Unique identifyer at Bundle level

[tomto66]

We need to agree on how to create unique Ids on bundle level. Standard says "for Documents the .identifier SHALL be populated such that the .identifier is globally unique. " but it does not say how to make this globally unique. Questions: is this relevant to Belgian laboratory results and b) if so what standard to follow for global unique identifiers?

[costateixeira]

I'd like to review this on 2 aspects:

1. The uniqueness of the ID may be addressed with the Identifier data tpye and a proper NamingSystem. However,
2. I think it is relevant but not specific on Lab. I don't see any normative artifacts on Bundle. Are we constraining Laboratory Report to be a Document or a Message? If so, shouldn't this discussion be more technical/infrastructural? Solving something for Lab and then having a different solution for Summary or MedicationSchema would cause issues.

[costateixeira]

On documents and messages:
We should create a (narrative) page describing the difference between document-based and message-based approaches, and make a logical model for each of the "envelopes" - message and document.
About the id:

• the message unique ID is not a business persisted identifier, so it is in messageheader.id
• the document ID is a business identifier, so it goes into composition.identifier
  For the document business identifier, there should be a NamingSystem also defined.

[bdc-ehealth]

Decision of the WG:
We will create a NamingSystem:

1. system url: to be determined, but only one for Belgium, it will start with https://www.ehealth.fgov.be/...
2. value: the RIZIV/INAMI number of the lab + dot + a unique number for the lab (the same number will be considered a new version of the same bundle)

[bdc-ehealth]

The decision of the WG contradicts the following from the standard:
Once assembled into a bundle, the document is immutable - its content can never be changed, and the document id can never be reused. Note that the document may be represented in either XML or JSON and interconverted between these or have its character encoding changed, all the while remaining the same document. However, the directly referenced content within the document and the presentation of the document cannot change substantially (such that it changes the clinical meaning of the content). Any additional documents derived from the same composition SHALL have a different document id.

https://www.hl7.org/fhir/documents.html#content

This means that for every update of the laboratory report, there should be a new document id. This should be discussed again.
@tomto66 's suggestion, to add the ordernumber as a unique number cannot be used.

[tomto66]

@bdc-ehealth : several comments here:

1. We did not say we need to use ordernumber; we just said the lab reference needs to be unique. If needed we can append e.g. a sequence or version number to the ordernumber to make it unique. So technically this is not a problem.
2. However, if 2 bundles are sent, at 2 different times, for the same order and same patient (just with other or more results), how will the receiver ever know that it needs to overwrite the previous values, if the bundle ID is not the same???? Receiver will never know whether a new bundle is a totally new one or an update to a previously sent one.

Today we have versioning on DiagnosticReport. So every time we have an update for a report for an order, we send a new version of the DiagnosticReport. If those DiagnosticReports are not in the same bundle (ID), receiver will never be abl to link the 2 versions to one another! So if for every protocol version the Bundle Id changes .... do we need to make sure the DiagnosticReport Id is the same? And unique per System? Technically we can do that, if needed!

[bdc-ehealth]

Indeed, we should refer to https://build.fhir.org/ig/hl7-be/hl7-be-fhir-laboratory-report/guidance.html#versioning-of-reports . During the previous WG, we erroneously assumed that we could use the bundle id for this.

[tomto66]

@bdc-ehealth so if I understand correctly, we will use in deed the Id of the DiagnoticReport as identifier. We will change our examples accordingly!

[tomto66]

Example with unique bundle Id here : https://github.com/hl7-be/hl7-be-fhir-laboratory-report/tree/master/testing/Macsys/20221119

[bdc-ehealth]

proposal for the NamingSystem on Bundle level: https://www.ehealth.fgov.be/lab-report/bundle-id
proposal for the NamingSystem on DiagnosticReport level: https://www.ehealth.fgov.be/lab-report/diagnostic-report-id

[thibaultmh]

proposal for the NamingSystem on Bundle level: https://www.ehealth.fgov.be/lab-report/bundle-id proposal for the NamingSystem on DiagnosticReport level: https://www.ehealth.fgov.be/lab-report/diagnostic-report-id

Hi,

These links redirect to a login/error page. Is it possible to view this without login?

Thanks,
Thibault

[bdc-ehealth]

These URLs are only identifiers, they are not resolvable.