},"maxLevel":{"value":"2"},"outline":{"value":"false"},"style":{"value":"none"},"type":{"value":"list"},"printable":{"value":"true"}},"macroMetadata":{"macroId":{"value":"082d28e2-8418-4adb-8103-8adacd796de4"},"schemaVersion":{"value":"1"},"title":"Table of Contents"}},"localId":"3a013c3c-3bff-4bbd-9f0c-3693a65a7ee3"}},{"type":"paragraph"},{"type":"paragraph"},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"The national document-sharing infrastructure is based on Integrating the Health Enterprise (IHE) Cross-enterprise Document Sharing (XDS-b) profiles and uses Danish profiles for ","type":"text"},{"text":"document metadata","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2698903576/Sharing+through+Registering+Documents+in+National+Document+Sharing+Infrastructure#Document-Metadata-for-Document-Registering"}}]},{"text":". While XDS-b is content-agnostic, currently shared documents are XML documents (ideally) adhering to Danish profiles of Clinical Document Architecture (CDA) document types.","type":"text"}]},{"type":"paragraph","content":[{"text":"Queries for document metadata and retrieval of documents can be performed through the healthcare domain National Service Platform (NSP) Document Sharing Service (Danish: Dokumentdelingsservice DDS). Acting as a front, the DDS encapsulates details about the topology of XDS-b components, whether this is one or more XDS Registry containing document metadata or one or more XDS Repository containing documents.","type":"text"}]}]},{"type":"paragraph","content":[{"text":"The eHealth Infrastructure:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Performs registering of measurement data to the KIH XDS Repository (see ","type":"text"},{"text":"Registering of documents","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2698903576"}}]},{"text":")","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Performs registering of appointments to the XDS Repository fronted by NSP Document Registering and Update Service (see ","type":"text"},{"text":"Registering of documents","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2698903576"}}]},{"text":")","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Provides a FHIR wrapping for performing querying for document metadata and retrieving documents on the NSP DDS (see ","type":"text"},{"text":"Performing Document Query and Document Retrieve","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/2242281473/Query%2C+Retrieve+and+Transform+Documents+from+NSP#Performing-Document-Query-and-Document-Retrieve"}}]},{"text":" below)","type":"text"}]}]}]},{"type":"paragraph","content":[{"text":"The eHealth Infrastructure provides operations to transform between FHIR resources and Danish profiles of Clinical Document Architecture (CDA) XML documents. ","type":"text"}]},{"type":"paragraph","content":[{"text":"The transformations to CDA documents are used (see details below) when the eHealth infrastructure uploads documents and metadata to the national document-sharing infrastructure. ","type":"text"}]},{"type":"paragraph","content":[{"text":"The transformations to FHIR resources can be used by a client performing XDS-b document metadata query and document retrieving.","type":"text"}]},{"type":"heading","attrs":{"level":1},"content":[{"text":"Services to perform Document Query and Document Retrieve","type":"text"}]},{"type":"paragraph","content":[{"text":"The Danish National Service Platform (NSP) in Healthcare provides a national document-sharing service (Danish: Dokumentdelingsservice DDS). ","type":"text"}]},{"type":"paragraph","content":[{"text":"The DDS provides the following operations described in ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://profiles.ihe.net/ITI/TF/Volume1/ch-10.html"}},{"text":":","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The Registry Stored Query (XDS-b transaction ITI-18) lets you search for document metadata using criteria like patient ID and period. It returns matching results, which could be none, one, or more.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The Retrieve Document Set (XDS-b transaction ITI-43) allows you to get documents based on their metadata. It returns the documents, which could be none, one, or more.","type":"text"}]}]}]},{"type":"paragraph","content":[{"text":"Further details on how the NSP DDS processes ITI-18 and ITI-43 requests, including possibly withholding data due to patient’s consent (Danish: Min Spærring) are described in Danish at ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://www.nspop.dk/x/WJC6"}},{"text":".","type":"text"}]},{"type":"paragraph","content":[{"text":"These operations are supported through the following eHealth infrastructure operations provided by the ","type":"text"},{"text":"document-query service","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/CapabilityStatement-document-query.html"}}]},{"text":":","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"DocumentReference?","type":"text","marks":[{"type":"code"}]},{"text":" see ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth.sundhed.dk/fhir/ehealth-documentreference-search.html"}},{"text":" ","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Binary/$retrieve-document","type":"text","marks":[{"type":"code"}]},{"text":" return document as CDA. See ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Binary-t-retrieve-document.html"}},{"text":" ","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Binary/$retrieve-and-transform-QRD","type":"text","marks":[{"type":"code"}]},{"text":" return document as FHIR resource. See ","type":"text"},{"text":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Bundle-t-retrieve-and-transform-QRD.html","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Bundle-t-retrieve-and-transform-QRD.html"}}]},{"text":". This operation is a little special as it requires QFDD to be present in the infrastructure and the corresponding FHIR Questionnaire. See below. ","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Binary/$retrieve-and-transform-PHMR","type":"text","marks":[{"type":"code"}]},{"text":" return document as FHIR resource. See ","type":"text"},{"text":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Bundle-t-retrieve-and-transform-PHMR.html","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Bundle-t-retrieve-and-transform-PHMR.html"}}]},{"text":" ","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Binary/$retrieve-and-transform-APD","type":"text","marks":[{"type":"code"}]},{"text":" return document as FHIR resource. See ","type":"text"},{"text":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Bundle-t-retrieve-and-transform-APD.html","type":"text","marks":[{"type":"link","attrs":{"href":"https://ehealth.sundhed.dk/fhir/OperationDefinition-Bundle-t-retrieve-and-transform-APD.html"}}]},{"text":" ","type":"text"}]}]}]},{"type":"paragraph","content":[{"text":"Querying document metadata is a necessary step before retrieving the actual document.","type":"text"}]},{"type":"panel","attrs":{"panelType":"info"},"content":[{"type":"paragraph","content":[{"text":"While the XDS-b transaction ITI-43 Retrieve Document Set supports the retrieval of multiple documents, the ","type":"text"},{"text":"$retrieve-document","type":"text","marks":[{"type":"code"}]},{"text":" supports the retrieval of a single document only.","type":"text"}]}]},{"type":"heading","attrs":{"level":2},"content":[{"text":"Special notes on retrieve-and-transform-QRD operation","type":"text"}]},{"type":"paragraph","content":[{"text":"The retrieval and transformation are offered as a single call via operations (one per document type).","type":"text"}]},{"type":"paragraph","content":[{"text":"The retrieve-and-transform-QRD operation is a little special as it requires QFDD to be present in the infrastructure and the corresponding FHIR Questionnaire.","type":"text"}]},{"type":"paragraph","content":[{"text":"Prerequisites:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The QFDD is uploaded to the infrastructure (e.g., via KAM), and the infrastructure has stored the QFDD in an FHIR DocumentReference.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The FHIR Questionnaire:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"is an analogue (or close match) to the QFDD","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"has QFDD document ID as an identifier.","type":"text"}]}]}]}]}]},{"type":"paragraph","content":[{"text":"Client Applications must:","type":"text"}]},{"type":"orderedList","attrs":{"order":1},"content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Look up metadata for the QRD for specific QFDD (via document query and DocumentReference Search)","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Retrieve the FHIR Questionnaire from the Questionnaire service with the identifier of the QFDD document ID","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Call Retrieve and transform QRD providing the URL for the CDA document and the FHIR Questionnaire as input (optional)","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The Document-query service returns the FHIR QuestionnaireResponse if the FHIR Questionnaire is provided as input and the transformation is successful. Otherwise, it returns the QRD CDA XML. ","type":"text"}]}]}]},{"type":"heading","attrs":{"level":1},"content":[{"text":"Transformations Operations between FHIR resources and Danish CDA Profiles","type":"text"}]},{"type":"paragraph","content":[{"text":"The ","type":"text"},{"type":"inlineCard","attrs":{"url":"https://ehealth.sundhed.dk/fhir/CapabilityStatement-document-transformation.html"}},{"text":" provides operations for transforming documents between FHIR Resources and Danish CDA Profiles.","type":"text"}]},{"type":"paragraph","content":[{"text":"Details on the transformations are provided in the table below, which includes references to Danish CDA profiles.","type":"text"}]},{"type":"paragraph","content":[{"text":"The transformations have the following characteristics:","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The transformations are idempotent (except for generated identifiers such as the CDA document ID in the output).","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The transformations do not provide access to any FHIR resources. Client Applications must supply the necessary FHIR resources as input. 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From NarrativeBlock documentation: mediaType is akin to mimeType. This is a fixed value in the CDA narrative block, and so can be omitted.","type":"text"}]}]}]}]},{"type":"heading","attrs":{"level":3},"content":[{"text":"Validation","type":"text"}]},{"type":"paragraph","content":[{"text":"The returned Bundle from the operation can contain an OperationOutcome with information, warnings and errors. In case of validation errors no FHIR questionnaire will be generated.","type":"text"}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Errors","type":"text"}]},{"type":"paragraph","content":[{"text":"Errors can occur if for instance some mandatory information is missing or QFDD content is not supported in FHIR questionnaire.","type":"text"}]},{"type":"paragraph","content":[{"text":"Examples:","type":"text","marks":[{"type":"underline"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Unsupported question type: '%s'","type":"text","marks":[{"type":"code"}]},{"text":" (safeguard against future question types supported in CDA Builder. Currently(August 2024) all question types are supported)","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Choice option is missing either code, codeSystem. Question id: %s","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Question is missing id. Organizer id: %s","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Precondition group type: '%s' is not supported. Question id: %s","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Precondition group type: '%s' is not supported for conditions referring to numeric questions. Only 'AllTrue' is supported. Question id: %s","type":"text","marks":[{"type":"code"}]}]}]}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Warnings","type":"text"}]},{"type":"paragraph","content":[{"text":"Warnings can occur if some information is missing but not mandatory or content which will not be transformed as it is not supported.","type":"text"}]},{"type":"paragraph","content":[{"text":"Examples:","type":"text","marks":[{"type":"underline"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Numeric question has no interval. Cannot determine type. Setting item.type to 'decimal'. Question id: %s","type":"text","marks":[{"type":"code"}]}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Feedback will not be transformed to FHIR questionnaire. Question id: %s","type":"text","marks":[{"type":"code"}]}]}]}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Information","type":"text"}]},{"type":"paragraph","content":[{"text":"Message unrelated to the transformation success.","type":"text"}]},{"type":"paragraph","content":[{"text":"Examples:","type":"text","marks":[{"type":"underline"}]},{"text":" ","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Question with id: '%s' has associated text question with id: '%s'. The questions will be split into two separate question items in Fhir questionnaire.","type":"text","marks":[{"type":"code"}]}]}]}]},{"type":"heading","attrs":{"level":3},"content":[{"text":"Preconditions","type":"text"}]},{"type":"paragraph","content":[{"text":"In some scenarios a questions should only be asked to the user based on answers given to other questions. The sections below describes the rules and limitations regarding preconditions.","type":"text"}]},{"type":"heading","attrs":{"level":4},"content":[{"text":"Precondition rules","type":"text"}]},{"type":"paragraph","content":[{"text":"As the modeling of preconditions in FHIR questionnaire and QFDD is not 1 to 1 the table below describes which combination of preconditions that are supported.","type":"text"}]},{"type":"table","attrs":{"layout":"align-start","width":1448.0,"localId":"7de37e98-52fa-4e1b-a95f-ac8abdf7bc29"},"content":[{"type":"tableRow","content":[{"type":"tableHeader","attrs":{"colspan":1,"rowspan":1,"colwidth":[676.0]},"content":[{"type":"paragraph","content":[{"text":"Condition","type":"text","marks":[{"type":"strong"}]}]}]},{"type":"tableHeader","attrs":{"colspan":1,"rowspan":1,"colwidth":[772.0]},"content":[{"type":"paragraph","content":[{"text":"Rules","type":"text","marks":[{"type":"strong"}]}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[676.0]},"content":[{"type":"paragraph","content":[{"text":"If one or more precondition refers to numeric question then","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[772.0]},"content":[{"type":"paragraph","content":[{"text":"AllTrue(all) is supported.","type":"text"}]}]}]},{"type":"tableRow","content":[{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[676.0]},"content":[{"type":"paragraph","content":[{"text":"If no precondition refers to a numeric question then","type":"text"}]}]},{"type":"tableCell","attrs":{"colspan":1,"rowspan":1,"colwidth":[772.0]},"content":[{"type":"paragraph","content":[{"text":"AllTrue(all) and AtLeastOneTrue(any) is supported.","type":"text"}]}]}]}]},{"type":"paragraph","content":[{"text":"Not supported:","type":"text","marks":[{"type":"underline"}]}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"The following precondition types is not supported: AllFalse, AtLeastOneFalse, OnlyOneTrue, OnlyOneFalse.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Multiple grouper (Only one grouper is supported eg. AllTrue).","type":"text"}]}]}]},{"type":"heading","attrs":{"level":3},"content":[{"text":"Additional information","type":"text"}]},{"type":"bulletList","content":[{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Associated text question which can be part of Multiple Choice and Discrete Slider question will be created as two items in FHIR questionnaire. The item for the associated text question will contain the preconditions specified in the QFDD.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"As QFDD Numeric Question do not have a type, reference range is used to determine if it is integer, decimal or timestamp. If no reference range is specified the question item is created with ","type":"text"},{"text":"item.type ","type":"text","marks":[{"type":"code"}]},{"text":" ‘decimal’.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Analog Slider Question is created with ","type":"text"},{"text":"item.type ","type":"text","marks":[{"type":"code"}]},{"text":" ‘decimal’.","type":"text"}]}]},{"type":"listItem","content":[{"type":"paragraph","content":[{"text":"Feedback is not supported","type":"text"}]}]}]},{"type":"paragraph"},{"type":"paragraph"}],"version":1}

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