Mobile access to Health Documents (MHD)

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Contents


Summary

Mobile access to Health Documents (MHD) profile defines a simple HTTP interface to an XDS like environment. It defines transactions to a) submit a new document and metadata from the mobile device to a document receiver, b) get the metadata for an identified document, c) find document entries containing metadata based on query parameters, and d) retrieve a copy of a specific document. These transactions leverage the document content and format agnostic metadata concepts from XDS, but simplify them for access by constrained environments such as mobile devices. The MHD profile does not replace XDS. It can be used to allow mobile devices constrained access to an XDS health information exchange. The following figure shows one possible way to implement MHD with a document sharing environment (that may, but is not necessarily, XDS based). This implementation choice is not mandatory and we recognize other architectures will be implemented. An Implementation Guide is being maintained at mHealth Dossier Guide.

Benefits

RESTful interface to XDS and other Document Sharing environments The XDS profile is specifically designed to support the needs of Cross-Enterprise security, privacy, interoperability, and includes characteristics to support this level of policy and operational needs. The MHD profile has simplified the interactions in ways that are more consistent with a single policy domain use. The MHD transactions are not specifically tied to XDS, and some of the system implementations envisioned would interface directly to an organizational EHR, or a multi-national PHR.

The following lists a few examples of the environments which might choose to use the MHD profile instead of the XDS profile. The MHD profile supports a broad set of the XDS use cases and functionality while keeping the technology as simple as possible. The MHD profile is focused on a useful subset of the use-cases that XDS supports and does not try to reproduce the full scalability, flexibility, privacy, or security supported by the more robust XDS infrastructure.

  • Medical devices such as those targeted by the Patient Care Devices (PCD) domain or Continua organization, submitting data in the form of documents.
  • Kiosks used by patients in hospital registration departments, where it is anticipated that a hospital staff member will review, edit, and approve the document before it is allowed into the hospital system.
  • PHR publishing into a staging area for subsequent import into an EHR or HIE.
  • Patient or provider application that is configured to securely connect to a PHR in order to submit a medical history document.
  • Electronic measurement device participating in an XDW workflow and pulling medical history documents from an HIE.
  • A General Practitioner physician’s office with minimal IT capabilities using a mobile application to connect to an HIE or EHR.

Details

Applications specific to mobile device is an emerging platform for healthcare enhancing software. These devices are resource and platform constrained, which drives the implementer to use simpler network interface technology. There are numerous uses of documents, for example hosted by a Health Information Exchange (HIE), large health provider electronic health record (EHR), or personal health record (PHR).

The Mobile access to Health Documents (MHD) profile defines one standardized interface to health documents for use by mobile devices so that deployment of mobile applications is more consistent and reusable. In this context, mobile devices include tablets and smart-phones, plus embedded devices like home-health devices. This profile is also applicable to larger systems where the needs are simple, such pulling the latest summary for display. The critical aspects of the ‘mobile device’ are that it is resource constrained, has a simple programming environment (e.g., JSON, javascript), simple network stack (e.g., HTTP), and simple display functionality (e.g., HTML browser). The goal is to limit the additional libraries that are necessary to process SOAP, WSSE, MIME-Multipart, MTOM/XOP, ebRIM, and multi-depth XML.

The Mobile access to Health Documents (MHD) profile defines actors and transactions. There is one set of actors and a transaction used to submit a single new document entry from the mobile device to a receiving system. The other set of actors and transactions is used to get a list of document entries containing metadata, and to retrieve a copy of a specific document.

These transactions leverage the metadata concepts from XDS, but simplify the technology requirements for access by mobile devices. The MHD profile defines a Document Dossier that is focused on the Document Entry as defined by XDS with all the related metadata including Submission Sets, Folders, and Associations. The MHD profile does not replace XDS. It enables simplified access by mobile devices to an XDS (or a similar) document management environment containing health information.

Systems Affected

Systems involved in this profile are:

  • Any application or service that would like to use RESTful interactions for Document Sharing.

Actors & Transactions:

Figure 33.1-1 MHD Actor Diagram

Specification

Profile Status: Trial Implementation

The IHE MHD profile and the HL7 FHIR activities are working together to revise and enhance the transactions profiled here. At present, the MHD profile is being held stable while the FHIR development activity proceeds. The schema and details shown here in the MHD profile differ slightly from the FHIR proposal, and FHIR is still evolving. When FHIR reaches a natural stable point, this MHD profile will be updated to reflect the changes made in FHIR. See http://hl7.org/fhir

Documents: MHD Supplement

Underlying Standards:

  • RFC2616 IETF Hypertext Transfer Protocol – HTTP/1.1
  • RFC3986 IETF Uniform Resource Identifier (URI): Generic Syntax
  • RFC4627 The application/json Media Type for JavaScript Object Notation (JSON)
  • RFC6585 IETF Additional HTTP Status Codes
  • RFC4287 The Atom Syndication Format

See Also

This profile supports the security/privacy model discussed in Health Information Exchange: Enabling Document Sharing Using IHE Profiles white paper.

This is a work item in 2012. The draft documents can be found on the FTP in the following folder

An Implementation Guide is being maintained at mHealth Dossier Guide.

Related Profiles

  • Profile Proposal for 2013 on Mobile Application Authentication and Authorization.

This page is based on the Profile Template

Current: IT Infrastructure Technical Framework.

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