MHD Implementation Guide

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MHD Submissions

This is an example of an MHD submission. It is minimal in that it is a submission of a single document, its associated metadata, and the DocumentManifest/SubmissionSet which documents the submission. Also, each metadata object includes only the required attributes. Some are required by the IHE XDS profile and others required by the FHIR specification. Either way, this is the minimal set.

Sorry for the horrible use of codes but remember that famous quote from Star Trek (with apologies): Darn-it Jim, I'm an engineer, not a doctor.

FHIR Document

This example of a Provide Document Resources transaction only shows the minimum required fields and attributes. The HL7 FHIR documentation contains the full specification at http://www.hl7.org/implement/standards/fhir/xml.html#atom. The specification for what goes into the Atom feed (which makes it a FHIR Document) can be found at http://www.hl7.org/implement/standards/fhir/documents.html.

A FHIR Document is a submission of a bundle of resources organized by the Atom Feed wrapper. The term FHIR Document is unrelated to the IHE Document Sharing concept of Document which is a piece of stored content.

This example shows the most basic MHD submission: DocumentManifest, single DocumentReference, and the Binary resource holding the content of the Document Sharing document. In this example the Binary resource is packaged in the Atom Feed as a separate entry. It could have been packaged inside the DocumentReference in a <contained/> section. FHIR allows either encoding.

<?xml version="1.0" encoding="UTF-8"?>

<feed xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
 xsi:schemaLocation="http://www.w3.org/2005/Atom ../../../HL7/FHIR/Schema/atom.xsd"
 xmlns="http://www.w3.org/2005/Atom">
    <title>FHIR Document</title>
    <id>urn:uuid:29b42a31-4dc0-4021-ad67-fede99c5d3c1</id>
    <updated>2005-12-24T09:35:00</updated>
    <category scheme="http://hl7.org/fhir/tag" term="http://hl7.org/fhir/tag/document"/>
    <entry>
        <title>Entry title</title>
        <id>urn:uuid:5749d5ca-df77-4dd2-b9f4-dcdcdeb5c746</id>
        <updated>2005-12-24T09:35:00</updated>
        <content type="text/xml">
            <!-- The Composition resource anchors the submission by duplicating content in 
                the SubmissionSet and Association content in composing these separate 
                elements into a single submission. In XDS these elements are naturally 
                grouped.  In FHIR they would more naturally be submitted separately.  
                The Composition resource bridges the gap.
               -->
            <Composition xsi:schemaLocation="http://hl7.org/fhir file:/Users/bmajur/Documents/HL7/FHIR/Schema/fhir-all-xsd/fhir-all.xsd"
                xmlns="http://hl7.org/fhir">
                <text>
                    <status value="generated"/>
                    <div xmlns="http://www.w3.org/1999/xhtml"/>
                </text>
                <date value="2005-12-24T09:35:00"/>
                <type>
                    <text value="MHD Submission"/>
                </type>
                <status value="final"/>
                <confidentiality>
                    <system value="http://ihe.net/xds/connectathon/confidentialityCodes"/>
                    <code value="1.3.6.1.4.1.21367.2006.7.101"/>
                    <display value="Clinical-Staff"/>
                </confidentiality>                
                <subject>
                    <display value="King George"/>
                </subject>
                <author>
                    <display value="King George's Royal Doctor"/>
                </author>
                <!-- The sections tie together all the composed entries -->
                <section>
                    <!-- DocumentManifest -->
                    <content>
                        <!-- references the entry below -->
                        <reference value="urn:uuid:9d8257d3-ae40-4b02-b2b9-c0e8849bac8b"/>
                    </content>
                </section>
                <section>
                    <!-- DocumentReference -->
                    <content>
                        <!-- references the entry below -->
                        <reference value="urn:uuid:e15620b3-0dd3-44fd-b75b-f57598f7c752"/>
                    </content>
                </section>
                <section>
                    <!-- Binary (document content) -->
                    <content>
                        <!-- references the entry below -->
                        <reference value="urn:uuid:72fe0400-db3f-43a5-99ed-cad93a1595ad"/>
                    </content>
                </section>
            </Composition>
        </content>
    </entry>
    <entry>
        <title>Entry title</title>
        <id>urn:uuid:9d8257d3-ae40-4b02-b2b9-c0e8849bac8b</id>
        <updated>2005-12-24T09:35:00</updated>
        <content type="text/xml">
            <DocumentManifest xmlns="http://hl7.org/fhir">
                <!-- content removed -->
            </DocumentManifest>
        </content>
    </entry>
    <entry>
        <title>Entry title</title>
        <id>urn:uuid:e15620b3-0dd3-44fd-b75b-f57598f7c752</id>
        <updated>2005-12-24T09:35:00</updated>
        <content type="text/xml">
            <DocumentReference xmlns="http://hl7.org/fhir">
                <!-- content removed -->
            </DocumentReference>
        </content>
    </entry>
    <entry>
        <title>Entry title</title>
        <id>urn:uuid:72fe0400-db3f-43a5-99ed-cad93a1595ad</id>
        <updated>2005-12-24T09:35:00</updated>
        <content type="text/xml">
            <Binary xmlns="http://hl7.org/fhir" contentType="text/plain">
                QmFzZS02NCBjb250ZW50IGdvZXMgaGVyZQ==
            </Binary>
        </content>
    </entry>
</feed>

Minimal DocumentReference

This is the most basic MHD DocumentReference object. It contains the attributes required by XDS and by FHIR and includes nothing extra. The target of the reference #binary is not included. This has been validated with the FHIR schema but not yet tested against any of the FHIR test servers. It is parsed correctly by the Java Reference Implementation.

<?xml version="1.0" encoding="UTF-8"?>

<!-- DocumentReference
    This is the absolute minimalistic coding of an MHD DocumentReference with
    requirements coming from both FHIR and XDS.
-->
<DocumentReference xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
    xsi:schemaLocation="http://hl7.org/fhir file:/Users/bmajur/Documents/HL7/FHIR/Schema/fhir-all-xsd/fhir-all.xsd"
    xmlns="http://hl7.org/fhir">
    <!-- DocumentEntry.sourcePatientId and DocumentEntry.sourcePatientInfo
         coded as extension with a reference from the Patient resource representing
         the sourcePatient (information stored outside XDS environment on the patient -->
    <extension url="http://ihe.net/fhir/Profile/XDS/extensions#sourcePatient">
        <valueResource>
            <reference value="#sourcepatient"/>
        </valueResource>
    </extension>
    <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"/>
    </text>
    <contained>
        <!-- only detail is Patient ID 
             referenced by <subject/> DocumentEntry.patientId 
             this is the Affinity Domain patientID -->
        <Patient id="patient">
            <identifier>
                <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                <value value="1234"/>
            </identifier>
        </Patient>
    </contained>
    <contained>
        <!-- this could contain the full sourcePatientInfo detail 
             referenced by <subject/> DocumentEntry.patientId 
             this is the Source patientID -->
        <Patient id="sourcepatient">
            <identifier>
                <value value="DTG1234"/>
                <system value="urn:oid:7.7.7"/>
            </identifier>
        </Patient>
    </contained>
    <contained>
        <!-- DocumentEntry.author.authorPerson -->
        <Practitioner id="docdave">
            <name>
                <family value="Careful"/>
                <given value="Dave"/>
                <prefix value="Dr"/>
            </name>
        </Practitioner>
    </contained>
    <!-- DocumentEntry.uniqueId -->
    <masterIdentifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
    </masterIdentifier>
    <!-- DocumentEntry.patientId -->
    <subject>
        <reference value="#patient"/>
    </subject>
    <!-- DocumentEntry.typeCode -->
    <type>
        <coding>
            <system value="urn:oid:2.16.840.1.113883.6.1"/>
            <code value="28651-8"/>
            <display value="Nurse Transfer note"/>
        </coding>
    </type>
    <!-- DocumentEntry.classCode -->
    <class>
        <coding>
            <system value="urn:oid:1.3.6.1.4.1.21367.100.1"/>
            <code value="DEMO-Pt Mgmt"/>
            <display value="Patient Management"/>
        </coding>
    </class>
    <!-- DocumentEntry.author 
         this is required by FHIR and optional in XDS -->
    <author>
        <reference value="#docdave"/>
    </author>
    <!-- DocumentEntry.creationTime -->
    <created value="2005-12-24T09:35:00"/>
    <!-- required by FHIR - when was DocumentReference created -->
    <indexed value="2005-12-24T09:35:00"/>
    <!-- DocumentEntry.availabilityStatus (Approved) 
         FHIR requires this on submission -->
    <status value="current"/>
    <!-- DocumentEntry.confidentialityCode -->
    <confidentiality>
        <coding>
            <system value="urn:oid:2.16.840.1.113883.5.25"/>
            <code value="N"/>
            <display value="Normal"/>
        </coding>
    </confidentiality>
    <!-- DocumentEntry.languageCode -->
    <primaryLanguage value="en-US"/>
    <!-- DocumentEntry.mimeType -->
    <mimeType value="text/plain"/>
    <format value="urn:wustl:mir:ppoc:1999"/>
    <location value="#binary1"/>
    <!-- DocumentEntry.formatCode - 
         not a coded value like in XDS -->
    <context>
        <!-- DocumentEntry.healthcareFacilityTypeCode -->
        <facilityType>
            <coding>
                <system value="urn:oid:2.16.840.1.113883.5.11"/>
                <code value="PEDHO"/>
                <display value="Pediatric oncology clinic"/>
            </coding>
        </facilityType>
    </context>
</DocumentReference>

Minimal DocumentManifest

This is the most basic MHD DocumentManifest object. It contains the attributes required by XDS and by FHIR and includes nothing extra. This has been validated with the FHIR schema but not yet tested against any of the FHIR test servers.

<?xml version="1.0" encoding="UTF-8"?>

<!-- DocumentManifest
    This is the absolute minimalistic coding of an MHD DocumentManifest with
    requirements coming from both FHIR and XDS.
-->

<DocumentManifest xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
    xsi:schemaLocation="http://hl7.org/fhir file:/Users/bmajur/Documents/HL7/FHIR/Schema/fhir-all-xsd/fhir-all.xsd"
    xmlns="http://hl7.org/fhir">
    <!-- SubmissionSet.contentTypeCode. See Open Issue MHD022 for discussion on why this may be wrong! -->
    <extension url="http://ihe.net/fhir/Profile/XDS/extensions#contentTypeCode">
        <valueCodeableConcept>
            <coding>
                <system value="2.16.840.1.113883.6.1"/>
                <code value="28570-0"/>
                <display value="Procedure Note"/>
            </coding>
        </valueCodeableConcept>
    </extension>
    <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"/>
    </text>
    <contained>
        <!-- only detail is Patient ID 
             referenced by <subject/> SubmissionSet.patientId 
             this is the Affinity Domain patientID -->
        <Patient id="patient">
            <identifier>
                <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                <value value="1234"/>
            </identifier>
        </Patient>
    </contained>
    <!-- SubmissionSet.uniqueId -->
    <masterIdentifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:1.3.6.1.4.1.21367.2005.3.8"/>
    </masterIdentifier>
    <!-- DocumentEntry.patientId -->
    <subject>
        <reference value="#patient"/>
    </subject>
    <!-- SubmissionSet.availabilityStatus 
         FHIR requires this on submission -->
    <status value="current"/>
    <!-- This takes the place of the HasMember association placing
         a DocumentEntry/DocumentReference in the SubmissionSet. The
         referenced value is not present in the example since this is an example
         of just the DocumentManifest object. -->
    <content>
        <reference value="#DocumentEntry1"/>
    </content>
</DocumentManifest>

Full DocumentReference

This example contains all the attributes defined by XDS. The target of the reference #binary is not included. This is a work in progress.

<?xml version="1.0" encoding="UTF-8"?>

<!-- DocumentReference
    This example contains all the attributes defined by XDS.
-->
<DocumentReference xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
    xsi:schemaLocation="http://hl7.org/fhir file:/Users/bmajur/Documents/HL7/FHIR/Schema/fhir-all-xsd/fhir-all.xsd"
    xmlns="http://hl7.org/fhir">
    <!-- DocumentEntry.sourcePatientId and DocumentEntry.sourcePatientInfo
         coded as extension with a reference from the Patient resource representing
         the sourcePatient (information stored outside XDS environment on the patient -->
    <extension url="http://ihe.net/fhir/Profile/XDS/extensions#sourcePatient">
        <valueResource>
            <reference value="#sourcepatient"/>
        </valueResource>
    </extension>
    <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"/>
    </text>
    <contained>
        <!-- only detail is Patient ID 
             referenced by <subject/> DocumentEntry.patientId 
             this is the Affinity Domain patientID -->
        <Patient id="patient">
            <identifier>
                <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                <value value="1234"/>
            </identifier>
        </Patient>
    </contained>
    <contained>
        <!-- this could contain the full sourcePatientInfo detail 
             referenced by <subject/> DocumentEntry.patientId 
             this is the Source patientID -->
        <Patient id="sourcepatient">
            <identifier>
                <value value="DTG1234"/>
                <system value="urn:oid:7.7.7"/>
            </identifier>
        </Patient>
    </contained>
    <contained>
        <!-- DocumentEntry.author.authorPerson -->
        <Practitioner id="docdave">
            <name>
                <family value="Careful"/>
                <given value="Dave"/>
                <prefix value="Dr"/>
            </name>
        </Practitioner>
    </contained>
    <!-- DocumentEntry.uniqueId -->
    <masterIdentifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
    </masterIdentifier>
    <!-- DocumentEntry.patientId -->
    <subject>
        <reference value="#patient"/>
    </subject>
    <!-- DocumentEntry.typeCode -->
    <type>
        <coding>
            <system value="urn:oid:2.16.840.1.113883.6.1"/>
            <code value="28651-8"/>
            <display value="Nurse Transfer note"/>
        </coding>
    </type>
    <!-- DocumentEntry.classCode -->
    <class>
        <coding>
            <system value="urn:oid:1.3.6.1.4.1.21367.100.1"/>
            <code value="DEMO-Pt Mgmt"/>
            <display value="Patient Management"/>
        </coding>
    </class>
    <!-- DocumentEntry.author 
         this is required by FHIR and optional in XDS -->
    <author>
        <reference value="#docdave"/>
    </author>
    <!-- DocumentEntry.creationTime -->
    <created value="2005-12-24T09:35:00"/>
    <!-- required by FHIR - when was DocumentReference created -->
    <indexed value="2005-12-24T09:35:00"/>
    <!-- DocumentEntry.availabilityStatus (Approved) 
         FHIR requires this on submission -->
    <status value="current"/>
    <!-- DocumentEntry.confidentialityCode -->
    <confidentiality>
        <coding>
            <system value="urn:oid:2.16.840.1.113883.5.25"/>
            <code value="N"/>
            <display value="Normal"/>
        </coding>
    </confidentiality>
    <!-- DocumentEntry.languageCode -->
    <primaryLanguage value="en-US"/>
    <!-- DocumentEntry.mimeType -->
    <mimeType value="text/plain"/>
    <format value="urn:wustl:mir:ppoc:1999"/>
    <location value="#binary1"/>
    <!-- DocumentEntry.formatCode - 
         not a coded value like in XDS -->
    <context>
        <event>
          <coding>
            <system value="http://ihe.net/xds/connectathon/eventCodes"/>
            <code value="T-D8200"/>
            <display value="Arm"/>
          </coding>
        </event>
        <!-- DocumentEntry.healthcareFacilityTypeCode -->
        <facilityType>
            <coding>
                <system value="urn:oid:2.16.840.1.113883.5.11"/>
                <code value="PEDHO"/>
                <display value="Pediatric oncology clinic"/>
            </coding>
        </facilityType>
    </context>
</DocumentReference>

Transactions

Provide Document Bundle (ITI-65)

This transaction obsoletes "Put Document Dossier" (ITI-65) as described in section 3.65 of MHD Rev. 1.2 – 2013-09-20. Note that most of this text has been superceded by the MHD 2014 version. The examples and implementation guidance are left here as informative resources.

Most notable changes:

  • The new transaction leverages HL7 FHIR resources for request and response
  • The limitation to submit one document has been dropped

Closed issues:

  • Use Mailbox and FHIR messaging? No: has seen very limited use and would lead to unnecessary complication of the transaction.
  • How to efficiently encode large binary contained in the submission? For now: use FHIR binary and include the location as DocumentReference in the submission (example provided above). Could be checked as accessible.
  • Re-cycle transaction ITI-65 or introduce a new one? Re-use ITI-65.
  • Introduce an XDS option to further profile the expected actions - the availability of the created resources through XDS transactions? Or mark this out of scope? No option needed, used actor grouping with XDS Document Source.

Out of scope:

  • FHIR Conformance (declared or automated)

Informative stuff

Resource ids can be both relative URLs as well as full URIs, but only references to URLs can be made. In a bundle, the feed id is a UUID, but the individual resources are best coded as absolute URLs. In references, also full URLs need to be search locally before using it as a reference to an existing resource.

[1]

Example transactions

Request (JSON)
POST /net.ihe/DocumentManifest?patientID=patientID HTTP/1.1
Host: example.org
Accept: application/json
Content-Type: application/json+fhir
Origin: trustme.org

{
    "resourceType": "Bundle",
    "title": "example submission bundle",
    "id": "urn:uuid:f5207893-3074-4d38-8c83-0fdbfd79bdc0",
    "updated": "2004-12-25T22:20:10+01:00",
    "category": [{
        "scheme": "http://hl7.org/fhir/tag",
        "term": "http://ihe.net/fhir/tag/iti-65"
    }],
    "entry": [
        {
            "title": "title",
            "id": null,
            "updated": "2004-12-25T22:20:10+01:00",
            "content": {
                "resourceType": "DocumentManifest",
                "text": {
                    "status": "generated",
                    "div": "<div><p>comments for the submission set<\/p><\/div>"
                },
                "contained": [
                    {
                        "resourceType": "Practitioner",
                        "_id": "11375",
                        "role": [{"text": "Referrer"}],
                        "specialty": [{"text": "Radiology"}]
                    },
                    {
                        "resourceType": "Patient",
                        "_id": "patient",
                        "identifier": [
                            {
                                "use": "official",
                                "system": "urn:oid:1.3.6.1.4.1.21367.2005.3.7",
                                "value": "6578946"
                            },
                            {
                                "use": "usual",
                                "system": "urn:oid:1.2.3",
                                "value": "6578946"
                            }
                        ]
                    }
                ],
                "masterIdentifier": {
                    "system": "urn:ietf:rfc:3986",
                    "value": "urn:oid:1.3.6.1.4.1.40371.1.3.33830.62584.31048.57049.54365.50019.53148"
                },
                "subject": [{"reference": "#patient"}],
                "source": "urn:oid:1.3.6.1.4.1.21367.2005.3.7",
                "status": "current",
                "content": [
                    {"reference": "urn:uuid:bcf1fee3-6803-4fd5-9ef3-69d744d22823"},
                    {"reference": "urn:uuid:47c42e8e-38f3-4e1f-a096-4d15183d4f36"}
                ]
            }
        },
        {
            "title": "example DocumentEntry",
            "id": "urn:uuid:47c42e8e-38f3-4e1f-a096-4d15183d4f36",
            "updated": "2004-12-25T22:20:10+01:00",
            "content": {
                "resourceType": "DocumentReference",
                "text": {
                    "status": "generated",
                    "div": "<div><p>comments<\/p><\/div>"
                },
                "contained": [
                    {
                        "resourceType": "Practitioner",
                        "_id": "lisa.jensen",
                        "telecom": [{"value": "^^Internet^lisa.jensen@vestamedical.com"}],
                        "role": [{"text": "Referrer"}]
                    },
                    {
                        "resourceType": "Patient",
                        "_id": "patient",
                        "identifier": [
                            {
                                "use": "official",
                                "system": "urn:oid:1.3.6.1.4.1.21367.2005.3.7",
                                "value": "6578946"
                            },
                            {
                                "use": "usual",
                                "system": "urn:oid:1.2.3",
                                "value": "6578946"
                            }
                        ]
                    }
                ],
                "masterIdentifier": {
                    "system": "urn:ietf:rfc:3986",
                    "value": "urn:oid:1.3.6.1.4.1.40371.1.3.27817.10071.25344.32327.14622.20248.7826"
                },
                "subject": {"reference": "#patient"},
                "type": {"coding": [{
                    "system": "2.16.840.1.113883.6.1",
                    "code": "34104-0",
                    "display": "Consultation Note"
                }]},
                "class": {"coding": [{
                    "system": "2.16.840.1.113883.6.1",
                    "code": "28570-0",
                    "display": "Procedure Note"
                }]},
                "author": [{"reference": "#lisa.jensen"}],
                "created": "2004-12-25T22:20:10+01:00",
                "indexed": "2004-12-25T22:20:10+01:00",
                "status": "current",
                "description": "doc1",
                "mimeType": "text/plain",
                "format": ["urn:ihe:xds:formatCode:pdf^^Forcare formatCodes"],
                "location": "document1"
            }
        },
        {
            "title": "example DocumentEntry",
            "id": "urn:uuid:bcf1fee3-6803-4fd5-9ef3-69d744d22823",
            "updated": "2004-12-25T22:20:10+01:00",
            "content": {
                "resourceType": "DocumentReference",
                "text": {
                    "status": "generated",
                    "div": "<div><p>comments<\/p><\/div>"
                },
                "contained": [
                    {
                        "resourceType": "Practitioner",
                        "_id": "lisa.jensen",
                        "telecom": [{"value": "^^Internet^lisa.jensen@vestamedical.com"}],
                        "role": [{"text": "Referrer"}]
                    },
                    {
                        "resourceType": "Binary",
                        "_id": "doc1",
                        "contentType": "text/plain",
                        "content": "dGhpcyBpcyBteSBkb2N1bWVudC4="
                    },
                    {
                        "resourceType": "Patient",
                        "_id": "patient",
                        "identifier": [
                            {
                                "use": "official",
                                "system": "urn:oid:1.3.6.1.4.1.21367.2005.3.7",
                                "value": "6578946"
                            },
                            {
                                "use": "usual",
                                "system": "urn:oid:1.2.3",
                                "value": "6578946"
                            }
                        ]
                    }
                ],
                "masterIdentifier": {
                    "system": "urn:ietf:rfc:3986",
                    "value": "urn:oid:1.3.6.1.4.1.40371.1.3.8540.60734.56247.63167.57179.25543.26611"
                },
                "subject": {"reference": "#patient"},
                "type": {"coding": [{
                    "system": "2.16.840.1.113883.6.1",
                    "code": "34104-0",
                    "display": "Consultation Note"
                }]},
                "class": {"coding": [{
                    "system": "2.16.840.1.113883.6.1",
                    "code": "28570-0",
                    "display": "Procedure Note"
                }]},
                "author": [{"reference": "#lisa.jensen"}],
                "created": "2004-12-25T22:20:10+01:00",
                "indexed": "2004-12-25T22:20:10+01:00",
                "status": "current",
                "description": "doc2",
                "mimeType": "text/plain",
                "format": ["urn:ihe:xds:formatCode:pdf^^Forcare formatCodes"],
                "location": "document2"
            }
        },
        {
            "title": "DocumentEntry content",
            "id": "document1",
            "updated": "2004-12-25T22:20:10+01:00",
            "content": {
                "resourceType": "Binary",
                "contentType": "text/plain",
                "content": "TUhEIG9uIEZISVI="
            }
        },
        {
            "title": "DocumentEntry content",
            "id": "document2",
            "updated": "2004-12-25T22:20:10+01:00",
            "content": {
                "resourceType": "Binary",
                "contentType": "text/plain",
                "content": "TUhEIG9uIEZISVI="
            }
        }
    ]
}
Request (XML)
POST /net.ihe/DocumentManifest?patientID=patientID&_format=application/atom+xml HTTP/1.1
Host: example.org
Accept: application/xml
Content-Type: application/atom+xml
Origin: trustme.org

<feed xmlns="http://www.w3.org/2005/Atom">
    <title>example submission bundle</title>
    <id>urn:uuid:f5207893-3074-4d38-8c83-0fdbfd79bdc0</id>
    <updated>2004-12-25T22:20:10+01:00</updated>
    <category scheme="http://hl7.org/fhir/tag" term="http://ihe.net/fhir/tag/iti-65"/>
    <entry>
        <title>title</title>
        <id>0ff2318b-c524-42a4-bec4-f221c8081359</id>
        <updated>2004-12-25T22:20:10+01:00</updated>
        <content type="text/xml">
            <DocumentManifest xmlns="http://hl7.org/fhir">
                <text>
                    <status value="generated"/>
                    <div xmlns="http://www.w3.org/1999/xhtml">comments for the submission set</div>
                </text>
                <contained>
                    <Practitioner id="11375">
                        <role>
                            <text value="Referrer"/>
                        </role>
                        <specialty>
                            <text value="Radiology"/>
                        </specialty>
                    </Practitioner>
                </contained>
                <contained>
                    <Patient id="patient">
                        <identifier>
                            <use value="official"/>
                            <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                            <value value="6578946"/>
                        </identifier>
                        <identifier>
                            <use value="usual"/>
                            <system value="urn:oid:1.2.3"/>
                            <value value="6578946"/>
                        </identifier>
                    </Patient>
                </contained>
                <masterIdentifier>
                    <system value="urn:ietf:rfc:3986"/>
                    <value value="urn:oid:1.3.6.1.4.1.40371.1.3.33830.62584.31048.57049.54365.50019.53148"/>
                </masterIdentifier>
                <subject>
                    <reference value="#patient"/>
                </subject>
                <source value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                <status value="current"/>
                <content>
                    <reference value="0ff2318b-c524-42a4-bec4-f221c808133e"/>
                </content>
                <content>
                    <reference value="documententry2"/>
                </content>
                <!--
                <content id="0ff2318b-c524-42a4-bec4-f221c808133e"/>
                <content id="documententry2"/>
                -->
            </DocumentManifest>
        </content>
    </entry>
    <entry>
        <title>example DocumentEntry</title>
        <updated>2004-12-25T22:20:10+01:00</updated>
        <id>0ff2318b-c524-42a4-bec4-f221c808133e</id>
        <content type="text/xml">
            <DocumentReference xmlns="http://hl7.org/fhir">
                <language value="en-US"/>
                <text>
                    <status value="generated"/>
                    <div xmlns="http://www.w3.org/1999/xhtml">comments</div>
                </text>
                <contained>
                    <Practitioner id="lisa.jensen">
                        <telecom>
                            <value value="^^Internet^lisa.jensen@vestamedical.com"/>
                        </telecom>
                        <role>
                            <text value="Referrer"/>
                        </role>
                    </Practitioner>
                </contained>
                <contained>
                    <Patient id="patient">
                        <identifier>
                            <use value="official"/>
                            <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                            <value value="6578946"/>
                        </identifier>
                        <identifier>
                            <use value="usual"/>
                            <system value="urn:oid:1.2.3"/>
                            <value value="6578946"/>
                        </identifier>
                    </Patient>
                </contained>
                <masterIdentifier>
                    <system value="urn:ietf:rfc:3986"/>
                    <value value="urn:oid:1.3.6.1.4.1.40371.1.3.27817.10071.25344.32327.14622.20248.7826"/>
                </masterIdentifier>
                <subject>
                    <reference value="#patient"/>
                </subject>
                <type>
                    <coding>
                        <system value="2.16.840.1.113883.6.1"/>
                        <code value="34104-0"/>
                        <display value="Consultation Note"/>
                    </coding>
                </type>
                <class>
                    <coding>
                        <system value="2.16.840.1.113883.6.1"/>
                        <code value="28570-0"/>
                        <display value="Procedure Note"/>
                    </coding>
                </class>
                <author>
                    <reference value="#lisa.jensen"/>
                </author>
                <created value="2004-12-25T22:20:10+01:00"/>
                <indexed value="2004-12-25T22:20:10+01:00"/>
                <status value="current"/>
                <description value="doc1"/>
                <mimeType value="text/plain"/>
                <format value="urn:ihe:xds:formatCode:pdf^^Forcare formatCodes"/>
                <size value="11"/>
                <hash value="A2E2298974C2BE5A6E2C635247210C2CFCB42A94"/>
                <location value="document1"/>
            </DocumentReference>
        </content>
    </entry>
    <entry>
        <title>example DocumentEntry</title>
        <id>documententry2</id>
        <updated>2004-12-25T22:20:10+01:00</updated>
        <content type="text/xml">
            <DocumentReference xmlns="http://hl7.org/fhir">
                <language value="en-US"/>
                <text>
                    <status value="generated"/>
                    <div xmlns="http://www.w3.org/1999/xhtml">comments</div>
                </text>
                <contained>
                    <Practitioner id="lisa.jensen">
                        <telecom>
                            <value value="^^Internet^lisa.jensen@vestamedical.com"/>
                        </telecom>
                        <role>
                            <text value="Referrer"/>
                        </role>
                    </Practitioner>
                </contained>
                <contained>
                    <Patient id="patient">
                        <identifier>
                            <use value="official"/>
                            <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
                            <value value="6578946"/>
                        </identifier>
                        <identifier>
                            <use value="usual"/>
                            <system value="urn:oid:1.2.3"/>
                            <value value="6578946"/>
                        </identifier>
                    </Patient>
                </contained>
                <masterIdentifier>
                    <system value="urn:ietf:rfc:3986"/>
                    <value value="urn:oid:1.3.6.1.4.1.40371.1.3.8540.60734.56247.63167.57179.25543.26611"/>
                </masterIdentifier>
                <subject>
                    <reference value="#patient"/>
                </subject>
                <type>
                    <coding>
                        <system value="2.16.840.1.113883.6.1"/>
                        <code value="34104-0"/>
                        <display value="Consultation Note"/>
                    </coding>
                </type>
                <class>
                    <coding>
                        <system value="2.16.840.1.113883.6.1"/>
                        <code value="28570-0"/>
                        <display value="Procedure Note"/>
                    </coding>
                </class>
                <author>
                    <reference value="#lisa.jensen"/>
                </author>
                <created value="2004-12-25T22:20:10+01:00"/>
                <indexed value="2004-12-25T22:20:10+01:00"/>
                <status value="current"/>
                <description value="doc2"/>
                <mimeType value="text/plain"/>
                <format value="urn:ihe:xds:formatCode:pdf^^Forcare formatCodes"/>
                <size value="11"/>
                <hash value="805F6F66D093A19E589E3500EEBE2165A6BC51FC"/>
                <location value="document2"/>
            </DocumentReference>
        </content>
    </entry>
    <entry>
        <title>example DocumentEntry</title>
        <id>document1</id>
        <updated>2004-12-25T22:20:10+01:00</updated>
        <content type="text/xml">
            <Binary xmlns="http://hl7.org/fhir" contentType="text/plain">
                TUhEIG9uIEZISVI=
            </Binary>
        </content>
    </entry>
    <entry>
        <title>example DocumentEntry</title>
        <id>document2</id>
        <updated>2004-12-25T22:20:10+01:00</updated>
        <content type="text/xml">
            <Binary xmlns="http://hl7.org/fhir" contentType="text/plain">
                TUhEIFRlc3Rpbmc=
            </Binary>
        </content>
    </entry>
</feed>

Failure Response (JSON)
HTTP/1.1 400 Bad Request
Connection: close
Content-Type: application/json+fhir
Date: Thu, 23 Oct 2014 12:02:03 GMT
Access-Control-Allow-Origin: trustme.org
Access-Control-Expose-Headers: Content-Location, Location
Access-Control-Allow-Methods: GET, POST, PUT, DELETE, OPTIONS

{
  "resourceType": "OperationOutcome",
  "text": {
    "status": "generated",
    "div": "<p>failed to process transaction.</p>"
  },
  "issue": [
    {
      "severity": "error",
      "details": "Incorrect document syntax."
    }
  ]
}
Failure Response (XML)

HTTP/1.1 400 Bad Request
Connection: close
Content-Type: application/xml
Date: Thu, 23 Oct 2014 12:02:03 GMT
Access-Control-Allow-Origin: trustme.org
Access-Control-Expose-Headers: Content-Location, Location
Access-Control-Allow-Methods: GET, POST, PUT, DELETE, OPTIONS

<?xml version="1.0" encoding="UTF-8"?>
<OperationOutcome xmlns="http://hl7.org/fhir">
  <text>
    <status value="generated"/>
    <p xmlns="http://www.w3.org/1999/xhtml">failed to process transaction.</p>
  </text>
  <issue>
    <severity value="error"/>
    <details value="Incorrect document syntax."/>
  </issue>
</OperationOutcome>

Success response (XML)

HTTP/1.1 200 OK
Content-Type: application/xml
Date: Thu, 23 Oct 2014 12:02:03 GMT
Access-Control-Allow-Origin: trustme.org
Access-Control-Expose-Headers: Content-Location, Location
Access-Control-Allow-Methods: GET, POST, PUT, DELETE, OPTIONS

<?xml version="1.0" encoding="UTF-8"?>

<feed xmlns="http://www.w3.org/2005/Atom">
  <title>example submission bundle</title>
  <id>urn:uuid:c03319ea-f614-41a6-826e-24e85aa8c33f</id>
  <updated>2014-12-14T20:42:58.844+01:00</updated>
  <category scheme="http://hl7.org/fhir/tag" term="http://ihe.net/fhir/tag/iti-65"/>
  <entry>
    <title>title</title>
    <id>urn:uuid:e4254d45-f0c6-4efa-9a9c-444f5f41e0ce</id>
    <updated>2014-12-14T20:42:59.474+01:00</updated>
    <content type="text/xml">
      <DocumentManifest xmlns="http://hl7.org/fhir">
        <text>
          <status value="generated"/>
          <p xmlns="http://www.w3.org/1999/xhtml">comments for the submission set</p>
        </text>
        <contained>
          <Practitioner id="11375">
            <role>
              <text value="Referrer"/>
            </role>
            <specialty>
              <text value="Radiology"/>
            </specialty>
          </Practitioner>
        </contained>
        <masterIdentifier>
          <value value="1.3.6.1.4.1.40371.1.3.21757.47558.26996.14909.64014.54613.13514"/>
        </masterIdentifier>
        <identifier>
          <use value="official"/>
          <value value="urn:uuid:2b072aa4-4b59-498d-9db0-6cc818fd19ad"/>
        </identifier>
        <subject>
          <reference value="#patient"/>
        </subject>
        <created value="2004-12-25T22:20:10+01:00"/>
        <source value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
        <status value="current"/>
      </DocumentManifest>
    </content>
  </entry>
  <entry>
    <title>example DocumentEntry</title>
    <id>urn:uuid:eacf0462-e15a-46c6-b675-7300a06c9e99</id>
    <updated>2014-12-14T20:42:59.482+01:00</updated>
    <content type="text/xml">
      <DocumentReference xmlns="http://hl7.org/fhir">
        <language value="en-US"/>
        <text>
          <status value="generated"/>
          <p xmlns="http://www.w3.org/1999/xhtml">comments</p>
        </text>
        <contained>
          <Practitioner id="lisa.jensen">
            <telecom>
              <value value="^^Internet^lisa.jensen@vestamedical.com"/>
            </telecom>
            <role>
              <text value="Referrer"/>
            </role>
          </Practitioner>
        </contained>
        <contained>
          <Patient id="patient">
            <identifier>
              <use value="official"/>
              <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
              <value value="6578946"/>
            </identifier>
            <identifier>
              <use value="usual"/>
              <system value="urn:oid:1.2.3"/>
              <value value="6578946"/>
            </identifier>
          </Patient>
        </contained>
        <identifier>
          <value value="1.3.6.1.4.1.40371.1.3.46370.54362.21315.10486.39520.53654.43185"/>
        </identifier>
        <subject>
          <reference value="#patient"/>
        </subject>
        <type>
          <coding>
            <system value="2.16.840.1.113883.6.1"/>
            <code value="34104-0"/>
            <display value="Consultation Note"/>
          </coding>
        </type>
        <class>
          <coding>
            <system value="2.16.840.1.113883.6.1"/>
            <code value="28570-0"/>
            <display value="Procedure Note"/>
          </coding>
        </class>
        <author>
          <reference value="#lisa.jensen"/>
        </author>
        <created value="2004-12-25T22:20:10+01:00"/>
        <indexed value="2004-12-25T22:20:10+01:00"/>
        <status value="current"/>
        <description value="doc1"/>
        <mimeType value="application/pdf"/>
        <format value="urn:ihe:xds:formatCode:pdf^^Forcare formatCodes"/>
        <size value="20"/>
        <hash value="da39a3ee5e6b4b0d3255bfef95601890afd80709"/>
        <location value="https://localhost/mhd2/Binary/145952f8-70c4-4ffd-a388-5fd4d216fac7"/>
      </DocumentReference>
    </content>
  </entry>
  <entry>
    <title>example Binary resource</title>
    <id>http://example.org/Binary/f185f16b-3608-4c48-af48-a878831453c5</id>
    <updated>2014-12-14T20:42:59.482+01:00</updated>
    <content type="text/xml">
      <Binary xmlns="http://hl7.org/fhir" contentType="text/plain">dGhpcyBpcyBteSBkb2N1bWVudC4=</Binary>
    </content>
  </entry>
  <entry>
    <title>example DocumentEntry</title>
    <id>urn:uuid:f185f16b-3608-4c48-af48-a878831453c4</id>
    <updated>2014-12-14T20:42:59.482+01:00</updated>
    <content type="text/xml">
      <DocumentReference xmlns="http://hl7.org/fhir">
        <language value="en-US"/>
        <text>
          <status value="generated"/>
          <p xmlns="http://www.w3.org/1999/xhtml">comments</p>
        </text>
        <contained>
          <Practitioner id="lisa.jensen">
            <telecom>
              <value value="^^Internet^lisa.jensen@vestamedical.com"/>
            </telecom>
            <role>
              <text value="Referrer"/>
            </role>
          </Practitioner>
        </contained>
        <contained>
          <Patient id="patient">
            <identifier>
              <use value="official"/>
              <system value="urn:oid:1.3.6.1.4.1.21367.2005.3.7"/>
              <value value="6578946"/>
            </identifier>
            <identifier>
              <use value="usual"/>
              <system value="urn:oid:1.2.3"/>
              <value value="6578946"/>
            </identifier>
          </Patient>
        </contained>
        <identifier>
          <value value="1.3.6.1.4.1.40371.1.3.35523.18870.12035.13365.18120.26591.19818"/>
        </identifier>
        <subject>
          <reference value="#patient"/>
        </subject>
        <type>
          <coding>
            <system value="2.16.840.1.113883.6.1"/>
            <code value="34104-0"/>
            <display value="Consultation Note"/>
          </coding>
        </type>
        <class>
          <coding>
            <system value="2.16.840.1.113883.6.1"/>
            <code value="28570-0"/>
            <display value="Procedure Note"/>
          </coding>
        </class>
        <author>
          <reference value="#lisa.jensen"/>
        </author>
        <created value="2004-12-25T22:20:10+01:00"/>
        <indexed value="2004-12-25T22:20:10+01:00"/>
        <status value="current"/>
        <description value="doc2"/>
        <mimeType value="application/pdf"/>
        <format value="urn:ihe:xds:formatCode:pdf^^Forcare formatCodes"/>
        <size value="20"/>
        <hash value="da39a3ee5e6b4b0d3255bfef95601890afd80709"/>
        <location value="Binary/doc1"/>
      </DocumentReference>
    </content>
  </entry>
  <entry>
    <title>example Binary resource</title>
    <id>http://example.org/Binary/f185f16b-3608-4c48-af48-a878831453c6</id>
    <updated>2014-12-14T20:42:59.482+01:00</updated>
  </entry>
</feed>