FHIRcast
2.1.0-ballot - ballot
FHIRcast
2.1.0-ballot - ballot
This page is part of the FHIRcast (v2.1.0-ballot: STU3 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions 
| eventMaturity | 1 - Submitted |
The DiagnosticReport-update event is used by clients to support content sharing in communication with a Hub which also supports content sharing. A DiagnosticReport-update request will be posted to the Hub when an application desires a change be made to the current state of exchanged information or to add or remove a reference to a FHIR resource contained in the content of the current anchor context. One or more updates MAY occur while the anchor context is open.
The updates include:
The context MUST contain a Bundle resource in an updates key which contains zero or more resources which are to be updated as entries in the Bundle. Normally at least one entry exists in the Bundle resource; however, if only updating attributes of the anchor context or associated context resources the Bundle resource may have no entries.
Exchange of information is made transactionally using change sets in the DiagnosticReport-update event (i.e., the complete current state of the content is not provided in the Bundle resource in the updates key). Therefore it is essential that applications interested in the current state of exchanged information process all events and process the events in the order in which they were successfully received by the Hub. Each DiagnosticReport-update event posted to the Hub SHALL be processed atomically by the Hub (i.e., all entries in the request’s Bundle should be processed prior to the Hub accepting another request).
The Hub plays a critical role in helping applications stay synchronized with the current state of exchanged information. On receiving a [FHIR resource]-update request the Hub SHALL examine the context.versionId of the anchor context. The Hub SHALL compare the context.versionId of the incoming request with the context.versionId the Hub previously assigned to the anchor context (i.e, the context.versionId assigned by the Hub when the previous DiagnosticReport-open or DiagnosticReport-update request was processed). If the incoming context.versionId and last assigned context.versionId do not match, the request SHALL be rejected and the Hub SHALL return a 4xx/5xx HTTP Status Code.
If the context.versionId values match, the Hub proceeds with processing each of the FHIR resources in the Bundle and SHALL process all Bundle entries in an atomic manner. After updating its copy of the current state of exchanged information, the Hub SHALL assign a new context.versionId to the anchor context and use this new context.versionId in the DiagnosticReport-update event it forwards to subscribed applications. The Hub SHALL also include the context.priorVersionId in the distributed event which receiving applications MAY use to ensure they are apply the updates to the proper context version. The distributed update event SHALL contain a Bundle resource with the same Bundle id which was contained in the request.
When a DiagnosticReport-update event is received by an application, the application should respond as is appropriate for its clinical use. For example, an image reading application may choose to ignore an observation describing a patient’s blood pressure. Since transactional change sets are used during information exchange, no problems are caused by applications deciding to ignore exchanged information not relevant to their function. However, they should read and retain the context.versionId of the anchor context provided in the event for later use.
FHIR resources are used to carry the information being displayed. These are the entries in the Bundle resource inside the updates key. Commonly the information is contained in an entry’s resource. For example, an Observation resource most likely contains all information regarding that observation.
However, in some cases the information of a resource may best be conveyed by reference rather than being self-contained. When exchanging a resource by reference, an entry’s fullUrl is populated with a uri from which the full content of the resource may be retrieved. Additionally, the entry’s resource attribute contains at least the type and id of the resource. Finally, the method value in an entry’s request attribute must be appropriately populated.
If information is exchanged by reference, the fullUrl reference could be to a resource already persisted in a FHIR Server having a data store with long-term persistance. Alternatively, the reference could be to a temporary data store with a lifecycle of the content exchange session and managed by the Hub with a FHIR retrieve endpoint.
| Key | Optionality | FHIR operation to generate context | Description |
|---|---|---|---|
report |
REQUIRED | DiagnosticReport/{id}?_elements=identifier |
Anchor context |
patient |
OPTIONAL | Patient/{id}?_elements=identifier |
Present if one or more attributes in the Patient resource associated with the report have changed |
study |
OPTIONAL | ImagingStudy/{id}?_elements=identifier,accession |
Present if one or more attributes in the Patient resource associated with the report have changed |
updates |
REQUIRED | not applicable | Changes to be made to the current content of the anchor context |
Each entry in the updates Bundle resource must contain one of the below method values in an entry’s request attribute.
| Request Method | Operation |
|---|---|
POST |
Add a new resource |
PUT |
Replace/update an existing resource |
DELETE |
Remove an existing resource |
The following example shows adding an imaging study to the existing diagnostic report context and a new observation. The context holds the id and versionId of the diagnostic report as required in all DiagnosticReport-update events. The Bundle holds the addition (POST) of an imaging study and adds (POST) an observation derived from this study.
{
"timestamp": "2019-09-10T14:58:45.988Z",
"id": "0d4c7776",
"event": {
"hub.topic": "DrXRay",
"hub.event": "DiagnosticReport-update",
"context.versionId": "b9574cb0-e9e5-4be1-8957-5fcb51ef33c1",
"context": [
{
"key": "report",
"resource": {
"resourceType": "DiagnosticReport",
"id": "40012366"
}
},
{
"key": "updates",
"resource": {
"resourceType": "Bundle",
"id": "8i7tbu6fby5fuuey7133eh",
"type": "transaction",
"entry": [
{
"request": {
"method": "POST"
},
"resource": {
"resourceType": "ImagingStudy",
"description": "CHEST XRAY",
"started": "2010-02-14T01:10:00.000Z",
"id": "3478116342",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "ACSN"
}
]
},
"value": "3478116342"
},
{
"system": "urn:dicom:uid",
"value": "urn:oid:2.16.124.113543.6003.1154777499.30276.83661.3632298176"
}
]
}
},
{
"request": {
"method": "POST"
},
"resource": {
"resourceType": "Observation",
"id": "435098234",
"partOf": {
"reference": "ImagingStudy/3478116342"
},
"status": "preliminary",
"category": {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging",
"display": "Imaging"
},
"code": {
"coding": [
{
"system": "http://www.radlex.org",
"code": "RID49690",
"display": "simple cyst"
}
]
},
"issued": "2020-09-07T15:02:03.651Z"
}
}
]
}
}
]
}
}
The HUB SHALL distribute a corresponding event to all applications currently subscribed to the topic. The Hub SHALL replace the context.versionId in the request with a new context.versionId generated and retained by the Hub. The prior version, context.priorVersionId of the context is also provided to ensure that an application is currently in sync with the latest context prior to applying the new changes. If the value of context.priorVersionId is not in agreement with the context.versionId last received by an application, it is recommended that the application issue a GET request to the Hub in order to retrieve the latest version of the context (note that the GET request returns the context, all existing content, and its context.versionId).
{
"timestamp": "2019-09-10T14:58:45.988Z",
"id": "0d4c7776",
"event": {
"hub.topic": "DrXRay",
"hub.event": "DiagnosticReport-update",
"context.versionId": "efcac43a-ed38-49e4-8d79-73f78290292a",
"context.priorVersionId": "b9574cb0-e9e5-4be1-8957-5fcb51ef33c1",
"context": [
{
"key": "report",
"resource": {
"resourceType": "DiagnosticReport",
"id": "40012366"
}
},
{
"key": "updates",
"resource": {
"resourceType": "Bundle",
"id": "8i7tbu6fby5fuuey7133eh",
"type": "transaction",
"entry": [
{
"request": {
"method": "POST"
},
"resource": {
"resourceType": "ImagingStudy",
"description": "CHEST XRAY",
"started": "2010-02-14T01:10:00.000Z",
"id": "3478116342",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "ACSN"
}
]
},
"value": "3478116342"
},
{
"system": "urn:dicom:uid",
"value": "urn:oid:2.16.124.113543.6003.1154777499.30276.83661.3632298176"
}
]
}
},
{
"request": {
"method": "POST"
},
"resource": {
"resourceType": "Observation",
"id": "435098234",
"partOf": {
"reference": "ImagingStudy/3478116342"
},
"status": "preliminary",
"category": {
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "imaging",
"display": "Imaging"
},
"code": {
"coding": [
{
"system": "http://www.radlex.org",
"code": "RID49690",
"display": "simple cyst"
}
]
},
"issued": "2020-09-07T15:02:03.651Z"
}
}
]
}
}
]
}
}
| Version | Description |
|---|---|
| 0.1 | Initial draft |
IG © 2017+ HL7 International - Infrastructure and Messaging. Package hl7.fhir.uv.fhircast#2.1.0-ballot based on FHIR 4.0.1. Generated 2022-04-01
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change