Page Comparison

Context

Shared Health Record (SHR) serves as a repository containing clinical care information for patients. SHR houses subset of data from various EMRs from different care delivery organisations. This record is shared between different institutions and systems. For patients, such information are represented as Encounters in SHR. Each such encounter information therein is stored as a FHIR resource document.

FHIR encounter – is a resource that mainly has administrative information, for example contact with patient with date, participants etc. Whereas in medical domain, encounter is more holistic, that includes clinical information gathered for patients, drugs/tests advised, observations/diagnoses done etc.

Lets take an example of an outpatient consultation of a doctor with a patient where the patient is diagnosed with presumed “Influenza”, and doctor also noted down (after physical examination) her temperature readings.

The EMR sytsem at the Facility would communicate all the facts with SHR by means of a “document”, formed to provide coherent context for an “Encounter” information. The context description of an encounter can be modeled using a FHIR resource "Bundle".

In our context, this "bundle" is basically a collection of other FHIR resources. The most important resource within the bundle is “Composition”, that organizes/bundles other resources relevant to the clinical encounter within the document. Following is the basic structure

Basic Structure

A Composition resource will have

identifier - usually an unique id within the document

date - the date of editing the composition

status - the workflow status of the composition (final, preliminary etc) - usually final in our case.

subject -

1. Format

The API is based on REST convention and uses HL7 FHIR format for exchange of data.

2. Authentication

All APIs described below need authentication. The client_id and From are given when registering with the Identity Provider. The signin API of Identity Provider should be used to get the auth token(To be provided in the X-Auth-Token header). Refer the Identity Provider page for more information on how to use the Identity Provider APIs.

API

Save an encounter.

Panel

border	true
borderStyle	dashed

Request :

POST  /patients/{health Id}/encounters

Headers :

X-Auth-Token : {auth token returned from Identity Service Provider}

client_id : {client id of requester in Identity Service Provider}

From : {email_id of requester registered in Identity Service Provider}

Content-Type: application/xml;charset=utf-8

Code Block

title	Body(Example)
collapse	true

<Bundle xmlns="http://hl7.org/fhir">
	<id value="c820e3ea-d7a4-489a-9284-fbaaf0fe8e1a"/>
	<meta>
		<lastUpdated value="2017-03-14T11:39:10.000+05:30"/>
	</meta>
	<type value="collection"/>
	<entry>
		<fullUrl value="urn:uuid:d1624f29-6962-4d15-9931-09dd5c85b9cf"/>
		<resource>
			<Composition xmlns="http://hl7.org/fhir">
				<identifier>
					<value value="urn:uuid:d1624f29-6962-4d15-9931-09dd5c85b9cf"/>
				</identifier>
				<date value="2017-03-14T11:39:10.000+05:30"/>
				<type>
					<coding>
						<system value="http://hl7.org/fhir/vs/doc-typecodes"/>
						<code value="51899-3"/>
						<display value="Details Document"/>
					</coding>
				</type>
				<title value="Patient Clinical Encounter"/>
				<status value="final"/>
				<confidentiality value="N"/>
				<subject>
					<reference value="http://mci.twhosted.com/api/default/patients/98001098063"/>
					<display value="98001098063"/>
				</subject>
				<author>
					<reference value="http://fr.twhosted.com/api/1.0/facilities/10019842.json"/>
				</author>
				<encounter>
					<reference value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
				</encounter>
				<section>
					<entry>
						<reference value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
						<display value="Encounter"/>
					</entry>
				</section>
			</Composition>
		</resource>
	</entry>
	<entry>
		<fullUrl value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
		<resource>
			<Encounter xmlns="http://hl7.org/fhir">
				<identifier>
					<value value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
				</identifier>
				<status value="finished"/>
				<class value="field"/>
				<type>
					<text value="REG"/>
				</type>
				<patient>
					<reference value="http://mci.twhosted.com/api/default/patients/98001098063"/>
					<display value="98001098063"/>
				</patient>
				<participant>
					<individual>
						<reference value="http://pr.twhosted.com/api/1.0/providers/20.json"/>
					</individual>
				</participant>
				<period>
					<start value="2017-03-14T11:38:52.000+05:30"/>
				</period>
				<serviceProvider>
					<reference value="http://fr.twhosted.com/api/1.0/facilities/10019842.json"/>
				</serviceProvider>
			</Encounter>
		</resource>
	</entry>
</Bundle>

Code Block

language	js
title	Sample Success Response
collapse	true

{
    "encounterId": "9f81a363-ede1-4bd0-8af2-eb73045c9ab1",
    "errors": [],
    "successful": true,
    "errorResult": null
}

Any validation errors will be populated in errors field.

Code Block

language	js
title	Sample Failure Response
collapse	true

{
    "httpStatus": "422",
    "message": "Unprocessable entity : [{"field":"f:Encounter/f:patient","type":"invalid","reason":"http://mci.twhosted.com/api/default/patients/9801098063:Patient Health Id does not match."}]",
    "errors": [
        {
            "field": "f:Encounter/f:patient",
            "type": "invalid",
            "reason": "http://mci.twhosted.com/api/default/patients/9801098063:Patient's Health Id does not match."
        }
    ]
}

Update an encounter

Panel

border	true
borderStyle	dashed

Request :

PUT  /patients/{health Id}/encounters/{encounter_id}

Headers :

X-Auth-Token : {auth token returned from Identity Service Provider}

client_id : {client id of requester in Identity Service Provider}

From : {email_id of requester registered in Identity Service Provider}

Content-Type: application/xml;charset=utf-8

Code Block

title	Body(Example)
collapse	true

<Bundle xmlns="http://hl7.org/fhir">
	<id value="c820e3ea-d7a4-489a-9284-fbaaf0fe8e1a"/>
	<meta>
		<lastUpdated value="2017-03-14T11:39:10.000+05:30"/>
	</meta>
	<type value="collection"/>
	<entry>
		<fullUrl value="urn:uuid:d1624f29-6962-4d15-9931-09dd5c85b9cf"/>
		<resource>
			<Composition xmlns="http://hl7.org/fhir">
				<identifier>
					<value value="urn:uuid:d1624f29-6962-4d15-9931-09dd5c85b9cf"/>
				</identifier>
				<date value="2017-03-14T11:39:10.000+05:30"/>
				<type>
					<coding>
						<system value="http://hl7.org/fhir/vs/doc-typecodes"/>
						<code value="51899-3"/>
						<display value="Details Document"/>
					</coding>
				</type>
				<title value="Patient Clinical Encounter"/>
				<status value="final"/>
				<confidentiality value="N"/>
				<subject>
					<reference value="http://mci.twhosted.com/api/default/patients/98001098063"/>
					<display value="98001098063"/>
				</subject>
				<author>
					<reference value="http://fr.twhosted.com/api/1.0/facilities/10019842.json"/>
				</author>
				<encounter>
					<reference value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
				</encounter>
				<section>
					<entry>
						<reference value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
						<display value="Encounter"/>
					</entry>
				</section>
			</Composition>
		</resource>
	</entry>
	<entry>
		<fullUrl value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
		<resource>
			<Encounter xmlns="http://hl7.org/fhir">
				<identifier>
					<value value="urn:uuid:14278c1c-95b4-43f0-aa35-66e366fb45dc"/>
				</identifier>
				<status value="finished"/>
				<class value="field"/>
				<type>
					<text value="REG"/>
				</type>
				<patient>
					<reference value="http://mci.twhosted.com/api/default/patients/98001098063"/>
					<display value="98001098063"/>
				</patient>
				<participant>
					<individual>
						<reference value="http://pr.twhosted.com/api/1.0/providers/20.json"/>
					</individual>
				</participant>
				<period>
					<start value="2017-03-14T11:38:52.000+05:30"/>
				</period>
				<serviceProvider>
					<reference value="http://fr.twhosted.com/api/1.0/facilities/10019842.json"/>
				</serviceProvider>
			</Encounter>
		</resource>
	</entry>
</Bundle>

Code Block

language	js
title	Sample Success Response
collapse	true

{
    "encounterId": "9f81a363-ede1-4bd0-8af2-eb73045c9ab1",
    "errors": [],
    "successful": true,
    "errorResult": null
}

Any validation errors will be populated in errors field.

Code Block

language	js
title	Sample Failure Response
collapse	true

{
    "httpStatus": "422",
    "message": "Unprocessable entity : [{"field":"f:Encounter/f:patient","type":"invalid","reason":"http://mci.twhosted.com/api/default/patients/9801098063:Patient Health Id does not match."}]",
    "errors": [
        {
            "field": "f:Encounter/f:patient",
            "type": "invalid",
            "reason": "http://mci.twhosted.com/api/default/patients/9801098063:Patient's Health Id does not match."
        }
    ]
}

Get all encounters for a patient.

Panel

border	true
borderStyle	dashed

Request :

GET  /patients/{health Id}/encounters

Headers :

X-Auth-Token : {auth token returned from Identity Service Provider}

client_id : {client id of requester in Identity Service Provider}

From : {email_id of requester registered in Identity Service Provider}

Accept: application/json(default) OR application/atom+xml

Code Block

language	xml
title	Sample Response
collapse	true

<?xml version="1.0" encoding="UTF-8"?>
<feed 
    xmlns="http://www.w3.org/2005/Atom">
    <title>Patient Encounters</title>
    <link rel="self" type="application/atom+xml" href="http://shr-qa.twhosted.com/patients/98001095960/encounters" />
    <link rel="via" type="application/atom+xml" href="http://shr-qa.twhosted.com/patients/98001095960/encounters" />
    <author>
        <name>FreeSHR</name>
    </author>
    <id>e82bb647-6372-40bd-a69f-f0cba0b576fd</id>
    <generator uri="https://github.com/ICT4H/atomfeed">Atomfeed</generator>
    <updated>2016-07-18T04:17:03Z</updated>
    <entry>
        <title>Encounter:bf5a744a-797e-4115-a065-6b6c09f19d89</title>
        <link rel="via" type="application/xml" href="/patients/98001095960/encounters/bf5a744a-797e-4115-a065-6b6c09f19d89" />
        <category term="encounter" />
        <category term="encounter_updated_at:2016-07-18T09:47:03.027+0530" />
        <id>7ace6830-4c9e-11e6-b8ee-ea409bb33e8c</id>
        <updated>2016-07-18T04:17:03Z</updated>
        <content type="application/vnd.atomfeed+xml">
            <![CDATA[<Bundle 
            xmlns="http://hl7.org/fhir"><id value="0ccde14f-0047-4e9a-98bd-71f81991f6c2"/><meta><lastUpdated value="2016-07-18T09:46:40.000+05:30"/></meta><type value="collection"/><entry><fullUrl value="urn:uuid:ac5c9949-d46d-4138-9966-356dab31520a"/><resource><Composition 
            xmlns="http://hl7.org/fhir"><identifier><value value="urn:uuid:ac5c9949-d46d-4138-9966-356dab31520a"/></identifier><date value="2016-07-18T09:46:40.000+05:30"/><type><coding><system value="http://hl7.org/fhir/vs/doc-typecodes"/><code value="51899-3"/><display value="Details Document"/></coding></type><title value="Patient Clinical Encounter"/><status value="final"/><confidentiality value="N"/><subject><reference value="http://mci.twhosted.com/api/default/patients/98001095960"/><display value="98001095960"/></subject><author><reference value="http://fr.twohosted.com/api/1.0/facilities/10019842.json"/></author><encounter><reference value="urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41"/></encounter><section><entry><reference value="urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41"/><display value="Encounter"/></entry></section></Composition></resource></entry><entry><fullUrl value="urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41"/><resource><Encounter 
            xmlns="http://hl7.org/fhir"><identifier><value value="urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41"/></identifier><status value="finished"/><class value="outpatient"/><type><text value="REG"/></type><patient><reference value="http://mci.twhosted.com/api/default/patients/98001095960"/><display value="98001095960"/></patient><participant><individual><reference value="http://pr.twhosted.com/api/1.0/providers/20.json"/></individual></participant><period><start value="2016-07-18T09:46:40.000+05:30"/></period><serviceProvider><reference value="http://fr.twohosted.com/api/1.0/facilities/10019842.json"/></serviceProvider></Encounter></resource></entry></Bundle>]]>
        </content>
    </entry>
    <entry>
        <title>Encounter:ccb7eb5d-66c7-4d4c-810b-2c6c7b8911b1</title>
        <link rel="via" type="application/xml" href="/patients/98001095960/encounters/ccb7eb5d-66c7-4d4c-810b-2c6c7b8911b1" />
        <category term="encounter" />
        <category term="encounter_updated_at:2016-07-18T09:49:02.444+0530" />
        <id>c1fbfec0-4c9e-11e6-b8ee-ea409bb33e8c</id>
        <updated>2016-07-18T04:19:02Z</updated>
        <content type="application/vnd.atomfeed+xml">
            <![CDATA[<Bundle 
            xmlns="http://hl7.org/fhir"><id value="39c0a368-04af-4ca9-89e2-78f183d7d63c"/><meta><lastUpdated value="2016-07-18T09:48:00.000+05:30"/></meta><type value="collection"/><entry><fullUrl value="urn:uuid:63aace39-9348-4c43-bc7a-9485b9f3f2bc"/><resource><Composition 
            xmlns="http://hl7.org/fhir"><identifier><value value="urn:uuid:63aace39-9348-4c43-bc7a-9485b9f3f2bc"/></identifier><date value="2016-07-18T09:48:00.000+05:30"/><type><coding><system value="http://hl7.org/fhir/vs/doc-typecodes"/><code value="51899-3"/><display value="Details Document"/></coding></type><title value="Patient Clinical Encounter"/><status value="final"/><confidentiality value="N"/><subject><reference value="http://mci.twhosted.com/api/default/patients/98001095960"/><display value="98001095960"/></subject><author><reference value="http://fr.twohosted.com/api/1.0/facilities/10019842.json"/></author><encounter><reference value="urn:uuid:25f16b01-af42-47e7-b3b7-cef40077dc0e"/></encounter><section><entry><reference value="urn:uuid:25f16b01-af42-47e7-b3b7-cef40077dc0e"/><display value="Encounter"/></entry></section><section><entry><reference value="urn:uuid:29c25af3-9360-406a-abc3-00ed4102ba84"/><display value="Immunization"/></entry></section></Composition></resource></entry><entry><fullUrl value="urn:uuid:25f16b01-af42-47e7-b3b7-cef40077dc0e"/><resource><Encounter 
            xmlns="http://hl7.org/fhir"><identifier><value value="urn:uuid:25f16b01-af42-47e7-b3b7-cef40077dc0e"/></identifier><status value="finished"/><class value="outpatient"/><type><text value="Consultation"/></type><patient><reference value="http://mci.twhosted.com/api/default/patients/98001095960"/><display value="98001095960"/></patient><participant><individual><reference value="http://pr.twhosted.com/api/1.0/providers/20.json"/></individual></participant><period><start value="2016-07-18T09:46:40.000+05:30"/></period><serviceProvider><reference value="http://fr.twohosted.com/api/1.0/facilities/10019842.json"/></serviceProvider></Encounter></resource></entry><entry><fullUrl value="urn:uuid:29c25af3-9360-406a-abc3-00ed4102ba84"/><resource><Immunization 
            xmlns="http://hl7.org/fhir"><identifier><value value="urn:uuid:29c25af3-9360-406a-abc3-00ed4102ba84"/></identifier><status value="completed"/><date value="2016-07-18T00:00:00.000+05:30"/><vaccineCode><coding><system value="http://172.18.46.56:9080/openmrs/ws/rest/v1/tr/drugs/e90ee3ac-83b0-11e5-aa01-0050568276cf"/><code value="e90ee3ac-83b0-11e5-aa01-0050568276cf"/><display value="BCG"/></coding></vaccineCode><patient><reference value="http://mci.twhosted.com/api/default/patients/98001095960"/><display value="98001095960"/></patient><wasNotGiven value="false"/><reported value="true"/><requester><reference value="http://pr.twhosted.com/api/1.0/providers/20.json"/></requester><encounter><reference value="urn:uuid:25f16b01-af42-47e7-b3b7-cef40077dc0e"/></encounter><doseQuantity><value value="10.0"/></doseQuantity></Immunization></resource></entry></Bundle>]]>
        </content>
    </entry>
</feed>

The response is list of encounters published in Atom or Json Feed format, depending on the Accept Header.

You can find more information of the feed and protocol and reference libraries here.

Get a specific encounter for a patient.

Panel

border	true
borderStyle	dashed

Request :

GET /patients/{health Id}/encounters/{encounter id}

Headers :

X-Auth-Token : {auth token returned from Identity Service Provider}

client_id : {client id of requester in Identity Service Provider}

From : {email_id of requester registered in Identity Service Provider}

Accept: application/xml

Code Block

language	xml
title	Sample Response
collapse	true

{
    "content": "<Bundle xmlns=\"http://hl7.org/fhir\"><id value=\"0ccde14f-0047-4e9a-98bd-71f81991f6c2\"/><meta><lastUpdated value=\"2016-07-18T09:46:40.000+05:30\"/></meta><type value=\"collection\"/><entry><fullUrl value=\"urn:uuid:ac5c9949-d46d-4138-9966-356dab31520a\"/><resource><Composition xmlns=\"http://hl7.org/fhir\"><identifier><value value=\"urn:uuid:ac5c9949-d46d-4138-9966-356dab31520a\"/></identifier><date value=\"2016-07-18T09:46:40.000+05:30\"/><type><coding><system value=\"http://hl7.org/fhir/vs/doc-typecodes\"/><code value=\"51899-3\"/><display value=\"Details Document\"/></coding></type><title value=\"Patient Clinical Encounter\"/><status value=\"final\"/><confidentiality value=\"N\"/><subject><reference value=\"http://mci.twhosted.com/api/default/patients/98001095960\"/><display value=\"98001095960\"/></subject><author><reference value=\"http://fr.twhosted.com/api/1.0/facilities/10019842.json\"/></author><encounter><reference value=\"urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41\"/></encounter><section><entry><reference value=\"urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41\"/><display value=\"Encounter\"/></entry></section></Composition></resource></entry><entry><fullUrl value=\"urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41\"/><resource><Encounter xmlns=\"http://hl7.org/fhir\"><identifier><value value=\"urn:uuid:68cb6fd6-6e92-4720-9407-7d3df47ecd41\"/></identifier><status value=\"finished\"/><class value=\"outpatient\"/><type><text value=\"REG\"/></type><patient><reference value=\"http://mci.twhosted.com/api/default/patients/98001095960\"/><display value=\"98001095960\"/></patient><participant><individual><reference value=\"http://pr.twhosted.com/api/1.0/providers/20.json\"/></individual></participant><period><start value=\"2016-07-18T09:46:40.000+05:30\"/></period><serviceProvider><reference value=\"http://fr.twhosted.com/api/1.0/facilities/10019842.json\"/></serviceProvider></Encounter></resource></entry></Bundle>",
    "healthId": "98001095960",
    "id": "bf5a744a-797e-4115-a065-6b6c09f19d89",
    "receivedAt": "2016-07-18T09:47:03.027+0530",
    "updatedAt": "2016-07-18T09:47:03.027+0530"
}

Response Codes :

412 - PRECONDITION_FAILED

400 - BAD_REQUEST

422 - UNPROCESSABLE_ENTITY

401 - UNAUTHORIZED

403 - FORBIDDEN

Get all encounters for a catchment

GET /catchments/{catchment code}/encounters

headers

    Accept: application/atom+xml

For more details, please refer Catchment Encounters API

Context

Shared Health Record (SHR) serves as a repository containing clinical care information for patients. SHR houses subset of data from various EMRs from different care delivery organisations. This record is shared between different institutions and systems. For patients, such information are represented as Encounters in SHR. Each such encounter information therein is stored as a FHIR resource document.

FHIR encounter – is a resource that mainly has administrative information, for example contact with patient with date, participants etc. Whereas in medical domain, encounter is more holistic, that includes clinical information gathered for patients, drugs/tests advised, observations/diagnoses done etc.

Lets take an example of an outpatient consultation of a doctor with a patient where the patient is diagnosed with presumed “Influenza”, and doctor also noted down (after physical examination) her temperature readings.

The EMR sytsem at the Facility would communicate all the facts with SHR by means of a “document”, formed to provide coherent context for an “Encounter” information. The context description of an encounter can be modeled using a FHIR resource "Bundle".

In our context, this "bundle" is basically a collection of other FHIR resources. The most important resource within the bundle is “Composition”, that organizes/bundles other resources relevant to the clinical encounter within the document. Following is the basic structure

Basic Structure

A Composition resource will have

identifier - usually an unique id within the document
date - the date of editing the composition
status - the workflow status of the composition (final, preliminary etc) - usually final in our case.
subject - reference to the patient. This is the complete URL reference to the patient
encounter - references to the administrative encounter resource contained within the same document
List of sections - this are other FHIR resources that form the facts within the encounter. Usually these are internal references to the other entry resources in the same document.

The document will have references to existing and new resources. Existing resources include Patient, practitioner (provider) and some clinical resources like condition, medication & tests. In FHIR terms, we will have internal and external resource references in the document. See here for resource references.

Composition

Below is a sample example of FHIR Composition Resource. For detailed information of definition of composition (attributes), see here

Code Block

language	xml
title	Sample Composition
collapse	true

<Composition xmlns="http://hl7.org/fhir">
   <identifier>
     <value value="urn:12fafd36-20f7-4f88-8721-9a4a31fbeacf"/>
   </identifier>
   <date value="2015-01-07T12:00:15+05:30"/>
   <status value="final"/>
   <subject>
     <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
     <display value="Monika Ramesh"/>
   </subject>
   <encounter>
     <reference value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>
     <display value="Encounter"/>
   </encounter>
   <section>
     <content>
        <reference value="urn:40b43d8a-b582-4080-8c04-93697b82a795"/>
        <display value="Temperature"/>
     </content>
   </section>
   <section>
     <content>
        <reference value="urn:e45dbdca-4e39-4a79-b1b8-fd622fdff6e3"/>
        <display value="Diagnosis"/>
     </content>
   </section>
</Composition>

Encounter

Encounter happens between Practitioner/care-provider and a patient. The encounter snippet shown below is FHIR encounter, which captures the administrative information for workflow management. For SHR, the entire composition resource is the clinical "Encounter" the API serves.

Code Block

language	xml
title	Sample Encounter
collapse	true

<Encounter xmlns="http://hl7.org/fhir">
   <identifier>
      <value value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>
   </identifier>
   <status value="finished"/>
   <class value="outpatient"/>
   <type>
      <text value="outpatient"/>
   </type>
   <subject>
      <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
      <display value="Monika Ramesh"/>
   </subject>
   <participant>
      <individual>
        <reference value="http://pr.twhosted.com/providers/18.json"/>
        <display value="Dr. Azad"/>
      </individual>
   </participant>
</Encounter>

Where

class: classification - inpatient | outpatient | ambulatory | emergency | home | field | daytime | virtual
status: planned | in progress | onleave | finished | cancelled.
type: 0..*. Specifies type of encounter. e.g. consultation, surgical day-care, rehab etc. We will have to define a coded set for this. TBD.
participant: 0..*. Specifies care providers in this encounter. For example, in a surgery, there maybe multiple providers of different type.
serviceProvider: identifies the facility or community health clinic
identifier: local identifier in HMIS
subject - reference to the patient. This is the complete URL reference to the patient

encounter - references to the administrative encounter resource contained within the same document

List of sections - this are other FHIR resources that form the facts within the encounter. Usually these are internal references to the other entry resources in the same document.

The document will have references to existing and new resources. Existing resources include Patient, practitioner (provider) and some clinical resources like condition, medication & tests. In FHIR terms, we will have internal and external resource references in the document. See here for resource references.

Composition

For detailed information of definition of composition (attributes), see here

<Composition xmlns="http://hl7.org/fhir">
<identifier>
<value value="urn:12fafd36-20f7-4f88-8721-9a4a31fbeacf"/>
</identifier>
<date value="2015-01-07T12:00:15+05:30"/>
<status value="final"/>
<subject>
<reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
<display value="Monika Ramesh"/>
</subject>
<encounter>
<reference value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>
<display value="Encounter"/>
</encounter>
<section>
<content>
<reference

NOTE: there are many other attributes of FHIR encounter (like hospitalization, location etc). They maybe included as we see use cases.

Important to note, how the encounter links with the composition resource described above. The composition resource above references the encounter resource within the same document using the same reference id.

Now, lets see how the temperate reading is recorded as "observation", and diagnosis (influenza) as "condition".

Observation

Observations are made for measurements and simple assertions made about a patient. Lets say, the patient's temperature reading was recorded as 101 F.

Code Block

language	xml
title	Sample Observation
collapse	true

<Observation xmlns="http://hl7.org/fhir">
   <identifier>
      <value value="urn:40b43d8a-b582-4080-8c04-93697b82a795"/>

</

content>

identifier>

</section>

 <name>

<coding>

</content>

</section>
</Composition>

Encounter

Encounter happens between Practitioner/care-provider and a patient. The encounter snippet shown below is FHIR encounter, which captures the administrative information for workflow management. For SHR, the entire composition resource is the clinical "Encounter" the API serves.

<Encounter xmlns

<system value="http://

hl7.org/fhir">

tr.twhosted.com/openmrs/ws/rest/v1/tr/concepts/a1257651-7473-4c9b-bb0a-1244c5f3c09d"/>

<value

<code value="

urn:07f02524

a1257651-

7647

7473-

43c1

4c9b-

a579

bb0a-

0c2c80f285ed

1244c5f3c09d"/>

</identifier>

<status

value="finished"/>

<class

<display value="

outpatient

Temperature"/>

<type>

</coding>
   </

type>

name>

<valueDecimal

<reference

value="

http://mci.twhosted.com/api/v1/patients/5893922485019082753

101.0"/>

<display

<status value=

"Monika Ramesh"/>
</subject>

"final"/>

 <reliability value="ok"/>

<subject>
      <reference value="http://

pr

mci.twhosted.com/api/

providers/18.json

v1/patients/5893922485019082753"/>


      <display value="

Dr.

Monika

Azad

Ramesh"/>

</

individual>

subject>
</

participant>
</Encounter>

Observation>

Where

class: classification - inpatient | outpatient | ambulatory | emergency | home | field | daytime | virtual
status: planned | in progress | onleave | finished | cancelled.
type: 0..*. Specifies type of encounter. e.g. consultation, surgical day-care, rehab etc. We will have to define a coded set for this. TBD.
participant: 0..*. Specifies care providers in this encounter. For example, in a surgery, there maybe multiple providers of different type.
serviceProvider: identifies the facility or community health clinic
identifier: local identifier in HMIS
subject - reference to the patient. This is the complete URL reference to the patient

NOTE: there are many other attributes of FHIR encounter (like hospitalization, location etc). They maybe included as we see use cases.

Important to note, how the encounter links with the composition resource described above. The composition resource above references the encounter resource within the same document using the same reference id.

Now, lets see how the temperate reading is recorded as "observation", and diagnosis (influenza) as "condition".

Observation

Observations are made for measurements and simple assertions made about a patient. Lets say, the patient's temperature reading was recorded as 101 F.

:

identifier - is the unique id of this resource within the document.
name - describes what happened. This is a CodeableConcept. In the above example, it explains that "Temperature" was recorded. The system and the coding further uniquely identifies the concept in the Terminology Registry.
value[x] - result of the observation. It maybe - valueQuantity, valueString, valueDecimal, valueRation etc etc.
status - status of the observation. example - final, registered etc
subject - reference to the patient.

Again note, how the identifier of the above observation is used to link with the composition section.

Diagnosis

Diagnosis is captured through FHIR condition, with "category" as "Diagnosis".

Code Block

language	xml
title	Sample Diagnosis
collapse	true

<Condition xmlns="http://hl7.org/fhir">
   <identifier>
     <value value="urn:e45dbdca-4e39-4a79-b1b8-fd622fdff6e3"/>
   </identifier>
   <subject>
     <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
     <display value="Monika Ramesh"/>
   </subject>
   <encounter>
     <reference value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>
     <display value="Encounter"/>
   </encounter>
   <asserter>
     <reference value="http://pr.twhosted.com/providers/18.json"/>
     <display value="Dr. Azad"/>
   </asserter>
   <dateAsserted value="2015-01-07T12:00:15+05:30"/>
   <category>
     <coding>
       <system value="http://

tr

hl7.

twhosted.com

org/

openmrs/ws/rest/v1/tr/concepts/a1257651-7473-4c9b-bb0a-1244c5f3c09d

fhir/condition-category"/>


       <code value="

a1257651-7473-4c9b-bb0a-1244c5f3c09d

diagnosis"/>

<display value="

Temperature

Diagnosis"/>


     </coding>

</

name>

category>

 <code>

 <coding>

    <system

<reference

value="http://

mci

tr.twhosted.com/

api

openmrs/ws/rest/v1

/patients/5893922485019082753

/tr/referenceterms/2218636a-0ef0-4fb1-ac7e-cf2a915b0ee4"/>
      <code value="J11.1"/>


      <display value="

Monika Ramesh

Influenza due to unidentified influenza virus with other respiratory manifestations"/>

</

subject>
</Observation>

Where:

identifier - is the unique id of this resource within the document.
name - describes what happened. This is a CodeableConcept. In the above example, it explains that "Temperature" was recorded. The system and the coding further uniquely identifies the concept in the Terminology Registry.
value[x] - result of the observation. It maybe - valueString, valueDecimal, valueRation etc etc.
status - status of the observation. example - final, registered etc
subject - reference to the patient.

Again note, how the identifier of the above observation is used to link with the composition section.

Diagnosis

Diagnosis is captured through FHIR condition, with "category" as "Diagnosis".

{
  "resourceType": "Condition",
  "text": {
    "status": "generated",
    "div": "Left thorax \n heart structure"
  },
  "subject": {
    "reference": "http://mci.twhosted.com/BD1001",
    "display": "Shahrukh Khan"
  },
  "encounter": {
    "reference": "#E1001"
  },
  "asserter": {
    "reference": "http://providers.twhosted.com/D101",
    "display": "Dr. Heuvel"
  },
  "dateAsserted": "2011-10-05",
  "code": {
    "coding": [
      {
        "system": "http://bdshr-tr.twhosted.com/ICD10/I39",
        "code": "I39",
        "display": "Heart valve disorder"
      }
    ]
  },
  "category": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/vs/condition-category",
        "code": "Diagnosis",
        "display": "Diagnosis"
      }

] }, "status": "confirmed", "severity": { "coding": [ { "system":

coding>
   </code>
   <status value="provisional"/>
 </Condition>

Where:

Condition.identifier - is the unique id of this resource within the document. Note, how the identifier is linked to the composition through the section identifier.
Condition.subject - the reference to the patient resource
Condition.encounter - reference to the encounter where the diagnosis was made. Note how it points to the encounter identifier in the same document.
Condition.asserter - the provider who asserted this condition
Condition.dateAsserted: Estimated or actual date the condition/problem/diagnosis was first detected/suspected.
Condition.code - identifies the condition, problem or diagnosis. In this case, the system is the URL reference where the code J11.1 can be found.
Condition.category: A category assigned to the condition. E.g. complaint | symptom | finding | diagnosis.
Condition.status: The clinical status of the Condition or diagnosis. Possible values - provisional, working, confirmed, refuted.
Condition.certainty: Non mandatory. But used in many diagnosis conditions.We probably need to define a coded concept like SNOMED for certainty. TBD
Condition.severity: Value set defines
- 399166001: Fatal
- 24484000: Severe
- 6736007: Moderate
- 255604002: Mild
Condition.onset[x] - can be "onsetDate" or "onsetAge" : Estimated or actual date when the condition began.

NOTE: This definition of the "condition" is meant to be minimal set of definitions seen at a point of time, and maybe expanded if needed.

Putting it all together

As explained above, all the resources in the example (encounter, observation, condition) are organized in the composition resource and bundling everything together to form the SHR "encounter" document.

Expand

<?xml version="1.0" encoding="UTF-8"?>
 <feed xmlns="http://www.w3.org/2005/Atom">
 <title>Encounter</title>
 <id>urn:73b7eb36-a1e2-4754-8518-19360c87ea62</id>
 <updated>2015-01-07T12:00:15+05:30</updated>
 <entry>
   <title>Composition</title>
   <id>urn:12fafd36-20f7-4f88-8721-9a4a31fbeacf</id>
   <updated>2015-01-07T12:00:40.097+05:30</updated>
   <author>
     <name>OpenMRS</name>
   </author>
   <content type="text/xml">

     <Composition xmlns="http://hl7.org/fhir

/vs/condition-severity",

">

       <identifier>

         <value

"code": "6736007",

value="urn:12fafd36-20f7-4f88-8721-9a4a31fbeacf"/>

       </identifier>

"display": "Moderate"

   <date value="2015-01-07T12:00:15+05:30"/>

}

<status value="final"/>

] },

"onsetDate": "2011-08-05" }

Where:

Condition.dateAsserted: Estimated or actual date the condition/problem/diagnosis was first detected/suspected.
Condition.category: A category assigned to the condition. E.g. complaint | symptom | finding | diagnosis.
Condition.status: The clinical status of the Condition or diagnosis. Possible values - provisional, working, confirmed, refuted.
Condition.certainty: Non mandatory. But used in many diagnosis conditions.We probably need to define a coded concept like SNOMED for certainty. TBD
Condition.severity: Value set defines
- 399166001: Fatal
- 24484000: Severe
- 6736007: Moderate
- 255604002: Mild
Condition.onset[x] - can be "onsetDate" or "onsetAge" : Estimated or actual date when the condition began.

NOTE: This definition of the "condition" is meant to be minimal set of definitions seen at a point of time, and maybe expanded if needed.

Complaint

Complaints are captured through FHIR condition, with "category" as "Complaint".

    "title": "Complaint",

    "id": "#C1002",

    "content": {

        "resourceType": "Condition",

        "identifier": [

                "value": "#C1002"

],

        "subject": {

            "reference": "http://mci.twhosted.com/BD1001"

},

        "encounter": {

            "reference": "#E1001",

            "display": "encounter"

},

        "asserter": {

            "reference": "http://providers.twhosted.com/D101"

},

        "dateAsserted": "2014-07-24T12:00:00+05:30",

        "code": {

            "coding": [

                    "system": "http://bdshr-tr.twhosted.com/ICD10/I39",

                    "code": "M79.605",

                    "display": "Pain in left leg"

},

        "category": {

            "coding": [

                    "system": "http://hl7.org/fhir/vs/condition-category",

                    "code": "Complaint",

                    "display": "Complaint"

},

        "status": "confirmed",

        "severity": {

            "coding": [

                    "system": "http://hl7.org/fhir/vs/condition-severity",

                    "code": "6736007",

                    "display": "Moderate"

},

        "onsetDateTime": "2014-07-03T12:00:00+05:30"

Where:

Condition.dateAsserted: Estimated or actual date the condition/problem/diagnosis was first detected/suspected.
Condition.category: A category assigned to the condition. E.g. complaint | symptom | finding | diagnosis.
Condition.status: The clinical status of the Condition or diagnosis. Possible values - provisional, working, confirmed, refuted.
Condition.certainty: Non mandatory. But used in many diagnosis conditions.We probably need to define a coded concept like SNOMED for certainty. TBD
Condition.severity: Value set defines
- 399166001: Fatal
- 24484000: Severe
- 6736007: Moderate
- 255604002: Mild
Condition.onset[x] - can be "onsetDate" or "onsetAge" : Estimated or actual date when the condition began.

API

save an encounter.

   POST /patients/{health Id}/encounters

get all encounters for a patient.

    GET /patients/{health Id}/encounters

get a specific encounter for a patient.

     GET /patients/{health Id}/encounters/{encounter id}

get all encounters for a catchment

     GET /catchments/{catchment code}/encounters

for details, please refer Catchment Encounters API

 <subject>

          <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>

          <display value="Monika Ramesh"/>

       </subject>

       <encounter>

         <reference value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>

         <display value="Encounter"/>

       </encounter>

       <section>

         <content>

           <reference value="urn:40b43d8a-b582-4080-8c04-93697b82a795"/>

           <display value="Temperature"/>

         </content>

       </section>

       <section>

         <content>

           <reference value="urn:e45dbdca-4e39-4a79-b1b8-fd622fdff6e3"/>

           <display value="Diagnosis"/>

         </content>

       </section>

     </Composition>

   </content>
 </entry>
 <entry>
   <title>Encounter</title>
   <id>urn:07f02524-7647-43c1-a579-0c2c80f285ed</id>
   <updated>2015-01-07T12:00:40.097+05:30</updated>
   <author>
     <name>bahmni</name>
   </author>
   <content type="text/xml">
     <Encounter xmlns="http://hl7.org/fhir">
       <identifier>
         <value value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>
       </identifier>
       <status value="finished"/>
       <class value="outpatient"/>
       <type>
         <text value="outpatient"/>
       </type>
       <subject>
         <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
         <display value="Monika Ramesh"/>
       </subject>
       <participant>
         <individual>
           <reference value="http://pr.twhosted.com/providers/18.json"/>
           <display value="Dr. Azad"/>
         </individual>
       </participant>
     </Encounter>
   </content>
 </entry>
 <entry>
 <title>Temperature</title>
 <id>urn:40b43d8a-b582-4080-8c04-93697b82a795</id>
 <updated>2015-01-07T12:00:40.303+05:30</updated>
 <author>
 <name>bahmni</name>
 </author>
 <content type="text/xml">
 <Observation xmlns="http://hl7.org/fhir">
 <name>
 <coding>
 <system value="http://tr.twhosted.com/openmrs/ws/rest/v1/tr/concepts/a1257651-7473-4c9b-bb0a-1244c5f3c09d"/>
 <code value="a1257651-7473-4c9b-bb0a-1244c5f3c09d"/>
 <display value="Temperature"/>
 </coding>
 </name>
 <valueDecimal value="97.0"/>
 <status value="final"/>
 <reliability value="ok"/>
 <identifier>
 <value value="urn:40b43d8a-b582-4080-8c04-93697b82a795"/>
 </identifier>
 <subject>
 <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
 <display value="Monika Ramesh"/>
 </subject>
 </Observation>
 </content>
 </entry>
 <entry>
 <title>Diagnosis</title>
 <id>urn:e45dbdca-4e39-4a79-b1b8-fd622fdff6e3</id>
 <updated>2015-01-07T12:00:40.316+05:30</updated>
 <author>
 <name>bahmni</name>
 </author>
 <content type="text/xml">
 <Condition xmlns="http://hl7.org/fhir">
 <identifier>
 <value value="urn:e45dbdca-4e39-4a79-b1b8-fd622fdff6e3"/>
 </identifier>
 <subject>
 <reference value="http://mci.twhosted.com/api/v1/patients/5893922485019082753"/>
 <display value="Monika Ramesh"/>
 </subject>
 <encounter>
 <reference value="urn:07f02524-7647-43c1-a579-0c2c80f285ed"/>
 <display value="Encounter"/>
 </encounter>
 <asserter>
 <reference value="http://pr.twhosted.com/providers/18.json"/>
 <display value="Dr. Azad"/>
 </asserter>
 <dateAsserted value="2015-01-07T12:00:15+05:30"/>
 <code>
 <coding>
 <system value="http://tr.twhosted.com/openmrs/ws/rest/v1/tr/referenceterms/2218636a-0ef0-4fb1-ac7e-cf2a915b0ee4"/>
 <code value="J11.1"/>
 <display value="Influenza due to unidentified influenza virus with other respiratory manifestations"/>
 </coding>
 </code>
 <category>
 <coding>
 <system value="http://hl7.org/fhir/condition-category"/>
 <code value="diagnosis"/>
 <display value="Diagnosis"/>
 </coding>
 </category>
 <status value="provisional"/>
 </Condition>
 </content>
 </entry>F
 </feed>

In this page:

Table of Contents

...

Versions Compared

Old Version 29

New Version Current

Key

Context

Basic Structure

API

Save an encounter.

Get a specific encounter for a patient.

Get all encounters for a catchment

Context

Basic Structure

Composition

Encounter

Composition

Observation

Encounter

Observation

Diagnosis

Diagnosis

Putting it all together

Complaint

API

save an encounter.

get all encounters for a patient.

get all encounters for a catchment