Patient Registry Tool suite

Outline:

• PIXm Connector Component

  • Overview
  • Validation Process
  • ITI-83 Request cross reference identifiers
  • ITI-104 Request on Patient Resources
    • Create/Update
    • Merge duplicated patient
    • Delete patient
  • Errors returned

PIXm Connector Component

Overview

Here is a quick overview of the available functionality from PIXm connector

Capability statement of the application can be found with : https://example.com/pixm-connector/fhir/metadata

As described in HAPI FHIR resources, some strings are automatically escaped when the FHIR server parses URLs:

Validation process

Each operation implies a validation of requests for both ITI-104 and ITI-83 transactions.
Validation is done by calling:

• HTTP Validator for URL and Headers.
• Matchbox for Body with FHIR Resource.

Both validators allow to perform validation and have high customization if specifications changed for both transactions without refactoring pixm-connector application.
An error during validation process will result with an OperationOutcome with error 400 Bad Request with issues describing where it failed.

Request a Patient Cross Reference on a specific Target Identifier (ITI-83)

• IHE Specifications

Request a cross-referenced Patient is possible thanks to the $ihe-pixm.

Parameters allowed are :

• The Patient Identifier and the Target System attributed to this identifier as sourceIdentfier
• The Target System you want the cross-reference from as targetSystem.
• The format returned as _format: xml or json.

The URL to call is:

  GET https://example.com/pixm-connector/fhir/Patient/$ihe-pix

For example : Given the Patient with the id=69420 with the system=urn:oid:1.3.6.1.4.1.21367.13.20.3000 as sourceIdentifer=system|id
And you want the cross-referenced patient in the targetSystem=1.3.6.1.4.1.21367.13.20.1000
And you want the returned response as a json.

The corresponding url will be :

    https://example.com/pixm-connector/fhir/Patient/$ihe-pix?sourceIdentifier=urn:oid:1.3.6.1.4.1.21367.13.20.3000|69420&targetSystem=urn:oid:1.3.6.1.4.1.21367.13.20.1000&_format=json

Requests on Patient resources (ITI-104)

• IHE Specifications

Create/Update

Link: https://profiles.ihe.net/ITI/PIXm/ITI-104.html#2310441-add-or-revise-patient

PIXm connector accepts the creation of a Patient in the Patient Manager. Although a Patient could be created without any information in the HL7 model, PIXm connector will only allow a Patient to be created with minimum and/or mandatory information to permits cross-reference thanks to validation with Matchbox.

The Resource could not be parsed or failed basic FHIR validation rules. In the case of an error 400 Bad Request or 422 Unprocessable Entity being returned, please check the following guidelines to verify your query.

Create/Update request is done through a FHIR conditional update mechanism (cond-update) where the patient identifier has to be given as following.

    PUT https://example.com/pixm-connector/fhir/Patient/identifier=urn:oid:1.3.6.1.4.1.21367.13.20.1000|IHERED-m94

With body :

{
  "resourceType" : "Patient",
  "id" : "Patient-MaidenAlice-Red",
  "meta" : {
    "profile" : [
      "https://profiles.ihe.net/ITI/PIXm/StructureDefinition/IHE.PIXm.Patient"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>ALICE MOHR </b> female, DoB: 1958-01-30 ( id:\u00a0IHERED-m94)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td colspan=\"3\">true</td></tr></table></div>"
  },
  "identifier" : [
    {
      "system" : "urn:oid:1.3.6.1.4.1.21367.13.20.1000",
      "value" : "IHERED-m94"
    }
  ],
  "active" : true,
  "name" : [
    {
      "family" : "MOHR",
      "given" : [
        "ALICE"
      ]
    }
  ],
  "gender" : "female",
  "birthDate" : "1958-01-30"
}

If the patient exists then it is updated otherwise it is created. The response will return the updated/created patient.

Merge for resolving duplicated patient

Link : https://profiles.ihe.net/ITI/PIXm/ITI-104.html#2310442-resolve-duplicate-patient

The merge method allows the user to merge two patients together if two registered patients represent the same people.
This action is irreversible as it deactivates a resource making it only readable and immutable.

The request is a PUT method with the Patient to deactivate with a activate: false attribute and a link field with identifier for the kept patient resource.

PUT http://example.org/fhir/Patient?identifier=urn:oid:1.3.6.1.4.1.21367.13.20.1000|IHERED-m94 HTTP/1.1
Accept: application/fhir+json
Content-Type: application/fhir+json

{
  "resourceType": "Patient",
  "identifier": [
    {
      "system": "urn:oid:1.3.6.1.4.1.21367.13.20.1000",
      "value": "IHERED-m94"
    }
  ],
  "active": false,
  "name": [
    {
      "family": "MOHR",
      "given": [
        "MAIDEN"
      ]
    }
  ],
  "gender": "female",
  "birthDate": "1958-01-30",
  "link": [
    {
      "other": {
        "identifier": {
          "system": "urn:oid:1.3.6.1.4.1.21367.13.20.1000",
          "value": "IHERED-994"
        }
      },
      "type": "replaced-by"
    }
  ]
}

Delete one or more patient(s)

Link: https://profiles.ihe.net/ITI/PIXm/ITI-104.html#2310443-remove-patient

The delete operation allows suppression of the patient with its identifier thanks to a conditional deletion. This application allows multiple deletion if the identifier returned more than one Patient.

DELETE http://example.org/fhir/Patient?identifier=urn:oid:1.3.6.1.4.1.21367.13.20.1000|IHERED-994 HTTP/1.1
Accept: application/fhir+json

if the delete is successful the application returns a 200 OK response otherwise it would be a 204 No Content.

Errors returned

Malformed requests can cause different types of error, for now 422 Unprocessable Entity is mostly returned.
Future features will allow a better granularity for code returned.