Prehospital Patient Care Report

PPCR

The PPCR integration profile describes the content and format of a CDA document to be used for reporting the care and treatment recieved by a patient prior to arrival at an emergency room, urgent care center or similar emergency care facility. The purpose of this profile is to support the interoperabal exchange of clinical data between the EMS system used by the first responders and the emergency department information systems used in the emergency care setting.

Actors/Transaction

There are two actors in the PPCR profile, the Content Creator and the Content Consumer. Content is created by a Content Creator and is to be consumed by a Content Consumer. The sharing or transmission of content from one actor to the other is addressed by the appropriate use of IHE profiles described below, and is out of scope of this profile. A Document Source or a Portable Media Creator may embody the Content Creator Actor. A Document Consumer, a Document Recipient or a Portable Media Importer may embody the Content Consumer Actor. The sharing or transmission of content or updates from one actor to the other is addressed by the use of appropriate IHE profiles described in the section on Content Bindings with XDS, XDM and XDR.

PPCR Actor Diagram

Options

PPCR Options

Actor	Option
Content Consumer	View Option (1)
	Document Import Option (1)
	Section Import Option (1)
	Discrete Data Import Option (1)

Note 1: The Actor shall support at least one of these options.

Content Consumer Options

View Option

This option defines the processing requirements placed on Content Consumers for providing access, rendering and management of the medical document. See the View Option in PCC TF-2 for more details on this option.

A Content Creator Actor should provide access to a style sheet that ensures consistent rendering of the medical document content as was displayed by the Content Consumer Actor.

The Content Consumer Actor shall be able to present a view of the document using this style sheet if present.

Document Import Option

This option defines the processing requirements placed on Content Consumers for providing access, and importing the entire medical document and managing it as part of the patient record. See the Document Import Option in PCC TF-2 for more details on this option.

Section Import Option

This option defines the processing requirements placed on Content Consumers for providing access to, and importing the selected section of the medical document and managing them as part of the patient record. See the Section Import Option in PCC TF-2 for more details on this option.

Discrete Data Import Option

This option defines the processing requirements placed on Content Consumers for providing access, and importing discrete data from selected sections of the medical document and managing them as part of the patient record. See the Discrete Data Import Option in PCC TF-2 for more details on this option.

Coded Terminologies

This profile supports the capability to record entries beyond the IHE required coding associated with structured data. Actors from this profile may choose to utilize coded data, but interoperability at this level requires an agreement between the communicating parties that is beyond the scope of this Profile.

To facilitate this level of interoperability, the applications that implement actors within this profile shall provide a link to their HL7 conformance profile within their IHE Integration statement. The conformance profile describes the structure of the information which they are capable of creating or consuming. The conformance profile shall state which templates are supported by the application implementing the profile Actors, and which vocabularies and/or data types are used within those templates. It should also indicate the optional components of the entry that are supported.

An Example HL7 Conformance Profile is available to show how to construct such a statement. See the HL7 Refinement Constraint and Localization for more details on HL7 conformance profiles.

PPCR Content Modules

PPCR Module

The content exchanged shall be structured and coded as required by the PHR Extract Module Content. The Content Creator Actor creates a PHR Extract and shares it with the Content Consumer.

PPCR Integration Profile Process Flow

Personal Health Record (PHR) to EMR

Precondition: A patient is using a Personal Health Record application system at home for the record keeping of patient-originated medical information (e.g. social history, family history), snapshots of clinical information that may have been provided from previous care encounters (e.g. medication list, immunization records, etc), and current observations from home care medical devices (e.g. blood pressure, blood sugar level, etc).

Events:

Postcondition:

Basic Process Flow in XPHR Profile

Grouping with Other Actors

Cross Enterprise Document Sharing, Media Interchange and Reliable Messages

Actors from the ITI XDS, XDM and XDR profiles embody the Content Creator and Content Consumer sharing function of this profile. A Content Creator or Content Consumer may be grouped with appropriate actors from the XDS, XDM or XDR profiles to exchange the content described therein. The metadata sent in the document sharing or interchange messages has specific relationships or dependencies (which we call bindings) to the content of the clinical document described in the content profile.

The Patient Care Coordination Technical Framework defines the bindings to use when grouping the Content Creator of this Profile with actors from the IHE ITI XDS, XDM or XDR Integration Profiles.

Content	Binding	Actor	Optionality
PHR Extract	Medical Document Binding to XDS, XDM and XDR	Content Creator	R
		Content Consumer	R

Document Digital Signature (DSG)

Content Creator actors should digitally sign all documents using the Digital Signature (DSG) Content Profile.

Content Consumer actors should verify the Digital Signature of the submission set before use of the information it contains.

Requirements of PPCR Actors

This section describes the specific requirements for each Actor defined within this profile. Specific details can be found in Volume 1 and Volume 2 of the technical framework.

Content Creator

1. A Content Creator shall be able to create a PPCR Document according to the specification for that content profile found in PCC TF-2.

1. A Content Creator shall be grouped with the Time Client Actor, and shall synchronize its clock with a Time Server.
2. A Content Creator shall be grouped with the Secure Node or Secure Application Actor of the ATNA profile.
3. All activity initiated by the application implementing the Content Creator shall generate the appropriate audit trail messages as specified by the ATNA Profile. The bare minimum requirements of a Content Creator are that it be able to log creation and export of clinical content.
4. A Content Creator shall use secure communications for any document exchanges, according to the specifications of the ATNA profile.

Content Consumer

1. A Content Consumer shall be able to consume a PPCR Document.

1. A Content Consumer shall implement the View Option or Discrete Data import option, or both.
2. A Content Consumer that implements the Document Import or Section Import Option shall implement the View Option as well.
3. A Content Consumer that implements the View option shall be able to:
   1. Demonstrate rendering of the document for display.
   2. Print the document.
   3. Display the document with its original stylesheet.
   4. Support traversal of any links contained within the document.
4. A Content Consumer that implements the Document Import Option shall:
   1. Store the document.
   2. Demonstrate the ability to access the document again from local storage.
5. A Content Consumer that implements the Section Import Option shall offer a means to import one or more document sections into the patient record as free text.
6. A Content Consumer that implements the Discrete Data Import Option shall offer a means to import structured data from one or more sections of the document.
7. A Content Consumer Actor shall be grouped with the Time Client Actor, and shall synchronize its clock with a Time Server.
8. All activity initiated by the application implementing the Content Consumer shall generate the appropriate audit trail messages as specified by the ATNA Profile. The bare minimum requirements of a Content Consumer are that it be able to log views or imports of clinical content.
9. A Content Consumer shall log events for any views of stored clinical content.
10. A Content Consumer shall use secure communications for any document exchanges, according to the specifications of the ATNA profile.