Query for Documents Outside a Specific Health Information Exchange Domain

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Implementation Specification	IHE-XCA (Cross-Community Access)	Final	Production		No	Free	Yes
Implementation Specification	IHE-XCPD (Cross-Community Patient Discovery)	Final	Production		No	Free	Yes Yes
Implementation Specification	Carequality Query-Based Document Exchange Implementation Guide	Final	Production		No	Free	N/A
Implementation Specification	eHealth Exchange Specification: Patient Discovery	Final	Production		No	Free	Yes
Implementation Specification	eHealth Exchange Specification: Messaging Platform	Final	Production		No	Free	Yes
Implementation Specification	eHealth Exchange Specification: Authorization Framework	Final	Production		No	Free	Yes
Implementation Specification	eHealth Exchange Specification: Query for Documents	Final	Production		No	Free	Yes
Implementation Specification	eHealth Exchange Specification: Retrieve Documents	Final	Production		No	Free	Yes
Implementation Specification	HL7® FHIR® DocumentReference resource	Final	Production		No	Free	No
Implementation Specification	IHE-PIX (Patient Identifier Cross-Reference)	Final	Production		No	Free	Yes Yes Yes
Implementation Specification	CommonWell Health Alliance Specification Services	Balloted Draft	Production		No	Free	N/A
Implementation Specification	HL7 FHIR DaVinci Clinical Data Exchange (CDex) Implementation Guide	Balloted Draft	Pilot		No	Free	No
Emerging Implementation Specification	IHE - MHDS (Mobile Health Document Sharing)	Balloted Draft	Pilot	Feedback Requested	No	Free	No
Implementation Specification	HL7 FHIR DaVinci Provider Data Exchange (PDex) Implementation Guide	Balloted Draft	Production		No	Free	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
IHE-PIX and IHE-XCPD are used for the purposes of patient matching and to support this interoperability need. While IHE-PIX and IHE-XCPD are best-available standards at this time, the current best-available standards may be insufficient to meet interoperability needs with sufficient accuracy. The FHIR DocumentReference reference includes the Patient/$match operation, which allows for patient matching using MPI-based logic. The Document Sharing exchange family of specifications from IHE fit this use-case well. This includes FHIR-based exchanges as specified in the Mobile access to Health Documents (MHD) and Mobile Health Documents Sharing (MHDS)	System Authentication – The information and process necessary to authenticate the systems involved. User Authentication – The information and process necessary to authenticate the end user. User Details – Identifies the end user who is accessing the data. User Role – Identifies the roles and clearances asserted by the individual initiating the transaction for purposes of authorization. E.g., the system must verify the initiator’s claims and match them against the security labels for the functionalities that the user attempts to initiate and the objects the user attempts to access. Purpose of Use – Identifies the purpose for the transaction, and for the purposes for which the end user intends to use the accessed objects. Patient Consent Information – Identifies the patient consent information that may be required before data can be accessed. May be required to authorize any exchange of patient information. May be required to authorize access and use of patient information. May be required to be sent along with disclosed patient information to advise the receiver about policies to which end users must comply. Query Request ID - Query requesting application assigns a unique identifier for each query request in order to match the response to the original query. Security Labeling – The health information is labeled with security metadata necessary for access control by the end user.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

IHE-PIX and IHE-XCPD are used for the purposes of patient matching and to support this interoperability need.
While IHE-PIX and IHE-XCPD are best-available standards at this time, the current best-available standards may be insufficient to meet interoperability needs with sufficient accuracy.
The FHIR DocumentReference reference includes the Patient/$match operation, which allows for patient matching using MPI-based logic.
The Document Sharing exchange family of specifications from IHE fit this use-case well. This includes FHIR-based exchanges as specified in the Mobile access to Health Documents (MHD) and Mobile Health Documents Sharing (MHDS)

System Authentication – The information and process necessary to authenticate the systems involved.
User Authentication – The information and process necessary to authenticate the end user.
User Details – Identifies the end user who is accessing the data.
User Role – Identifies the roles and clearances asserted by the individual initiating the transaction for purposes of authorization. E.g., the system must verify the initiator’s claims and match them against the security labels for the functionalities that the user attempts to initiate and the objects the user attempts to access.
Purpose of Use – Identifies the purpose for the transaction, and for the purposes for which the end user intends to use the accessed objects.
Patient Consent Information – Identifies the patient consent information that may be required before data can be accessed.
- May be required to authorize any exchange of patient information.
- May be required to authorize access and use of patient information.
- May be required to be sent along with disclosed patient information to advise the receiver about policies to which end users must comply.
Query Request ID - Query requesting application assigns a unique identifier for each query request in order to match the response to the original query.
Security Labeling – The health information is labeled with security metadata necessary for access control by the end user.

Comment

Submitted by juliemaas on 2022-09-30

UDAP for Client App Registration, Authentication & Authorization

This work has now been jointly published by UDAP.org and HL7. The Security for Scalable Registration, Authentication, and Authorization (UDAP Security - http://hl7.org/fhir/us/udap-security/) Business-to-Business workflow is therefore recommended for use in this type of exchange; it is an Emerging Implementation Specification for securely scaling FHIR transactions by validating trusted ecosystem endpoints.

Additionally, the Interoperable Digital Identity & Patient Matching IG is recommended as it includes best practice guidance for patient matching.

Submitted by John Moehrke on 2021-09-08

IHE - Document Sharing

The Document Sharing exchange family of specifications from IHE fit this use-case well.

https://profiles.ihe.net/ITI/HIE-Whitepaper/index.html

This includes FHIR based exchanges as specified in the Mobile access to Health Documents (MHD) and Mobile Health Documents Sharing (MHDS)

Submitted by dididavis on 2020-12-22

eHealth Exchange Specifications

To whom it may concern,

Can the hyperlinks to the eHealth Exchange Specifications listed below be corrected to reference this corrected link (https://ehealthexchange.org/testing-program/technical-specifications/) because the current links are broken. Also, the eHealth Exchange would like to request that the maturity level be increased to match the maturity of the Carequality Implementation Guide (level 5) since Carequality does references these exact same specifications for their Query IG with further constraints and the eHealth Exchange network is very mature with 300+ gateways in production today exchanging data using these specifications since 2009 when it was an ONC project. Also, the test tool availability should reference this link (https://wiki.ihe.net/index.php/IHE_Test_Tool_Information) instead of the Aegis DIL. The eHealth Exchange has not used the Aegis DIL for testing since July 2018. Please contact ddavis@sequoiaproject.org if you have any questions related to this request.

eHealth Exchange Specification: Patient Discovery

eHealth Exchange Specification: Messaging Platform

eHealth Exchange Specification: Authorization Framework

eHealth Exchange Specification: Query for Documents

eHealth Exchange Specification: Retrieve Documents

Submitted by dididavis on 2020-12-22

eHealth Exchange Specifications Tooling Comment

Rather than using the (https://wiki.ihe.net/index.php/IHE_Test_Tool_Information), please reference this link instead (https://validation.sequoiaproject.org). The Sequoia Interoperability Testing Platform has specific test cases and scripts designed for the eHealth Exchange specifications leveraging IHE tooling components.

Submitted by juliemaas on 2019-09-23

Since STU3, HL7 FHIR has…

Since STU3, HL7 FHIR has included the Patient/$match operation which allows for patient matching using MPI-based logic. The FHIR DocumentReference resource can then be used to query for documents. When these are performed across communities, this provides comparable functionality to the XCPD and XCA standards already referenced. For this reason, we recommend that HL7 FHIR be included as an implementation specification in this sub-section with the $match operation and DocumentReference resource called out specifically in the limitations, dependencies, & preconditions area. The match operation replaced a similar MPI query available in DSTU2. Suggested maturity of Pilot and Adoption Level of 1.

Julie Maas, CEO, EMR Direct

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