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 pair, 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 based upon information available from the Ontario Patient Summary Document Source. The only use for the update request for PS-ON will be to invalidate an existing Patient Summary by setting the Composition .status element to 'entered-in-error'. The Bundle business identifier and Composition business identifier for the update must match the identifiers from the original document.

PUT [base]/Bundle/[id] {?_format=[mime-type]}

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. Once invalidated, 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