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Representation (display) of FHIR Documents in the the context of the Swiss EPR

  1. Exchange formats for the swiss EPR require a readable representation.
  2. For the current proposed exchange formats it has been proposed that the presentation of the document has to be embedded PDF/A

Narrative Handling of section.text in FHIR documents with a PDF original representation

Adding the PDF to the FHIR Bundle

To represent the PFD in the FHIR document is added as a Binary resource within the bundle which is then reference from the narrative part of this section via an img element id form the narrative text.

Open Issue: The PDF is reference with the tag, but the pfd is actually not a image, this will not work directly with an XSLT Transformation, stylesheet.

Option 1: Leave it as it is with the img tag. Option 2: Remove the img element completely? Option 3: Option 2 + Create a text extension that references the PDF directly Option 4: Instead of creating a separate section just add the extension to the text pointing to the pdf to Composition.text and don't use the original section?

        <section>
          <title value="Original representation"/>
          <code>
            <coding>
              <system value="http://loinc.org"/>
              <code value="55108-5"/>
              <display value="Clinical presentation Document"/>
            </coding>
          </code>
          <text>
            <status value="generated"/>
            <div xmlns="http://www.w3.org/1999/xhtml">
            Representation of the original view:
              <img src="2-7-pdf"/>
            </div>
          </text>
          <entry>
            <reference value="Binary/2-7-pdf"/>
          </entry>
        </section>

CDA:

       <section>
          <templateId root="2.16.756.5.30.1.1.10.3.45"/>
          <code code="55108-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Clinical presentation Document"/>
          <title>Original representation</title>
          <text>
            Representation of the original view:
            <renderMultiMedia referencedObject="pdf1"/>
          </text>
          <entry typeCode='DRIV'>
            <observationMedia classCode="OBS" moodCode="EVN" ID="pdf1">
              <templateId root="2.16.756.5.30.1.1.10.4.83"/>
              <languageCode code="en-US"/>
              <value xsi:type='ED' mediaType="application/pdf" representation="B64">c25pcA==</value>
            </observationMedia>
          </entry>
        </section>

Referring to the PDF from another section

Since the representation of the other sections is described in the original representation it is not necessary for the other sections we have two possiblities

Option 1: Add a text referring to the embedded PDF.

            <status value="generated"/>
            <div xmlns="http://www.w3.org/1999/xhtml">
              <span id="refpdf">See PDF</span>
            </div>
          </text>

For handling references between structured elements and the narrative (pdf in this case) the http://hl7.org/fhir/StructureDefinition/narrativeLink has to be used to indicate the id (e.g. "refpdf") in the example.

Option 2: Do not add a text representation at all

Annotation Comment

A comment for the the document as a string is currently added as an own section in the document and is not represented as structured element.