From 968ea19a4bbc518f69b3a6a7f2eb81e4a101b8a8 Mon Sep 17 00:00:00 2001
From: Ryan Crichton <ryan@jembi.org>
Date: Mon, 5 Aug 2024 11:23:02 +0200
Subject: [PATCH] First pass a specifying the new workflows

---
 ...tient-level-clinical-data-workflow-fhir.md | 25 +++++++++++++++
 ...ry-patient-level-clinical-data-workflow.md |  6 ++--
 ...tient-level-clinical-data-workflow-fhir.md | 32 +++++++++++++++++++
 ...ve-patient-level-clinical-data-workflow.md |  4 ++-
 .../openhie-shared-health-record-shr.md       | 17 ++++++++--
 5 files changed, 78 insertions(+), 6 deletions(-)
 create mode 100644 introduction/shared-health-record/query-patient-level-clinical-data-workflow-fhir.md
 create mode 100644 introduction/shared-health-record/save-patient-level-clinical-data-workflow-fhir.md

diff --git a/introduction/shared-health-record/query-patient-level-clinical-data-workflow-fhir.md b/introduction/shared-health-record/query-patient-level-clinical-data-workflow-fhir.md
new file mode 100644
index 0000000..2cc0214
--- /dev/null
+++ b/introduction/shared-health-record/query-patient-level-clinical-data-workflow-fhir.md
@@ -0,0 +1,25 @@
+# Query Patient-level Clinical Data Workflow (FHIR native)
+
+This transaction allows a point of service (PoS) system to save patient-level clinical data to the SHR. The transaction is verified and validated against necessary metadata before it is saved in the SHR. The following sequence diagram shows the steps involved.
+
+| **Workflow Maturity**         | <p><img src="https://lh6.googleusercontent.com/Kxkqfa92YGW3mIOmWio0Twi4YLMA92z6mL1MuFzkx4AWS5CX5zbzWid5z4p2W-e6O66llKpaU0r6lzwyXfhbIiWmkVEuPDy6stX5x5L8uC2DkEXs6qUFX-7xxXTlb9hbkg" alt=""></p><p><strong>Newly Defined</strong></p> | <ul><li><strong>Workflow is newly defined</strong></li><li><strong>Initial implementations are being implemented</strong></li></ul>  |
+| --- | --- | --- |
+| Standards |  |  |
+| Assumptions and Prerequisites |  | <ul><li>The PoS system is a trusted application known by the HIE and it is registered with the interoperability layer to be able to send and receive data securely (<a href="https://wiki.ohie.org/display/documents/Common+message+security+workflow">Common message security workflow</a>).</li> |
+| Actors |  | <ul><li>PoS - The point of care system that captures a patient's clinical encounter, it is responsible for sending clinical data on to the HIE.</li><li>IL - Mediates the transactions between the PoS system and the infrastructure services to facilitate easier interoperability.</li><li>CR - The source of truth for patient demographic and identifier detail. It is able to be queried using an identifier to find the enterprise identifier for a particular person.</li><li>FR - The source of truth for facility information. It is able to be queried for details about a particular facility by ID.</li><li>SHR - Stored patients clinical information. It is able to receive and store patient clinical documents.</li></ul>    |
+
+## **Interaction Description**
+
+The following is a description of the interaction steps. The specific FHIR query that is used isn't strictly specified as this could be any necessary query conformant to the FHIR API that the PoS in the current implementation finds useful. Instead these interaction describe generic behavior for the HIE to support to ensure patient potential multiple identities are considered and resolved.
+
+[![](https://mermaid.ink/img/pako:eNp9Us1LwzAU_1ceOSnUg5-HHgZSlQ0m1vZoe4jN23ysTWqaDMbY_-7bsg3Mppck_PL7Inlr0RiFIhUDfnvUDT6RnFvZVRqgl9ZRQ73UDnJTxtDkbRpDWREj5biAi5fxpIAS7RLtZaW3FLa7Go3YIYWP6xrePdoV7GiP-WRLkI2jpXR4SOGNBVnB_JsapsYsfM9BjpBDSPFKfB5-SUObrDgm3daQn5UojEQh7qQ8e9zFbRNwckF6DqSd4fDGePaXbftXrTNPAqfgsfR9HaIKHHqjB4z6nnUL9YP-oYbMdJ-kEezeYoCZsdD51lHfYtQzaPmD0n9zmSYS0aHtJCmen_X2vhLuCzusRMpHJe2iEpXeMM_3ikXPipyxIp3JdsBESO9MudKNSJ31eCDtB_DIwp3oNUzpblg3P5jK5Xs?type=png)](https://mermaid.live/edit#pako:eNp9Us1LwzAU_1ceOSnUg5-HHgZSlQ0m1vZoe4jN23ysTWqaDMbY_-7bsg3Mppck_PL7Inlr0RiFIhUDfnvUDT6RnFvZVRqgl9ZRQ73UDnJTxtDkbRpDWREj5biAi5fxpIAS7RLtZaW3FLa7Go3YIYWP6xrePdoV7GiP-WRLkI2jpXR4SOGNBVnB_JsapsYsfM9BjpBDSPFKfB5-SUObrDgm3daQn5UojEQh7qQ8e9zFbRNwckF6DqSd4fDGePaXbftXrTNPAqfgsfR9HaIKHHqjB4z6nnUL9YP-oYbMdJ-kEezeYoCZsdD51lHfYtQzaPmD0n9zmSYS0aHtJCmen_X2vhLuCzusRMpHJe2iEpXeMM_3ikXPipyxIp3JdsBESO9MudKNSJ31eCDtB_DIwp3oNUzpblg3P5jK5Xs)
+
+| **#** | Interaction | Data  | Transaction Options |
+| ----- | --- | --- | --- |
+| 1 | Query FHIR API | Any conformant FHIR Query parameters | [Any FHIR Read Interaction](https://www.hl7.org/fhir/http.html#read) |
+| 2 | Lookup patient identities | Known Patient ID | Query Patient Demographic Records by Identifier Workflow |
+| 3 | Patient identities | | |
+| 4 | Query FHIR API, taking into account all identities | Any conformant FHIR Query parameters | [Any FHIR Read Interaction](https://www.hl7.org/fhir/http.html#read) |
+| 5 | FHIR Response | | |
+| 6 | Combine responses for multiple identities | | |
+| 7 | FHIR Response | | |
diff --git a/introduction/shared-health-record/query-patient-level-clinical-data-workflow.md b/introduction/shared-health-record/query-patient-level-clinical-data-workflow.md
index 68c67db..f2a6d48 100644
--- a/introduction/shared-health-record/query-patient-level-clinical-data-workflow.md
+++ b/introduction/shared-health-record/query-patient-level-clinical-data-workflow.md
@@ -1,6 +1,8 @@
-# Query Patient-level Clinical Data Workflow
+# Query Patient-level Clinical Data Workflow (Document-based)
 
-_\*\*_The transaction queries for previously stored clinical data for a specific patient. The following sequence diagram shows the steps involved in this transaction.
+Also see [FHIR native version of this workflow](./query-patient-level-clinical-data-workflow-fhir.md).
+
+The transaction queries for previously stored clinical data for a specific patient. The following sequence diagram shows the steps involved in this transaction.
 
 | **Workflow Maturity**         | <p><img src="https://lh5.googleusercontent.com/Vp6XBRGu-U_Dmd5EKNpCZvEEum0CxOcHOj9NgHh8UMMNLMlXHmLcUE_YWueDRr4uqWLzpPfzSBLJ2k33XQIelLypjQ4wyrD17-t33GtLa8fFxW9AYDvXhiJmBl4VaLgKDg" alt=""></p><p> <strong>Mature</strong></p> | <ul><li><strong>One or more OpenHIE implementations of this workflow exist in one or more countries</strong></li><li><strong>Workflow is defined and ARB approved</strong></li><li><strong>Workflow is supported by mature standards</strong></li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
 | ----------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
diff --git a/introduction/shared-health-record/save-patient-level-clinical-data-workflow-fhir.md b/introduction/shared-health-record/save-patient-level-clinical-data-workflow-fhir.md
new file mode 100644
index 0000000..234b0ce
--- /dev/null
+++ b/introduction/shared-health-record/save-patient-level-clinical-data-workflow-fhir.md
@@ -0,0 +1,32 @@
+# Save Patient-level Clinical Data Workflow (FHIR native)
+
+This transaction allows a point of service (PoS) system to save patient-level clinical data to the SHR. The transaction is verified and validated against necessary metadata before it is saved in the SHR. The following sequence diagram shows the steps involved.
+
+| **Workflow Maturity**         | <p><img src="https://lh6.googleusercontent.com/Kxkqfa92YGW3mIOmWio0Twi4YLMA92z6mL1MuFzkx4AWS5CX5zbzWid5z4p2W-e6O66llKpaU0r6lzwyXfhbIiWmkVEuPDy6stX5x5L8uC2DkEXs6qUFX-7xxXTlb9hbkg" alt=""></p><p><strong>Newly Defined</strong></p> | <ul><li><strong>Workflow is newly defined</strong></li><li><strong>Initial implementations are being implemented</strong></li></ul>  |
+| --- | --- | --- |
+| Standards |  | HL7 FHIR |
+| Assumptions and Prerequisites |  | <ul><li>The PoS system has a curated list of Providers that interact with that system, with knowledge of at least the providers that are relevant to that PoS system.</li><li>The PoS system has a curated list of Facilities that this system serves, with knowledge of at least one member (itself).</li><li>The PoS system is a trusted application known by the HIE and it is registered with the interoperability layer to be able to send and receive data securely (<a href="https://wiki.ohie.org/display/documents/Common+message+security+workflow">Common message security workflow</a>).</li> |
+| Actors |  | <ul><li>PoS - The point of service system that captures a patient clinical encounter, it is responsible for sending this encounter on to the HIE.</li><li>IL - Mediates the transactions between the PoS system and the infrastructure services to facilitate easier interoperability.</li><li>CR - The source of truth for patient demographic and identifier detail. It is able to be queried to find the identities of a patient.</li><li>SHR - Stored patients clinical information. It is able to receive and store a patient clinical data.</li></ul> |
+
+## **Interaction Description**
+
+The following is a description of the interaction steps.
+
+[![](https://mermaid.ink/img/pako:eNqNVE1v2kAQ_Ssjn4LkVqVJvzjkUEgVJBKQnfZS-7DxjmGE2XV310lQlP_eWRscYgjigICdN7Pvzbyd5yDTEoNBYPFfhSrDEYm5EatEAZTCOMqoFMrBTMfdo_F00j0aRt2T-DqCs1_X4whiNA9oeonyEC734fKSKwzgbz-FGvCzUrJAHxWZowfhcHsFf7XozyncGaFs4eMOzYqULvR8DV6H7aLPU7h6coYLwkw4QmYUodWVyfAVOowYeZHCbBrftbCGdK7NSrjeG1KNyGG0zfySwtCgjwhQ-AgGM21kCJQD52YLtOA04BNZR2oOze1AEkTF5wWpJWBhEUyl6n8Mai9oVHxNmbUvCuORD0nskGl07PWaU7-lMNF6WZVgXXXPo2nUmZ0mtLUOzAr2D1tW3z0rVxnVVtUGbn9PJh2KB8uKgg2Uw-20Ta4btDfAHyncaEn5Gu5re8BZ7AyV7ZhGuNLs13JBmQ1BSMkdYXU5PJJbvHbNT2CT8tH3OGSME6SYMs1JiaKN8lzOqopkr6ZZD4Z5HifZ_7THMsKyEDzmbsOB79xgaoZ7zWEfl-sNO2-Xt6y9QP6QI-1Jn6S1EaLkcaP0-5sHUAtB-e6bPNklB2_h5_tHFCR9pTpWGp1TgTy8ncccQi4yKsitQSi508QcjV9S9rgz--femrbUyuIpZmy6wjvJ5168m8uwIAxWTFOQ5JX57ONJ4Ba4wiQY8E8pzDIJEvXCuKr0Iq94VtoEg1ywk8LAP_l4rbJg4EyFW9Bm57YorJNumsVc7-eX_7nD3qM?type=png)](https://mermaid.live/edit#pako:eNqNVE1v2kAQ_Ssjn4LkVqVJvzjkUEgVJBKQnfZS-7DxjmGE2XV310lQlP_eWRscYgjigICdN7Pvzbyd5yDTEoNBYPFfhSrDEYm5EatEAZTCOMqoFMrBTMfdo_F00j0aRt2T-DqCs1_X4whiNA9oeonyEC734fKSKwzgbz-FGvCzUrJAHxWZowfhcHsFf7XozyncGaFs4eMOzYqULvR8DV6H7aLPU7h6coYLwkw4QmYUodWVyfAVOowYeZHCbBrftbCGdK7NSrjeG1KNyGG0zfySwtCgjwhQ-AgGM21kCJQD52YLtOA04BNZR2oOze1AEkTF5wWpJWBhEUyl6n8Mai9oVHxNmbUvCuORD0nskGl07PWaU7-lMNF6WZVgXXXPo2nUmZ0mtLUOzAr2D1tW3z0rVxnVVtUGbn9PJh2KB8uKgg2Uw-20Ta4btDfAHyncaEn5Gu5re8BZ7AyV7ZhGuNLs13JBmQ1BSMkdYXU5PJJbvHbNT2CT8tH3OGSME6SYMs1JiaKN8lzOqopkr6ZZD4Z5HifZ_7THMsKyEDzmbsOB79xgaoZ7zWEfl-sNO2-Xt6y9QP6QI-1Jn6S1EaLkcaP0-5sHUAtB-e6bPNklB2_h5_tHFCR9pTpWGp1TgTy8ncccQi4yKsitQSi508QcjV9S9rgz--femrbUyuIpZmy6wjvJ5168m8uwIAxWTFOQ5JX57ONJ4Ba4wiQY8E8pzDIJEvXCuKr0Iq94VtoEg1ywk8LAP_l4rbJg4EyFW9Bm57YorJNumsVc7-eX_7nD3qM)
+
+| **#** | Interaction | Data  | Transaction Options |
+| ----- | --- | --- | --- |
+| 1 | FHIR Bundle | A bundle of FHIR resources representing clinical data for a particular patient encounter. Recommended: FHIR IDs are predefined by the PoS to make looking up of saved data easier | [FHIR Transaction POST](https://www.hl7.org/fhir/http.html#transaction) |
+| 2 | Translate terminology codes | The IOL or a mediator uses TS workflows to transalate any necessary codes | Any TS workflows necessary |
+| 3 | Extract Patient Resource | | |
+| 4 | POST Patient (FHIR format) | FHIR Patient resource | [Create Patient Demographic Record Workflow](../patient-identity-management-workflows/create-patient-demographic-record-workflow-1.md) |
+| 5 | Create a new record, if matches to existing source id auto link else run linking | | |
+| 6 | Record ID | | |
+| 7 | Lookup stub patient resource | | |
+| 8 | Return patient or NULL | | |
+| 9 | Modify bundle (Strip Patient Demographics, add CR ref with Record ID to Patient.link, retain original Patient.id (uuid)) | | |
+| 10 | Modify bundle (Replace patient resource in bundle with SHR (FHIR Server) copy retaining Patient.link, add additional CR ref with Record ID to Patient.link) | | |
+| 11 | POST Modifed FHIR Bundle | FHIR Bundle | [FHIR Transaction POST](https://www.hl7.org/fhir/http.html#transaction) |
+| 12 | Validate FHIR profiles, terminology, facility and patient references | | |
+| 13 | Response | | |
+| 14 | Response | | |
diff --git a/introduction/shared-health-record/save-patient-level-clinical-data-workflow.md b/introduction/shared-health-record/save-patient-level-clinical-data-workflow.md
index aee09e6..c1ca8c6 100644
--- a/introduction/shared-health-record/save-patient-level-clinical-data-workflow.md
+++ b/introduction/shared-health-record/save-patient-level-clinical-data-workflow.md
@@ -1,4 +1,6 @@
-# Save Patient-level Clinical Data Workflow
+# Save Patient-level Clinical Data Workflow (Document-based)
+
+Also see [FHIR native version of this workflow](./save-patient-level-clinical-data-workflow-fhir.md).
 
 This transaction allows a point of service (PoS) system to save patient-level clinical data to the SHR. The transaction is verified and validated against the other registries before it is saved in the SHR. The following sequence diagram shows the steps involved.
 
diff --git a/openhie-component-specifications-1/openhie-shared-health-record-shr.md b/openhie-component-specifications-1/openhie-shared-health-record-shr.md
index 433011b..968fc1e 100644
--- a/openhie-component-specifications-1/openhie-shared-health-record-shr.md
+++ b/openhie-component-specifications-1/openhie-shared-health-record-shr.md
@@ -10,12 +10,23 @@ See also [Non-Functional Requirements](non-functional-requirements.md).
 
 A [core principle of the OpenHIE architecture](https://wiki.ohie.org/display/resources/Architectural+Principals) is to allow the various infrastructure services (such as the SHR) to be interchangeable. To support this, the [OpenHIE Standards and Profiles](https://wiki.ohie.org/display/documents/OpenHIE+Standards+and+Profiles) used by the Shared Health Record are outlined in the workflows below.
 
-To be an OHIE SHR component, the SHR application must be able to support the OHIE workflows listed below. Implementations may support only the workflows needed to support their use case:
+To be an OHIE SHR component, the SHR application must be able to support the OHIE workflows listed below. Implementations may support only the workflows needed to support their use case.
+
+There are two separate options for implementing these workflows. There is a document-based option which was part of the original OpenHIE specification and a newer, more modern and simpler native FHIR version of the workflows. An implementation may choose which workflow set to implement.
+
+### Document-based workflows
+
+| **#**                                                                                                             | **SHR Workflows (Described in detail in the later part of this document)**                                                       | **Recommendation/ Requirement** |
+| ----------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------- | ------------------------------- |
+| \*\*\*\*[**SHRWF-1**](../introduction/shared-health-record/save-patient-level-clinical-data-workflow.md)\*\*\*\*  | [Save patient-level clinical data workflow - document-based](../introduction/shared-health-record/save-patient-level-clinical-data-workflow.md)   | Requirement                     |
+| \*\*\*\*[**SHRWF-2**](../introduction/shared-health-record/query-patient-level-clinical-data-workflow.md)\*\*\*\* | [Query patient-level clinical data workflow - document-based](../introduction/shared-health-record/query-patient-level-clinical-data-workflow.md) | Requirement                     |
+
+### Native FHIR-based workflows (Recommended)
 
 | **#**                                                                                                             | **SHR Workflows (Described in detail in the later part of this document)**                                                       | **Recommendation/ Requirement** |
 | ----------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------- | ------------------------------- |
-| \*\*\*\*[**SHRWF-1**](../introduction/shared-health-record/save-patient-level-clinical-data-workflow.md)\*\*\*\*  | [Save patient-level clinical data workflow](../introduction/shared-health-record/save-patient-level-clinical-data-workflow.md)   | Requirement                     |
-| \*\*\*\*[**SHRWF-2**](../introduction/shared-health-record/query-patient-level-clinical-data-workflow.md)\*\*\*\* | [Query patient-level clinical data workflow](../introduction/shared-health-record/query-patient-level-clinical-data-workflow.md) | Requirement                     |
+| \*\*\*\*[**SHRWF-1**](../introduction/shared-health-record/save-patient-level-clinical-data-workflow.md)\*\*\*\*  | [Save patient-level clinical data workflow - FHIR native](../introduction/shared-health-record/save-patient-level-clinical-data-workflow-fhir.md)   | Requirement                     |
+| \*\*\*\*[**SHRWF-2**](../introduction/shared-health-record/query-patient-level-clinical-data-workflow.md)\*\*\*\* | [Query patient-level clinical data workflow - FHIR native](../introduction/shared-health-record/query-patient-level-clinical-data-workflow-fhir.md) | Requirement                     |
 
 ## **OpenHIE SHR Functional Requirements**