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Official URL: http://fhir.ch/ig/ch-epr-mhealth/ImplementationGuide/ch.fhir.ig.ch-epr-mhealth				Version: 3.0.0
Active as of 2024-03-05				Computable Name: CHEprMhealth
Copyright/Legal: CC0-1.0

Introduction

The national extensions documented in this implementation guide shall be used in conjunction with the definitions of integration profiles, actors and transactions provided in Volumes 1 through 3 of the IHE IT Infrastructure Technical Framework.

This implementation guide with national extensions of IHE integration profiles was authored in order to fulfil the Swiss regulations of the Ordinance on the Electronic Patient Record (EPRO, SR 816.11). The EPRO and the EPRO-DFI are published in Official Compilation of Federal Legislation (AS) (available in German, French and Italian).

Download: You can download this implementation guide in NPM format from here.

Conformance Expectations

The key words MUST, MUST NOT, REQUIRED, SHALL, SHALL NOT, SHOULD, SHOULD NOT, RECOMMENDED, MAY, and OPTIONAL in this document are to be interpreted as described in [RFC2119].

This implementation guide uses Must Support in StructureDefinitions with the definition found in Appendix Z. This is equivalent to the IHE use of R2 as defined in Appendix Z.

Scope of precisions

The extensions, restrictions and translations specified apply to the following IHE IT Infrastructure (ITI) Integration profiles:

• SMART on FHIR
• IUA
• PDQm
• PIXm
• MHD
• mCSD
• RESTful ATNA

Related profiles, actors and transactions

The FHIR API specifications to read audit trails is defined in a separate national Integration Profile (CH:ATC, SR816.11, Annex 5, Extension 2) with the supporting Implementation Guide.

Overview

Introduction

This national extension is motivated by the intention to provide FHIR based profiles for the Swiss EPR by extending the IHE FHIR based mobile profiles. The IHE FHIR based mobile profiles use technologies (REST, OAuth, etc.) which are widely spread in the developer community and may be used for Web Applications, for example in web based primary systems or portals.

This national extension strictly separates the authentication and authorization of the applications use to access the EPR on behalf of the user and the authentication and authorization of the user itself. By using this separation this national extension closely follows the underlying IUA Trial Implementation and OAuth 2.1:

• Client authentication - an application identifies and authenticates to an authorization server.
• Client authorization - an application is authorized by the user or system policy to access data and documents on behalf of the user.
• User authentication - a natural person identifies and authenticates using an Identity Provider with the authenticators registered for the natural person.
• User authorization - provision of an access token which includes the information required to perform authorization decisions and policy enforcement.

The scope of this extension covers the following use cases:

1. Client authentication and authorization;
2. User authentication and authorization;
3. Read data and documents from the EPR;
4. Write data and documents to the EPR;
5. Write logs to the EPR ATNA Audit Record Repository.

This extension covers two options:

1. Generic mHealth option – This option adresses primary systems or portals using the basic EPR flows replacing the XDS.b related and PIX/PDQ V3 profiles with the FHIR based profiles;
2. SMART on FHIR – This option adresses modular portals or primary systems that want to connect to the Swiss EPR using SMART on FHIR.

Profiles, actors and transactions

The following figure shows the profiles, actors and transactions specified or referenced in this national extension:

IP Statements

This document is licensed under Creative Commons “No Rights Reserved” (CC0).

HL7®, HEALTH LEVEL SEVEN®, FHIR® and the FHIR ® are trademarks owned by Health Level Seven International, registered with the United States Patent and Trademark Office.

This implementation guide contains and references intellectual property owned by third parties (“Third Party IP”). Acceptance of these License Terms does not grant any rights with respect to Third Party IP. The licensee alone is responsible for identifying and obtaining any necessary licenses or authorizations to utilize Third Party IP in connection with the specification or otherwise.

This publication includes IP covered under the following statements.

• CC0-1.0
  Show Usage
  • eCH-011 Types: CHPDQmPatient and CHPIXmPatientFeed
  • IHE XCPD Codesystem more attributes requested: Bundle/PDQm-QueryResponseTooManyResults, ChPdqmMoreAttriburesRequested, ChPdqmResponseMoreAttributesRequested and OperationOutcome/PDQmResponseMoreAttributesRequested
  • ch-ehealth-codesystem-language: CHMhdDocumentReferenceComprehensive
  • CH Codesystem PDQ More Attributes Requested: Bundle/PDQm-QueryResponseTooManyResults, ChPdqmMoreAttriburesRequested, ChPdqmResponseMoreAttributesRequested and OperationOutcome/PDQmResponseMoreAttributesRequested
  • ch-ehealth-codesystem-eprdeletionstatus: Bundle/2-7-BundleProvideDocument, Bundle/Bundle-FindDocumentReferences, ChExtDeletionStatus and DocumentReference/2-7-DocRefMedicationCard
  • ch-ehealth-codesystem-purposeOfUse: AuditEvent/ex-auditProvideBundle-source
  • ch-ehealth-codesystem-role: AuditEvent/ex-auditProvideBundle-source, Bundle/2-7-BundleProvideDocument... Show 5 more, Bundle/Bundle-FindDocumentReferences, Bundle/Bundle-FindSubmissionSets, ChExtAuthorAuthorRole, DocumentReference/2-7-DocRefMedicationCard and List/2-7-DocSubMedicationCard
  • ch-ehealth-codesystem-medreg: Bundle/FindMatchingCareServicesResponse, Practitioner/DrPeterPan, PractitionerRole/PeterPanPraxisP and PractitionerRole/PeterPanSpitalXDept3
• ISO Maintains the copyright on the country codes, and controls it's use carefully. For futher details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
  Show Usage
  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: CHEprMhealth, CHMhdDocumentReferenceComprehensive... Show 39 more, CHMhdProvideDocumentBundleComprehensive, CHMhdSubmissionSetComprehensive, CHMhdSubmissionSetComprehensiveBundle, CHPDQmPatient, CHPDQmProviderOrganization, CHPIXmPatientFeed, CH_ATNA_Audit_Creator, CH_ATNA_Audit_Record_Repository, CH_MHD_DocumentConsumer, CH_MHD_DocumentRecipient, CH_MHD_DocumentResponder, CH_MHD_DocumentSource, CH_PDQm_Consumer, CH_PDQm_Supplier, CH_PIXm, CH_PIXm_Consumer, CH_PIXm_Manager, CH_PIXm_Source, CH_mCSD_Care_Services_Selective_Consumer, CH_mCSD_Care_Services_Selective_Supplier, CH_mHealth_API, CH_mHealth_App, CHmCSDOrganization, CHmCSDPractitioner, CHmCSDPractitionerRole, ChEhealthCodesystemPqdMoreAttriburesRequested, ChEprMHealthBirthName, ChEprMHealthHumanName, ChExtAuthorAuthorRole, ChExtDeletionStatus, ChFindDocumentReferencesComprehensiveResponse, ChPDQmQueryPatientResourceResponseMessage, ChPdqmMoreAttriburesRequested, ChPdqmResponseMoreAttributesRequested, IHE_MHD_ProvideDocumentBundle_Comprehensive_Response_CH, IHE_PIXm_OUT_Parameters_CH, IheXcpdMoreAttriburesRequested, OidIdentifier and PIXm_IN_Parameters_CH
• Some content from IHE® Copyright © 2015 IHE International, Inc .
  Show Usage
  • IHE Format Code set for use with Document Sharing: Bundle/2-7-BundleProvideDocument, Bundle/Bundle-FindDocumentReferences, CHMhdDocumentReferenceComprehensive and DocumentReference/2-7-DocRefMedicationCard
• These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
  Show Usage
  • DICOM Controlled Terminology Definitions: AuditEvent/ex-auditProvideBundle-source
• This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyright of the International Health Terminology Standards Development Organisation (IHTSDO). Implementers of these artefacts must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/getsnomed-ct or info@snomed.org.
  Show Usage
  • ch-ehealth-codesystem-format: CHMhdDocumentReferenceComprehensive
• This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
  Show Usage
  • SNOMED Clinical Terms® (SNOMED CT®): Bundle/2-7-BundleProvideDocument, Bundle/Bundle-FindDocumentReferences... Show 12 more, Bundle/Bundle-FindSubmissionSets, Bundle/FindMatchingCareServicesResponse, CHMhdDocumentReferenceComprehensive, CHMhdSubmissionSetComprehensive, Dept. 3, DocumentReference/2-7-DocRefMedicationCard, List/2-7-DocSubMedicationCard, Practitioner/DrPeterPan, PractitionerRole/PeterPanPraxisP, PractitionerRole/PeterPanSpitalXDept3, Praxis P and Spital X
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
  Show Usage
  • Audit event entity type: AuditEvent/ex-auditProvideBundle-source
  • AuditEventEntityRole: AuditEvent/ex-auditProvideBundle-source
  • Audit Event Source Type: AuditEvent/ex-auditProvideBundle-source
  • identifierType: Bundle/2-7-BundleProvideDocument, Bundle/Bundle-FindDocumentReferences... Show 6 more, Bundle/PDQm-QueryResponse, CHPDQmPatient, CHPIXmPatientFeed, DocumentReference/2-7-DocRefMedicationCard, Patient/FranzMusterNeedsAbsoluteUrl and Patient/PatientPIXmFeed
• This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
  Show Usage
  • ActReason: AuditEvent/ex-auditProvideBundle-source, Patient/FranzMusterNeedsAbsoluteUrl and Patient/PatientPIXmFeed
  • RoleClass: AuditEvent/ex-auditProvideBundle-source
  • RoleCode: CHPDQmPatient and CHPIXmPatientFeed

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (ch.fhir.ig.ch-epr-mhealth.r4) and R4B (ch.fhir.ig.ch-epr-mhealth.r4b) are available.

Dependency Table

Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package ihe.formatcode.fhir#1.1.0 Implementation Guide for IHE defined FormatCode vocabulary. (built Thu, Feb 24, 2022 16:55-0600-06:00)

Package ch.fhir.ig.ch-epr-term#2.0.10 Implementation guide for the meta data specified in the framework of Annex 3 and 9 of the FDHA Ordinance on the electronic patient record in Switzerland (built Tue, Dec 19, 2023 12:36+0100+01:00)

Package ch.fhir.ig.ch-core#4.0.0 FHIR implementation guide CH Core (built Tue, Dec 19, 2023 13:50+0100+01:00)

Package ihe.iti.balp#1.1.3 The Basic Audit Log Patterns (BALP) Implementation Guide is a Content Profile that defines some basic and reusable AuditEvent patterns. This includes basic audit log profiles for FHIR RESTful operations to be used when there is not a more specific audit event defined. A focus is enabling Privacy centric AuditEvent logs that hold well formed indication of the Patient when they are the subject of the activity being recorded in the log. Where a more specific audit event can be defined it should be derived off of these basic patterns. (built Wed, Feb 14, 2024 15:23-0600-06:00)

Package ihe.iti.pixm#3.0.3 ImplementationGuide for IHE IT Infrastructure Technical Framework Supplement Patient Identifier Cross-referencing for mobile (PIXm) (built Thu, Aug 3, 2023 15:56-0500-05:00)

Package ihe.iti.pdqm#2.4.0 The Patient Demographics Query for Mobile (PDQm) Profile defines a lightweight RESTful interface to a patient demographics supplier leveraging technologies readily available to mobile applications and lightweight browser based applications. (built Tue, Feb 22, 2022 07:42-0600-06:00)

Package ihe.iti.mhd#4.2.1 ImplementationGuide for IHE IT Infrastructure Technical Framework Supplement Mobile access to Health Documents (MHD) (built Wed, Aug 2, 2023 10:57-0500-05:00)

Package ihe.iti.balp#1.1.0 The Basic Audit Log Patterns (BALP) Implementation Guide is a Content Profile that defines some basic and reusable AuditEvent patterns. This includes basic audit log profiles for FHIR RESTful operations to be used when there is not a more specific audit event defined. A focus is enabling Privacy centric AuditEvent logs that hold well formed indication of the Patient when they are the subject of the activity being recorded in the log. Where a more specific audit event can be defined it should be derived off of these basic patterns. (built Wed, May 4, 2022 10:07-0500-05:00)

Package ihe.iti.mcsd#3.8.0 The IHE Mobile Care Services Discovery (mCSD) IG provides a transaction for mobile and lightweight browser-based applications to find and update care services resources. (built Fri, Aug 12, 2022 09:41-0500-05:00)

Globals Table

There are no Global profiles defined