Specification for a SHR Transfer Order

Architecture & Standards
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Hi all,

I apologise in advance if I missed some obvious resources, and I’ll be grateful for being pointed to them.

Let us imagine an HIE architecture with at least the following three components:

  1. Client Registry
  2. SHR Repository
  3. Some remote EMR system authenticated to consume both the Client Registry and the SHR Repository APIs.

Let us now imagine a typical workflow where a patient identity was found within the Client Registry from the remote EMR system, and the SHR for that patient is being requested to be transferred to the EMR. I am trying to illustrate this below with a flow chart:

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This is an async workflow where the SHR transfer order needs to go through an approval process before the data can be sent out to the requester.

I am wondering if anyone in this group has come across such a workflow? And if yes, if there is any guidance, documentation or literature on how to generate, represent and handle those SHR transfer orders.

Any input would be much appreciated!

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Hi Dimitri,

In the OpenHIE spec, the Query patient-level clinical data workflow is probably closest to this, with a few variations.

We’ve also been looking at the IHE Mobile Health Document Sharing (MHDS) profile (see here and here) in supporting a FHIR-based HIE and Document Registry for the SHR. There’s support for a few different document sharing models for retrieving clinical content, and use of the IUA profile that looks aligned with the approval process you’ve described (there’s also been some discussion on related tools like Keycloak to support SSO and identity brokering).

Hope that helps, and happy to chat more about your use case more on an upcoming SHR community call if that’d help.

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Thanks @daniel.futerman, those are very useful resources.

Yes indeed the query patient-level clinical data workflow seems to be addressing a good part of the workflow that we envision.

For example this would be the sharing model:

Push – in this model, clinical content in the form of documents and metadata is sent directly to a known recipient, or published on media for delivery

That is because if the transfer order is validated, then it is up to the SHR Repository to push the requested SHR to the recipient as specified in the order.

I have been skimming through the links that you shared and I didn’t see anything specific about an order document. It is all part of the wider process of requesting patient level data. As for this request to materialize as an ex-cathedra order… that is not explicitly described (I think).

(I would be happy to join the next SHR Community Call, I’ll try to have it on my radar.)

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