Profiles & Operations Index > Operation: Submit Patient Summary

Operation: Submit Patient Summary

The Submit Patient Summary operation is used to transfer a Patient Summary document and metadata to an Ontario Patient Summary Document Recipient. This encompasses both Create and Update. Update, as described below, is only used to invalidate an existing Patient Summary document.

Scope

This transaction involves a request by an Ontario Patient Summary Document Source to transfer a Patient Summary Bundle, including a Patient Summary Composition and linked resources, to an Ontario Patient Summary Document Recipient. The request is received by the Ontario Patient Summary Recipient which stores the received Bundle and returns an HTTP response code and an OperationOutcome resource if applicable.

For example, an Electronic Medical Record (EMR user updates a patient's record in the EMR, then the EMR extracts Patient Summary data for that patient from the patient's record and submits it to the provincial repository, where it is available for viewing by other Ontario Patient Summary Consumers.

Interaction Diagram

Submit PSON

Actor: Ontario Patient Summary Document Source

Role: Submits Patient Summary document bundle containing a Patient Summary Composition and linked resources to the Ontario Patient Summary Document Recipient.

Actor: Ontario Patient Summary Document Recipient

Role: Receives and stores Patient Summary document Bundles from Ontario Patient Summary Document Sources.

Specification

This specification is based on the FHIR R4 Create and Update operations.

Patient Summary Create Request

The Create Request will create a new Patient Summary bundle based upon information available from the Ontario Patient Summary Document Source, if one does not already exist in the repository. If there is already an existing summary for the Patient + Health Information Custodian + Device triplet, the newly submitted version will replace the existing version in the repository.

POST [base]/Bundle/

Patient Summary Create Response

  • OperationOutcome

Patient Summary Update Request

The Update Request will update an existing Patient Summary document, using the bundle identifier to match against the respective existing Patient Summary document in the repository

PUT [base]/Bundle?[search parameters]

e.g. PUT [base]/Bundle?identifier=http://myemr.ca/|119A8F3Q where 'http://myemr.ca/|119A8F3Q' is the identifier of the originally submitted patient summary

The bundle business identifier (bundle.identifier) will be "search parameter" used to identify the patient summary document that will be updated in repository.

Patient Summary Amendment:

  • Set Composition.status to 'amended' when submitting the update.
  • If the repository finds an existing patient summary in the repository, the submitted patient summary document will logically replace the existing one in the repository
  • If the repository does not find an existing matching patient summary, the repository will create a new record

Patient Summary Invalidation:

  • Set Composition.status to 'entered-in-error' when submitting the update
  • Once invalidated, the entire series of patient summary documents (using the same Bundle business identifier and Composition business identifier) will no longer be valid for use in the EHR. Future submissions of the corrected patient summary and its subsequent updates must use a new Bundle identifier and Composition identifier

Patient Summary Update Response

  • OperationOutcome

Example Create Message

HTTP Method:

POST

Headers:

Content-Type: application/fhir+json

Address:

[base]/Bundle/

Message body:

Link to submit bundle

{
  "resourceType" : "Bundle",
  "meta" : {
    "lastUpdated" : "2021-12-11T14:30:00+01:00",
    "profile" : [
      "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-bundle"
    ]
  },
  "identifier" : {
    "system" : "http://ex-ps-identifier-system.org",
    "value" : "urn:uuid:175bd032-8b00-4728-b2dc-748bb1501aed"
  },
  "type" : "document",
  "timestamp" : "2021-12-11T14:30:00+01:00",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:d792b9de-b97a-4319-b34c-a3fe012ddfa2",
      "resource" : {
        "resourceType" : "Composition",
        "id" : "d792b9de-b97a-4319-b34c-a3fe012ddfa2",
        "identifier" : {
          "system" : "urn:oid:2.16.724.4.8.10.200.10",
          "value" : "0c625f31-6354-4625-baaf-09e8fe26eaef"
        },
        "status" : "final",
        "type" : {
          "coding" : [
            {
              "system" : "http://loinc.org",
              "code" : "60591-5",
              "display" : "Patient Summary Document"
            }
          ]
        },

...

Example Update Message

HTTP Method:

PUT

Headers:

Content-Type: application/fhir+json

Address:

[base]/Bundle/PSON-example-Bundle-03

Message body:

Link to update bundle

{
  "resourceType" : "Bundle",
  "id" : "PSON-example-Bundle-03",
  "meta" : {
    "lastUpdated" : "2021-12-11T14:30:00+01:00",
    "profile" : [
      "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-ps-profile-bundle"
    ]
  },
  "identifier" : {
    "system" : "http://ex-ps-identifier-system.org",
    "value" : "urn:uuid:175bd032-8b00-4728-b2dc-748bb1501aed"
  },
  "type" : "document",
  "timestamp" : "2021-12-11T14:30:00+01:00",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:d792b9de-b97a-4319-b34c-a3fe012ddfa2",
      "resource" : {
        "resourceType" : "Composition",
        "id" : "d792b9de-b97a-4319-b34c-a3fe012ddfa2",
        "identifier" : {
          "system" : "urn:oid:2.16.724.4.8.10.200.10",
          "value" : "0c625f31-6354-4625-baaf-09e8fe26eaef"
        },
        "status" : "entered-in-error",
        "type" : {
          "coding" : [
            {
              "system" : "http://loinc.org",
              "code" : "60591-5",
              "display" : "Patient Summary Document"
            }
          ]
        },

...

Expected Behavior

See Response Handling page for additional response handling behaviour.

Legend
code = OperationOutcome.issue.code
severity = OperationOutcome.issue.severity
details.coding.code=OperationOutcome.issue.details.coding.code
details.coding.display=OperationOutcome.issue.details.coding.display
details.text = OperationOutcome.issue.details.coding.text


HTTP Status Scenario Description severity code details.coding.code details.coding.display details.text
200 OK An update to an existing Patient Summary bundle is submitted in order to invalidate an existing Patient Summary. Returns the updated resource
201 Created A new Patient Summary bundle is submitted. Returns the created resource
400 Bad Request POST operation contains incorrect header value for "Content-Type" - should be "application/fhir+json" error invalid
400 Bad Request Missing security token error required Missing required security token: PIN
400 Bad Request When there was syntactical error such as a missing or invalid header, a missing or invalid URL parameter, a request body that can't be parsed or doesn't conform to the basic FHIR JSON/XML syntax rules, etc error invalid
406 Not Acceptable The Accept header requested a format that the server does not support error not-supported
401 Unauthorized Failed authentication error security Authorization is required for the interaction that was attempted
422 Unprocessible Entity FHIR validation errors such as invalid code, wrong date format, or violation of LOB defined business rules Will vary depending on the error Will vary depending on the error OH-defined error code OH-defined errror message
429 Too Many Requests Rate Limit error throttled Too Many Requests
500 Internal Server Error Unhandled Exception fatal exception Internal Error
503 Service Unavailable Indicates that the services has been temporarily taken down (on purpose)
504 Gateway Timeout Downstream system(s) did not return timely response error timeout
401 Unauthorized Failed to validate bundle.composition.custodian (i.e. organization) against UAO error security
401 Unauthorized Failed to validate bundle.entry.Organization against UAO error security
409 Conflict Rejected duplicate PS-ON submissions error processing Can not create resource of type {resource} as it would create a duplicate unique index matching query {query}
422 Content validation Failed to validate provider name error business-rule FHIR_PROV_2004 Submitted provider name does not match the provider name in PPR
422 Content validation Device identifier should be the Client ID supplied from OAG error business-rule FHIR_DEVC_1000 Submitted Device identifier does not match Client ID
422 Content validation FHIR submissions must conform to the profiles defined in the OH Patient Summary FHIR IG error business-rule FHIR_MD_1000 <Populated from IG error description>
422 Content validation HCN must pass MOD-10 validation error business-rule FHIR_PTNT_2001 Invalid Ontario HCN
422 Content validation HCN does not exist in PCR warning business-rule FHIR_PTNT_2002 HCN does not exist in PCR
422 Content validation HCN should match only one patient in PCR warning business-rule FHIR_PTNT_2003 Multiple patients for provided HCN
422 Content validation PCR patient must have DOB error business-rule FHIR_PTNT_2004 DOB does not exist in PCR
422 Content validation Patient DOB must match PCR DOB error business-rule FHIR_PTNT_2005 DOB does not match PCR DOB
422 Content validation Hospital MRN must be less than 40 characters error business-rule FHIR_PTNT_2006 Invalid MRN format
422 Content validation Hospital MRN should exist in PCR error business-rule FHIR_PTNT_2007 MRN does not exist in PCR
422 Content validation Hospital MRN should match only one patient in PCR warning business-rule FHIR_PTNT_2008 Multiple patients for provided MRN
422 Content validation PCR system error error exception FHIR_PTNT_2101 System error while trying to validate against PCR
422 Content validation Provider does not exist error business-rule FHIR_PROV_2001 Provider does not exist in PPR
422 Content validation Provider/Organization is not active warning business-rule FHIR_PROV_2002 [Provider/Organization] is not active in PPR
422 Content validation PPR system error error business-rule FHIR_PROV_2101 System error while trying to validate against PPR