HDR Version 7 HL7 Version 3 Messaging Conformance Specification

4.4 Clinical Document Message - POCD_RM000002HT02

This section contains the following topics:

4.4.1 Introduction
4.4.2 RMIM
4.4.3 State Transitions/Trigger Events
4.4.4 Interactions
4.4.5 Referenced CMETs
4.4.6 Links to Artifacts

4.4.1 Introduction

The Clinical Document Message models a message that can act as the vehicle for a CDA document, packaged along with any multimedia it contains as a MIME package and then inserted in the text attribute of the focal ClinicalDocumentMetadata Act. It does not duplicate the extensive header information available on the CDA document itself. The underlying assumption is that there will be no need to transmit different information in the message than what is in the CDA header for the same participation, act relationship and attributes.

CDA document may be transmitted to HDR in the Act.text attribute of the Clinical Document Message focal act, in a MIME package which is an ED datatype. The text element content in the CDA message must always be Base64 MIME encoded text.

The components of the ED datatype should be as follows:

• representation: 'TXT'
• compression: not present
• mediaType: "text/plain"
• mimeType: "application/xml" or "multipart/mixed"
• BIN - MIME content type
  
  • This may contain a charset within it. Processing is based on the presence of charset declaration.
    • If charset is not present, but there is an XML encoding declaration in the wrapping XML message, then CDA document's charset is inherited from the wrapping message
    • If charset is not present and there is no XML encoding declaration on the wrapping XML message, then CDA document's charset is defaulted to UTF - 8
    • If charset is present then it will be used. All values that are supported by javax.mail API will be supported. (For more information refer to http://java.sun.com/products/javamail/javadocs/javax/mail/internet/MimeUtility.html
  • If mimeType = "application/xml" then BIN must contain a base64 encoded, single part package containing the CDA document
  • If mimeType = "multipart/mixed" then BIN must contain a multipart MIME package, where:
    • All parts must be base64 encoded
    • The first part must be the CDA document
    • Subsequent parts must be binary files attached to the document; their file names must exactly match the URLs used in the document, e.g., a MIME part with file name = directory/file.gif" should be referred to in the clinical document as: (where "directory" is not mandatory)
      • These attachment references will work only inside the ObservationMedia.value attributes.

Appendix B shows an example of using a multipart MIME package. The XML represents a Clinical Document message in which a multipart MIME package has been placed in the ClinicalDocumentMetatdata.text element. The first part of the MIME package contains an Oracle CDA Document, while the second part contains multimedia data referred to in the document.

To maintain consistency with HL7 V2.x, the HL7 Medical Records Draft Standard for Trial Use (DSTU) has placed certain constrains on completionCode, confidentialityCode, storageCode, availabilityTime attributes of ClinicalDocument depending on the value of the statusCode. The following table illustrates:

In the Medical Records message, these attributes are found on the message focal act. (The confidentiallyCode attribute is also found in the CDA document.) In the Oracle solution, statusCode, completionCode, storageCode, and availabilityTime are found in the message (on the ClinicalDocumentMetadata act), confidentialityCode is found only in the Oracle-conformant CDA document (on ClinicalDocument). IMP does not validate these combinations. It is left up to the customer to determine whether restrictions to these combinations is necessary.

4.4.2 RMIM

The following figure diagrams the Clinical Document Message RMIM:

Figure: 4.4.2-1 Clinical Document Message RMIM

See Full-size Image

4.4.3 State Transitions/Trigger Events

The list of trigger events follows:

4.4.4 Interactions

The list of Interactions follows:

4.4.5 Referenced CMETs

• 5.53 R_AssignedEntity (universal) - COCT_RM090000HT02
  

4.4.6 Links to Artifacts

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