Guidance on writing Profiles of FHIR

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Current guidance to IHE profile writers when they profile FHIR. Comments and questions to JohnMoehrke@gmail.com

UPDATED for use of IG Publisher

IHE is starting to leverage the IG Publisher to develop, manage, and publish IHE-Profiles.

UPDATED for FHIR Release 4

  • previous use of period '.' can NOT be used in name/id/etc. This guidance has been updated to show the use of underscore '_' in the place where previous we recommended period.
  • to enable use of the FHIR IG build tools, we now put the type of conformance resource at the beginning of the filename
    • "structuredefinition-IHE_PDQm_Patient"
  • do not specify a .id value. The .url is now the canonical URI that the tooling will look for.
  • FHIR Release 4 specifics

checklist for when converting a FHIR STU3 to R4

From the experience with the priority set of profiles:

  • Convert all mentions of STU3 to R4. This requires careful editing in word, as just changing the visible text does not change the URL under.
    • When the target FHIR specification page is a Normative page (e.g. Patient Resource is normative), then the URL used could be non-version -- e.g. http://hl7.org/fhir/Patient
  • There was a common convention for expressing a code in the narrative as the URL"#"code. This convention is not useful in narrative. Express specifically system and code values explicitly.
  • Note that terminology that is not FHIR core is now on https://terminology.hl7.org, so check each terminology system is proper for R4
  • Confirm that the Resource elements are correct
    • Often element names change from STU3
    • Often elements position change from STU3
    • Often element cardinality or datatype change from STU3
    • Confirm proper use of Reference elements (at STU3 Reference datatype became complex to include url, id, and description. )
  • any canonical URI should NOT be marked in word as a hyperlink, use the style for xmlName to highlight it is a canonical URI and not a clickable link
  • Confirm that query parameter names and types are correct
  • Check Open Issues to determine if they can now be closed
    • Often where a change to the FHIR specification was needed a jira ticket would have been registered. Check that these are resolved and adjust
  • Check any IHE Change Proposals for the profile being worked on.
    • Often times a change proposal can be resolved along with the revision
    • When a change proposal is resolved, indicate this with a Closed Item mentioning it, and update the Change Proposal tracking
    • Sometimes when a change proposal can not be fully resolved it may still be best to include the issue as an Open Issue, and update the Change Proposal tracking.
  • Update any conformance resources to R4
    • Conformance resources are required starting with FHIR R4, but are informative.
    • Conformance resources are managed on GitHub
  • Volume 2 "References" section should only reference FHIR, and not include JSON, XHTML, XML, etc. Leave it to FHIR to pull these in.

Current Guidance on 'use' of FHIR

FHIR is an emerging standard from HL7. It is mostly at "Standard for Trial Use" (STU), with some foundational aspects at "Normative". FHIR is an acceptable stage for IHE Profile use. Using the portions of FHIR at STU would be less stable than a Normative standard. Sometimes IHE will Profile a STU standard because it is the best fit for the use-case analysis. See Standards Selection Process

An IHE Profile that is using a STU standard must stay at "Trial Implementation" until the underlying standard progresses to Normative status. See IHE Profile Phases of Development. See Final Text Process

Because FHIR is seen as unstable by some, we agree the FMM of the used FHIR parts should be exposed prominently within the IHE Profile supplement. (see #Normative content in IHE Supplement)

The general process explained here is:

  1. #Normative content in IHE Supplement
  2. #FHIR conformance resources with pointers back toward your #wiki Profiles page
  3. #Publish to global FHIR Registry
  4. Update your #wiki Profiles page with pointers to your conformance resources
  5. Get #Public Comment on your conformance resources in addition to your supplement
  6. Publish #Examples of messages

Going beyond these guidance is welcome, but not yet described. See #Near Future and #Ultimate Future

Tools

The person's name I have listed is not the only one to give credit to, but is listed to help explain the linage (Provenance) of that tool.

Current Guidance on writing Profiles of FHIR

FHIR offers some new ways to publish what IHE calls a Profile. IHE must first continue to follow our governance and produce normative content in IHE Supplement format. Second priority is to leverage the new FHIR conformance Resources.

Normative content in IHE Supplement

The human readable text is what IHE publishes as the Normative content. Following the long standing Supplement format, governance, public-comment, and publication mechanisms that IHE uses for all Profiles.

  • IG Publisher
    • All content in the IG Publisher is considered Normative unless marked as Informative.
    • The IG publisher produces many human readable pages given source material that is in a coded format (JSON, XML, FSH).
    • There are considerations for how this ultimately are reconciled, as experience shows it is hard to review everything when the IG publisher is used.
  • PDF publication mechanism
    • For RESTful exchange, right now the recommendation is to treat this as a Transaction profile. The common http portion is very small and can be copied from PDQm. RESTful profiles will need to define various actor requirements as typical for a Transaction profile (Trigger events, Query parameters, expected actions, etc), in addition to the encoding (Profile of the FHIR Resource). Thus at this time the recommendation is to do RESTful exchanges as a normal Transaction Profile.
  • Supplement should expose the FHIR Maturity Model (FMM) evaluation of the parts (e.g. Resources) used from FHIR. This helps expose to the reader of the supplement the level of maturity. A lower number means less stable FHIR specification.
    • Title page have text at 12 point (smaller than other text on the title page) "HL7® FHIR® STU 3",
    • and the range of FMM (this example is 1-5) -- "Using Resources at FMM Levels 1-5"
    • using "N" for resources that are normative
    • Note that when a resource is normative, the query parameters and extensions used are likely not. The recommendation so far is to just focus on the FMM of the resources, not each sub portion.
    • Introduction to the Supplement - should explain this FMM in more detail
    • See MHD as an example or the current supplement template [fhttps://drive.google.com/drive/folders/1q-p_efI8foXstZbm0t0NIsUuJoJgVdWZ here]
  • Volume 1 is very close to what is visualized for FHIR Implementation Guide. Defining Actors, Transactions, Options; and showing how they work together.
    • As with typical profiles, IHE will often require servers to support more capability than we require clients to use. Thus often the server actor will not need to have options, where as clients might need to have distinctions defined in options.
  • Volume 2+ should be kept to minimum, but must include ALL normative requirements (SHALL) of the profile
    • "References" section should only reference FHIR, and not include JSON, XHTML, XML, etc. Leave it to FHIR to pull these in.
    • When a FHIR resource is constrained in an IHE profile, the table documenting those constraints should contain the same column headings
      • FHIR Resource Element Name, IHE Constraint, Mapping, Notes
      • For rules (invariant) put a unique note number in the table, with the rules expressed in table end-notes
    • When documenting a constrained FHIR resource in an IHE profile the table should contain all elements in the resource, not just those constrained by IHE.
    • When a FHIR resource is extended in an IHE profile, the table documenting those constraints should contain the same column headings
    • ITI has a Volume 2 “Appendix Z on FHIR”. This is published now as a standalone supplement, and will be updated as needed. It is intended to be referenced by IHE FHIR-based profiles for ‘common’ stuff, eg error codes, cardinality definitions, security considerations. ITI expects the contents will grow over time, and other domains might suggest future expansions to the content by submitting a CP.
    • When a bug is found in FHIR, or where a new capability is needed in FHIR; the committee should submit a Change Request (CR) to FHIR, and include the resulting CR number as an "Open Issue" in their IHE Profile supplement. This aids with keeping track for future revisions and knowledge.
    • A link to submit a report is found at the bottom of all of HL7's FHIR pages. To do so requires a "Jira" account, which can be requested from the tracker logon page; account requests are usually approved within a day.
      • Contact JohnMoehrke@gmail.com if you need help submitting tracker items, or tracking them
  • Consider strongly the use of the .meta.profile element use as a method of tagging resources as compliant with your IHE Profile. This is a good constraint for IHE to add, it adds value.
    • On Query type transactions consider strongly the requirement to support the _profile query parameter. That is a server must support this query parameter, your profile will identify the canonical URI to be used. And the client of the query 'can' use this query parameter to constrain the results to the set of Resources that are complaint with your IHE Profile. This would limit the number of false-positive results, in an environment where the server is a multi-purpose FHIR server; this query parameter would likely do nothing in an environment where the FHIR server is dedicated to your IHE Profile. This works when the server support the query parameter, or is dedicated to your profile.

FHIR conformance resources

The second priority is to produce FHIR conformance resources. These are usually XML files as will be described here. The result of this is published conformance resources which are Informative at this time.

  • Published on IHE site in the Implementation Material See #Publish your conformance resources below for more detail on site layout, filenames, and URL
  • The profile specific wiki Profiles page should have a "FHIR Implementation Guide" section that
    • Link to the http://registry.fhir.org location where the profile specific conformance resources are published
    • Lists all of the FHIR conformance resources that are published on the IHE FTP site
    • List any examples that are on the IHE FTP site (in the domain specific directory)
    • List any TestScripts
    • List any reference implementations or other technical assistance.
    • See PDQm for example
  • URIs for your conformance resources would be rooted at http://ihe.net/fhir/ while they are published in possibly different ways
  • StructureDefinition to hold constraints on each FHIR Resource
  • CapabilityStatement to show minimal conformance requirements per Actor
  • ImplementationGuide resource -- don't confuse this with an Implementation Guide, which is human readable HTML. For the human readable we are using our PDF (by way of our wiki)
    • We are using ImplementationGuide resource only as a manifest of conformance resources we are publishing for our Profile
    • List each StructureDefinition, CapabilityStatement, and/or ValueSet
    • See #FHIR conformance Resource template below

Required if Known

In the context of IHE Profiles documented using the FHIR conformance resources, when the FHIR StructureDefintion - ElementDefinition - ".mustSupport" element is true is an indication that data element SHALL be interpreted as "Required if known". If the sending application has data for the element, it is required to populate the element with a non-empty value. If the value is not known, the element may be omitted. A receiving application may ignore the information conveyed by the element. A receiving application shall not raise an error solely due to the presence or absence of the element. This definition of Must Support is derived from IHE "Required if Known - R2 and "HL7v2 concept “Required but may be empty - RE” described in HL7v2 V28_CH02B_Conformance.doc.

Publish to global FHIR Registry

  • FHIR.org has a global registry of conformance resources at https://registry.fhir.org
    • This is intended to be a thin Registry (only), where the conformance resources are published elsewhere, but discoverable on the FHIR Registry

IHE has not licensed use of Simplifier, so please do not use Simplifier to publish conformance resources.

wiki Profiles page

  • All active IHE Profiles should have a Profiles page, and have the FHIR icon indicated on the mention on the Profiles page
  • The existence of a Profile page on the IHE wiki is very important for FHIR profiles as it will be the place where links to additional resources
    • later we might produce html directly from an automated ImplementationGuide build (see #future)
  • the profile specific wiki profiles pages should be marked with the FHIR category (see the profiles template for how) so that they show up on the FHIR page
  • New section on your page "FHIR Implementation Guide" should point at the FHIR conformance resources you have placed on the FTP site
  • Indicate your canonical URI for each resource. This is the identifier that your conformance resource is formally known as. It is not useful for a human browser access.

Public Comment

  • Getting community input on your profile should leverage the FHIR chat system (zulip) http://chat.fhir.org
  • There is an IHE stream for our use https://chat.fhir.org/#narrow/stream/ihe
    • posting outside this stream is okay. The stream is just there for our use, not as a constraint.
  • You may find it useful to start a new thread for your profile

Examples

It is very useful to provide examples to your audience.

  • For any Resource in your profile, there should be an example on the IHE FTP site at Implementation Material
  • Any publicly available FHIR reference implementation server that you know supports your profile should also be mentioned in your Profiles wiki page "FHIR Implementation Guide" section

Experimentation

Profile editors are not forbidden from experimenting beyond this guidance. Please report your lessons learned to the IHE-FHIR workgroup

Publish your conformance resources

There is now a GIThub for managing the conformance resources. This GIThub is reflected onto the IHE ftp location, and will eventually be reflected on an http location.

Implementation Guide publication tooling

When a Profile is published using the HL7 Implementation Guide build tool, the conformance resources will be published as part of that publication.

GIThub conformance resources

location https://github.com/IHE/fhir

  • This github repository is public readable.
  • This github repository is for management, not formal publication
  • Eventually everything here will be published on http://ihe.net/fhir
  • Request to be added to the group so that you can submit your conformance resources
  • Learning GIThub is not easy, we know this.. and likely will need to create training.

This is experimentation so please help improve this.

see layout below

IHE Google Drive conformance resources

Google Drive has replaced the

There are two different things we will publish in the Implementation Materials.

see layout below for conformance resources.

Please use GIThub for management if you can. If you can't, I can help reflect them into GIThub. However, this will not be useful for tracking.

Example resources, messages, interactions

layout for GIThub and FTP conformance resource publication

FHIR conformance resources (StructureDefinition, CapabilityStatement, ValueSet, etc)

  • These files will eventually be registered on the FHIR Registry, and that will be the primary way they will be discovered.
    • John does this registration, so let him know when you add something
  • All of these, regardless of domain will need to exist in the same directory, following the FHIR URL convention.
  • Note the naming conventions below for each type of conformance resource.
  • The Implementation Materials has a 'fhir' directory for all of these
    • ImplementationGuide directory for all of the ImplementationGuide resource files (not html files)
    • StructureDefinition directory for all of the StructureDefinitions resource files
    • CapabilityStatement directory for all the CapabilityStatements resource files
    • ValueSet directory for all the ValueSets resource files
    • CodeSystem directory for all the CodeSystem resource files

FHIR conformance Resource templates

StructureDefinition - content recommendation

StructureDefinition is critical for developers. It is equivalent to the Volume 2 "Message Encoding", or Volume 3 content

Many tools are good at producing a StructureDefinition. I have found Forge to be good at StructureDefinition. If you use a tool, then all of this is just filling out text entries.

We have two patterns recommended to help manage the name space for IHE and promote re-use. The 'name' and 'id' have different rules for encoding thus we must use underscore (_) in name, and period (.) in id.

  • name - "IHE_"+<Profile-acronym>+"_"+<Resource>+["_"+<option-name>]
    • e.g. "IHE_PDQm_Patient"
    • If you have options that change the structure, then also have StructureDefinition with them
      • e.g. "IHE_mCSD_Location_Distance"
  • id - "IHE."+<Profile-acronym>+"."+<Resource>+["."+<option-name>]
  • url - follow the url pattern given
  • title - full name of profile
  • status - most likely "draft" for now. Once we have Final-Text we would use "active".(I think)
  • date - update each time you edit and upload
  • publisher - IHE (see below)
  • description - simple string - describe this file and include url to wiki page. indicate that the conformance resource is Informative, the IHE profile text is Normative.
  • text - same as description but can be xhtml including href
  • purpose - describe in words what is constrained
  • copyright - IHE (see below)
  • fhirVersion - version of fhir needed
    • "4.0.1" is R4
  • snapshot - not necessary, but may contain the R4 definition of the resource (I have left them empty)
  • differential - your constraints (please use a tool like Forge)
  • use .mustSupport to indicate Required if Known (RE or R2)
  • the text element will be used by the IG publisher as the narrative for this structureDefinition, so it would tend to need to include all the parts included in the Volume 2 including trigger, message encoding, and expected actions.

Example

This from PDQm structure definition -- NOT actually used in PDQm as PDQm didn't constrain Patient 

<StructureDefinition xmlns="http://hl7.org/fhir">
   <id value="IHE.PDQm.Patient"/>
   <text><status value="additional"/>< div xmlns="http://www.w3.org/1999/xhtml"> 
	StructureDefinition for Patient resource constraints in the IHE IT Infrastructure Technical Framework Supplement 
	<a href="http://wiki.ihe.net/index.php/Patient_Demographics_Query_for_Mobile_(PDQm)">Patient Demographics Query or Mobile (PDQm)</a> 
	The IHE PDQm Profile text is Normative, this conformance resource is Informative.

</text> 

   <url value="http://ihe.net/fhir/StructureDefinition/structuredefinition-IHE.PDQm.Patient" /> 
   <name value="IHE_PDQm_Patient" /> 
   <title value="IHE Patient Demographics Query for Mobile" /> 
 <status value="draft" />
   <date value="2017-11-18" /> 
 <publisher value="Integrating the Healthcare Enterprise (IHE)" />
 <contact>
   <name value="IHE" />
   <telecom>
     <system value="url" />
     <value value="http://ihe.net" />
   </telecom>
 </contact>
   <description value="StructureDefinition for Patient resource constraints in the IHE PDQm Profile http://wiki.ihe.net/index.php/Patient_Demographics_Query_for_Mobile_(PDQm) . The IHE PDQm Profile text is Normative, this conformance resource is Informative. " /> 
   <purpose value="Lightweight RESTful query interface to a patient demographics supplier." /> 
 <copyright value="IHE http://www.ihe.net/Governance/#Intellectual_Property" />
 <fhirVersion value="4.0.1" />
 <kind value="resource" />
 <abstract value="false" />
 <type value="Patient" />
 <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Patient" />
 <derivation value="constraint" />
 <differential>
   <element id="Patient.animal">
     <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
       <valueString value="Animal" />
     </extension>
     <path value="Patient.animal" />
     <max value="0" />
   </element>
 </differential>
</StructureDefinition>

CapabilityStatement - content recommendation

CapabilityStatement is seen as informative for developers, but not critical. The CapabilityStatement has three different purposes. In this case we are defining what we WANT the Actor to support. Described in the FHIR specification as a "desired solution". It thus defines an Actor 'capability', so you will have one of these for each Actor. For simple client/server systems they are just mirrors.

Often times an IHE Profile Option will cause you to need to publish alternative CapabilityStatements.

No known tool helps at producing a CapabilityStatement. Simpifier does display them. If you use a tool, then all of this is just filling out text entries.

  • name - "IHE_"+<Profile-acronym>+"_"+<actor-name>"[+"_"+<option-name>]
    • e.g. IHE_PDQm_supplier
    • if you profile has options that affect Actors, then add the option name
      • e.g. IHE_mCSD_CareServicesSelectiveConsumer_Location
  • id - - "IHE."+<Profile-acronym>+"."+<actor-name>"[+"."+<option-name>]
  • url - follow the url pattern given
  • title - human readable full name of profile + Actor name
    • e.g. "IHE PDQm Supplier actor"
  • date - update each time you edit and upload
  • description - simple string - include url to wiki page. Explain that the IHE Profile text is Normative, and that the FHIR conformance resource is Informative.
  • text - html markup - same as description
  • purpose -- human readable explanation of why 'this' CapabilityStatement exists. This is more narrative than the title, but should not be too wordy. Expect reader will follow the url to the wiki page found in description
  • kind == "requirements" to indicate that this is a requirements capabiltyStatement indicating desired requirements
  • fhirVersion - indicate the FHIR version
    • Release 4 is "4.0.1"
  • format -- indicate the mime types
    • "application/fhir+xml"
    • "application/fhir+json"
  • profile - indicate your StructureDefinition
  • rest - indicate your actions and query parameters required

Example

This from PDQm structure definition for the Supplier Actor 

<CapabilityStatement xmlns="http://hl7.org/fhir">
    <id value="IHE.PDQm.supplier"/>
	<text><status value="additional"/>< div xmlns="http://www.w3.org/1999/xhtml"> 
		CapabilityStatement for Consumer Actor in the IHE IT Infrastructure Technical Framework Supplement 
		<a href="http://wiki.ihe.net/index.php/Patient_Demographics_Query_for_Mobile_(PDQm)">Patient Demographics Query or Mobile (PDQm)</a> 
		The IHE MHD Profile text is Normative, this conformance resource is Informative. 
	< /div></text> 
 	<url value="http://ihe.net/fhir/CapabilityStatement/capabilitystatement-IHE.PDQm.supplier" />  
 	<name value="IHE_PDQm_supplier" />  
 	<title value="IHE ITI Patient Demographics Query for Mobile (PDQm) - Supplier (server)" />  
	<status value="draft" />
	<experimental value="false" />
 	<date value="2017-11-01T09:37:21.358-05:00" />  
	<publisher value="Integrating the Healthcare Enterprise (IHE)" />
	<contact> 
		<name value="IHE"/> 
		<telecom> 
			<system value="url"/> 
			<value value="http://ihe.net"/> 
		</telecom> 
	</contact> 
   <description value="CapabilityStatement for Consumer Actor in the IHE IT Infrastructure Technical Framework Supplement IHE PDQm. See http://wiki.ihe.net/index.php/Patient_Demographics_Query_for_Mobile_(PDQm). The IHE MHD Profile text is Normative, this conformance resource is Informative." />  
 	<copyright value="IHE http://www.ihe.net/Governance/#Intellectual_Property" /> 
	<kind value="requirements" />
	<fhirVersion value="4.0.0" />
	<format value="application/fhir+xml" />
	<format value="application/fhir+json" />
	<profile>
 		<reference value="http://ihe.net/fhir/StructureDefinition/structuredefinition-IHE.PDQm.Patient" />  
	</profile>
 
	<rest>
		<mode value="server" />
		<documentation value="PDQm server provides capability to query for Patient resources matching a sub-set of the FHIR core Patient resource query parameters" />
		<security>
			<cors value="false" />
			<description value="Recommend IUA or SMART" />
		</security>
		<resource>

			<type value="Patient" />
			<profile>
				<reference value="http://ihe.net/fhir/StructureDefinition/structuredefinition-IHE.PDQm.Patient" />
			</profile>
			<interaction>
				
			</interaction>
			<interaction>
				
			</interaction>
			<interaction>
				
			</interaction>
			<interaction>
				
			</interaction>
			<searchParam>
				<name value="_id" />
				<definition value="http://hl7.org/fhir/SearchParameter/Patient-_id" />
				<type value="token" />
				<documentation value="Logical id of this artifact" />
			</searchParam>
 ...


		</resource>
		<interaction>
			
		</interaction>
  
	</rest>
</CapabilityStatement>

ValueSet - content recommendation

no guidance at this time. please experiment and help us with your lessons learned

Note that MHD has published the FormatCode ValueSet that might be used as an example

CodeSystem - content recommendation

no guidance at this time. please experiment and help us with your lessons learned

Note that MHD has published the IHE FormatCodes as a CodeSystem.

OperationDefinition- content recommendation

no guidance at this time. please experiment and help us with your lessons learned

So far the lesson some have reported is that STU3 can't define an Operation.

Implementation Guide - Content recommendation

The ImplementationGuide resource is very unstable right now, it is a combination of information that the HL7 FHIR build tools use to automatically create an Implementation Guide HTML pages for human readable, and partially it is output of this build process itemizing the conformance resources specified in the Implementation Guide.

For now, IHE will use the ImplementationGuide resource only as a manifest of the conformance resources defined in the IHE Profile. There is future work to improve this, but not the current goal.

It is difficult to create an ImplementationGuide resource using tooling, as they are focused on a different goal than we are. So it is best to start with the following and just fill in the few specifics for your IHE Profile.

Update the bold lines.

  • name - "IHE_"<Profile-acronym>
    • e.g. "IHE_PDQm"
  • id - DO NOT SPECIFY
  • url - follow the url pattern given
  • date - update each time you edit and upload
  • description - simple string -- short summary of THIS file include name of Profile and the url to wiki page. Explain Normative content is the IHE Profile text, not the conformance resource.
  • text, additional - xhtml version of description.
  • package.name - acronym
  • package.description - longer description of your profile
  • package.resource - include entry for each of your conformance resources (StructureDefinition, CapabilityStatement, ValueSet, etc)

Example

Example from PDQm 

<?xml version="1.0" encoding="utf-8"?>
<ImplementationGuide xmlns="http://hl7.org/fhir">
   <text><status value="additional" />< div xmlns="http://www.w3.org/1999/xhtml">
  Implementation Guide for IHE PDQm profile.
 The <a href="http://wiki.ihe.net/index.php/Patient_Demographics_Query_for_Mobile_(PDQm)">Patient Demographics Query or Mobile (PDQm)</a>
 Profile defines a lightweight RESTful interface to a patient demographics supplier leveraging technologies readily available
 to mobile applications and lightweight browser based applications.
 The IHE Profile text is Normative. This conformance resource is informative.
   </ div></text> 
   <url value="http://ihe.net/fhir/ImplementationGuide/IHE_PDQm" /> 
   <name value="IHE_PDQm" /> 
 <status value="draft" />
 <experimental value="false" />
   <date value="2017-12-18" /> 
 <publisher value="Integrating the Healthcare Enterprise (IHE)" />
 <contact>
   <name value="IHE" />
   <telecom>
     <system value="url" />
     <value value="http://ihe.net" />
   </telecom>
 </contact>
   <description value="This Implementation Guide conformance resource for IHE PDQm profile. See http://wiki.ihe.net/index.php/Patient_Demographics_Query_for_Mobile_(PDQm)" />  
 <copyright value="IHE http://www.ihe.net/Governance/#Intellectual_Property" />
 <fhirVersion value="4.0.0" />
 <package>
     <name value="PDQm" /> 
     <description value="The Patient Demographics Query for Mobile (PDQm) Profile defines a lightweight RESTful interface to a patient demographics supplier leveraging technologies readily available to mobile applications and lightweight browser based applications." />  
   <resource>
     <example value="false" />
       <name value="Consumer Actor" /> 
       <description value="Initiates query for a Patient resource given query parameters" />  
       <sourceUri value="http://ihe.net/fhir/CapabilityStatement/IHE_PDQm_consumer" />  
   </resource>
   <resource>
     <example value="false" />
       <name value="Supplier Actor" /> 
       <description value="Responds to queries for Patient resource " /> 
       <sourceUri value="http://ihe.net/fhir/CapabilityStatement/IHE_PDQm_supplier" /> 
   </resource>
 </package>
</ImplementationGuide>

SearchParameter- content recommendation

no guidance at this time. please experiment and help us with your lessons learned

MessageDefinition- content recommendation

no guidance at this time. please experiment and help us with your lessons learned

CompartmentDefinition- content recommendation

no guidance at this time. please experiment and help us with your lessons learned

TestScript -- content recommendation

Although TestScript is not considered by FHIR to be part of conformance resources, it is a critical Resource for documenting an ImplementationGuide.

no guidance at this time. please experiment and help us with your lessons learned

ElementDefinition- content recommendation

no guidance at this time. please experiment and help us with your lessons learned

other conformance?

no guidance at this time. please experiment and help us with your lessons learned

Near Future

The following are some items the IHE-FHIR-wg is close to having a recommendation. These should be considered experimental, but likely to become guidance.

  • Provide guidance to profile authors on how they should evaluate the need to create an IHE unique StructureDefinition. This is to drive re-use of existing StructureDefinition that may be found in other profiles/IG.
    • This process would express the various places to look first for existing StructureDefinition that meet the new Profiling need, but are also well managed (meeting our standards selection criteria). This effort would express that one should look within the FHIR Core specification, as there are some already existing profiles there. There are likely other places to look, we should determine what this is.
    • Problem Definition: There is a proliferation of StructureDefinition (profiles) that all say the same thing. IHE should not add to this mess, IHE should be looked to as a excellence in governance.
  • Similar guidance for Extensions. We should use extensions that exist from formal standards work over creating our own
  • Provide guidance to get consistency on the way IHE profiles express constraints on the elements.
    • Eventually this will happen with automated publication. so this is a short term solution to fill the time before we have automated publication.
    • Today I just point at PDQm and MHD as models that might be useful. The PCC and QRPH workgroups asked that we define specific guidance on element constraints.
    • The guidance would not be mandatory. It is intended to drive consistency.
    • MHD Volume 3 is close to what people liked, however there is interest in better exposing original cardinality vs profiled.
  • Provide guidance on how to link issues in the FHIR specification that prevent us from having an IHE Profile that is optimal. There are times when the specification has a gap, or constraint. We should register a Change Proposal with the FHIR specification, track that number in an open issue in your supplement, so that you can check on the status of that CP.
  • Provide guidance on how to use a publication tool for Implementation Guide.
    • Jose and John are working on this. If you are interested in trying it, we need people to help test our process.
  • How do we today send a public comment request on an IHE Profile on FHIR, where conformance resources are available, in a way that also directs the review to the conformance resources and asks for comments.
    • Now that conformance resources can be managed in GIThub, the public could provide comments using GIThub issues or pull-request
    • Use the wiki Profile page as the mechanism to itemize the conformance resources available for review.
    • wiki profile page is required at public comment, as that is the most friendly way to point at the conformance resources that we have today
    • Point out to the reviewer that they can review in XML, providing comment on line number in the XML
  • Publish the IHE profile on the FHIR.org (FHIR organization, not HL7) registry of Implementation Guides.
    • John Moehrke does this for all IHE Profiles when they are published in TI. Mary informs me.
    • This does NOT require any conformance (xml) resources to be available
  • Use of the CapabilityStatement extension for conformance requirements - http://build.fhir.org/extension-capabilitystatement-expectation.html
    • This can be inserted at many levels of the CapabilityStatement to indicate if that element is Required, Recommended, Allowed, or Forbidden

Ultimate Future

These are also potential items the IHE-FHIR-wg might further develop. These are less likely to become recommended, and a Profile author should be very cautious with these items.

  • Implementation Guide publication is not mature enough to support IHE governance
    • Experience with FHIR ImplementationGuide resource and various tooling shows that it not ready for use
    • There are some IHE Profile authors (Jose) who are experimenting with the HL7 Implementation Guide publication system
    • We encourage experimentation, please engage with us so that we can improve as a whole.
    • Note that to use the HL7 Implementation Guide publication, you still MUST have done all of that which this guidance procedure asks of you. You must still have all the conformance resources, and you must go through full IHE profile authoring and governance.
  • Use of GIT for publication rather than FTP
    • This might be more easy to automate with the FHIR Registry.
  • Use of ClinFHIR as a tool to capture Volume 1 like material
  • Will Simplifier be usable as a IG platform?
  • Will Art-Decor be a useful tool as an IG Platform?
    • There are experimentation for using this with CDA profiling
    • There are some roadmap on Art-Decor for their support of FHIR Document profiling
    • the PaLM domain used this for APSR (a CDA profile)
    • That pilot publishes the whole supplement, looking very much like a normal supplement, into HTML form on a prototype web site.
    • That pilot has methods of committing the whole thing to PDF so that existing governance can be used.
    • That team will join us in July to help us understand what they did, and where the tooling is going
  • Will Trifolia workbench be a useful tool?
  • Will DaVInci be useful as an IG tool?

Glossary

IHE and HL7 are using different words to cover similar areas.

IHE --> HL7/FHIR terms

  • IHE Profile --> HL7 Implementation Guide
    • FHIR has an ImplementationGuide resource, which is a grouping resource of all conformance resources used in an Implementation Guide
    • FHIR has an Implementation Guide, which is a html publication that is laid out very similar to an IHE Profile with use-case, actors, transactions, and options
  • IHE Actor --> HL7 Actor --> May be defined in a CapabilityStatement of "requirements" kind
    • CapabilityStatement is also used to describe a software system, or a network service endpoint
  • IHE Transaction --> FHIR StructureDefinition -
    • specifically only the "message semantics" part of IHE volume 2, or a "content profile" in IHE Volume 3.
    • FHIR SructureDefinition can also be used to define core resources and other thngs.
  • IHE Integration Statement --> HL7 CapabilityStatement of "instance" or "capability" kind
    • FHIR servers are expected to publish a CapabilityStatement (instance) that can be discovered by a client to determine if that server has the capability needed
    • The "capability" kind of CapabilityStatement is most similar to an IHE Integration Statement

HL7 -> IHE terms

  • FHIR ImplementationGuide --> IHE Profile
  • FHIR StructureDefinition --> IHE Message Encoding or Content Profile
  • FHIR CapabilityStatement --> IHE Actor, and Query Parameters
  • FHIR Profile --> likely FHIR StructureDefinitino --> IHE Message Semantics (e.g. Volume 2, message semantics; or Volume 3 content Profile)
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