Integrating the Healthcare Enterprise

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IHE IT Infrastructure
Technical Framework
Volume 3
IHE ITI TF-3
Cross-Transaction Specifications and Content
Specifications

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IHE IT Infrastructure Technical Framework, Volume 3 (ITI TF-3): Cross-Transaction andContent Specifications______________________________________________________________________________CONTENTS

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4.0 Metadata used in Document Sharing profiles ........................................................................... 4
4.1 Abstract Metadata Model .................................................................................................... 5
4.1.1 Metadata Object Types ................................................................................................ 6
4.1.2 Association Types ........................................................................................................ 8
4.1.3 Metadata Attributes ..................................................................................................... 9
4.1.4 Submission Request ................................................................................................... 15
4.2 ebRIM Representation ...................................................................................................... 16
4.2.1 Metadata Object Types .............................................................................................. 17
4.2.2 Association Types ...................................................................................................... 26
4.2.3 Metadata Attributes ................................................................................................... 47
4.2.4 Success and Error Reporting ................................................................................... 100
4.2.5 Metadata Vocabulary ............................................................................................... 107
4.3 Additional Document Sharing Requirements ................................................................. 109
4.3.1 Submission Metadata Attribute Optionality ............................................................ 109
4.3.2 Requirements on Query Type Transactions ............................................................ 111
5.0 IHE Content Specifications................................................................................................... 114
5.1 Basic Patient Privacy Consents Module .......................................................................... 114
5.1.1 References ................................................................................................................ 114
5.1.2 Patient Privacy Consent Acknowledgment Document Specification
1.3.6.1.4.1.19376.1.5.3.1.1.7 – With no Scanned Document Part ........................... 114
5.1.3 Patient Privacy Consent Acknowledgment Document Specification
1.3.6.1.4.1.19376.1.5.3.1.1.7.1 – With Scanned Document .................................... 118
5.2 Scanned Documents Content Module............................................................................. 119
5.2.1 Referenced Standards ............................................................................................... 119
5.2.2 XDS Metadata .......................................................................................................... 120
5.2.3 Specification ............................................................................................................. 122
5.2.4 Complete Example (Wrapped PDF) ........................................................................ 132
5.3 Intentionally Left Blank .................................................................................................. 135
5.4 XDW Workflow Content Module .................................................................................. 136
5.4.1 Referenced Standards ............................................................................................... 136
5.4.2 Discussion of Content Standards.............................................................................. 136
5.4.3 Content Specification ............................................................................................... 143
5.4.4 Complete Example ................................................................................................... 155
5.4.5 Workflow Document Management .......................................................................... 159
5.4.6 XDS Metadata .......................................................................................................... 163
5.5 Document Digital Signature (DSG) Document Content ................................................ 165
5.5.1 References ................................................................................................................ 165
5.5.2 Signature Specification ............................................................................................ 166
5.5.3 Detached Signature .................................................................................................. 168
5.5.4 Enveloping Signature ............................................................................................... 169
5.5.5 Signature Verification .............................................................................................. 169___________________________________________________________________________
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5.5.6 Document Sharing Metadata .................................................................................... 170
5.5.7 Security Considerations............................................................................................ 172___________________________________________________________________________
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4.0 Metadata used in Document Sharing profiles
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80This section describes the metadata that is used in IHE profiles designed for sharing documents(Document Sharing profiles). The Document Sharing profiles are implementing the Document
Sharing concept outlined in the ITI whitepaper entitled Health Information Exchange: Enabling
Document Sharing Using IHE Profiles available on the IHE website(http://ihe.net/Technical_Frameworks/#IT). This section assumes understanding of the concepts
presented in the white paper.
The ITI Document Sharing profiles which use this metadata include:

85•

Cross-Enterprise Document Sharing (XDS.b)•

Cross-Enterprise Document Reliable Interchange (XDR)•

Cross-Enterprise Document Media Interchange (XDM)•

Multi-Patient Queries (MPQ)•

Cross-Community Access (XCA)

It is likely that future ITI profiles will also use Document Sharing metadata. Profiles from IHE
domains other than ITI that use or constrain this metadata are not listed here. Those profiles will
document their use of this metadata.
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Document Sharing profiles manage two aspects of the documents being shared, the metadata
about the document and the contents of the document.
Metadata encodes the properties of Documents, the environments they come from, circumstancesof their submission, terms to reference in queries, and grouping with other Documents. If you
think of a document as a book in a library, the index card in the library’s card catalog is the
document metadata.

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A Document is a byte sequence managed by actors in one or more IHE Document Sharing
profiles. There is no concept of equivalent Documents. If the byte sequence is different, then theDocuments are different.
Note that this definition of a Document is stricter than document definitions in DICOM®1, HL7,
HL7 CDA®2, XML, and elsewhere. Those standards have concepts like "insignificant
whitespace". Documents with different byte sequences, that those standards consider equivalent,
will be treated as different Documents by IHE Document Sharing.
This stricter definition of a Document enables the Document Sharing actors to manage any
document format, without the need to include a parser that understands the details of all the

DICOM is the registered trademark of the National Electrical Manufacturers Association for its standards
publications relating to digital communications of medical information.

1

2

HL7 and CDA are registered trademarks of Health Level Seven International.

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different document formats. It also enables most document indexing, registration, etc. to be doneusing metadata alone, without examining the document contents.
Section 4 first explains the metadata at a conceptual level (Section 4.1), then at an
implementation level (Section 4.2) and then provides some profile- and transaction-specificmetadata constraints and considerations (Section 4.3).

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Content Profiles may impose restrictions on metadata attributes. See Section 5 for the restrictions
imposed by ITI Content Profiles.

4.1 Abstract Metadata Model
The metadata used in Document Sharing profiles is characterized by three types of objects andtwo types of Associations. In Figure 4.1-1, the three objects types and two Association types are
depicted using UML to show their relationships. The three object types are:115•

SubmissionSet – metadata describing a collection of Folders, DocumentEntries, andAssociations submitted together.

•

Folder – metadata describing a collection of related DocumentEntries.

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DocumentEntry – metadata describing a Document.

The two Association types are:120•

HasMember – represents membership of an object in a collection. The four variations of
HasMember are described in Section 4.1.2.

•

Relationship – represents a relationship (such as a transform) between two Documents(represented by DocumentEntries). The Relationship associations are described in
Section 4.1.2.

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Figure 4.1-1: Document Sharing Objects and Associations

4.1.1 Metadata Object Types
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There are three metadata object types supported by the Document Sharing metadata, as seen in
Figure 4.1-1:•

SubmissionSet•

Folder•DocumentEntry

SubmissionSet – The SubmissionSet can be thought of as the packing slip of a postal package.
The details of the submission of DocumentEntries, Folders, and Associations are captured in the
SubmissionSet object. The creating entity of each submission must group the DocumentEntries,
Folders and Associations into a unique SubmissionSet. The Document Sharing profiles ensurethat the documents are treated as a unit for submission purposes – either all of the documents
arrive at their destination, or none of them do. An example of the use of a Submission Set ispackaging all documents related to a care episode at the end of the hospital stay. The EHR
system can submit the package. If the submission fails, none of the documents made it to theirdestination, and a retry is possible.
SubmissionsSets, once submitted, are a permanent record of the collection of submitted
content.DocumentEntries may be bundled into a SubmissionSet by a human, machine, or
process. For example, a laboratory machine might automatically submit results associated with agiven lab order when they are ready, rather than waiting for a human to bundle them.
SubmissionSets may contain DocumentEntries for multiple patients, but there are specificlimitations on how this is done.
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A SubmissionSet shall be the source of at least one Association of type SS-FD HasMember, SSHM HasMember, and/or SS-DE HasMember.
Folder – A Folder is a logical collection of DocumentEntries that are related in some way, suchas to a clinical use case. A Folder is an arbitrary grouping relationship. Folders may be updated
by multiple SubmissionSets sent from multiple departments that are submitting their
DocumentEntry objects at different times. For example, a Folder may be used to collect theDocumentEntry objects for the patient’s documents that relate to an exam event, such as theexam request and prior results as well as the eventual exam results. As the exam results become
available, the DocumentEntry objects can be added to the Folder for the exam records.
All DocumentEntries in a Folder shall be for the same patient.

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The metadata structure discussed in this volume only specifies how to describe a Folder, andimposes no requirements for when or how a Folder should be used. Additional detail on whenand how to use a Folder may be described in IHE profiles.
DocumentEntry – DocumentEntry is a metadata object representing a document. This metadata
object does not contain the contents of the document; instead it contains attributes describing the
document.

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Details on how documents and metadata are managed depend on the requirements in a particularDocument Sharing Profile.
For example, in XDS, a Stable DocumentEntry is the logical representation in the Registry of theDocument that the Source submitted to a Repository. An entire document’s contents canconstitute several megabytes, but can be described in a few kilobytes of metadata. The
DocumentEntry metadata that describes the document are sufficient for the purposes of storing,organizing and locating documents for retrieval. Submitting a Stable DocumentEntry to a
Registry in lieu of submitting the document creates a separation of concerns, allowing theRegistry to specialize in indexing, while the Repository manages document storage.
There are two DocumentEntry Types: Stable DocumentEntry and On-Demand Document Entry.
The following sections describe these types in detail.
•

Stable DocumentEntry

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A Stable Document Entry contains metadata about an already created document available
for retrieval. Each Stable DocumentEntry represents a single document. This document isstable because the contents have been effectively combined in the exact representationthat will be returned in a Retrieve Document Set. A Stable Document Entry is an
XDSDocument Entry with objectType equal to the UUID for Stable (see Section 4.2.5.2
for the UUID) and availabilityStatus equal to Approved or Deprecated. All metadatafields contain valid values.

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The uniqueID metadata attribute of a Stable DocumentEntry identifies the specificdocument associated with the entry. It is used in a retrieve request to identify which
specific document should be retrieved.
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If the document returned on a retrieve request is CDA, it will have in theClinicalDocument/id field in the HL7 CDA R2 document header the same value as thevalue of the DocumentEntry uniqueId.
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On-Demand Document Entry
An On-Demand Document Entry provides a unique identifier which can be used to create
an on-demand document which collects the latest, most recent available information at
the time of retrieval. On-Demand Document Entries never reflect actual document
content, but rather the potential for a document with the characteristics described in themetadata of the entry. An On-Demand DocumentEntry has objectType equal to the
UUID for On-Demand (see Section 4.2.5.2 for the UUID) and availabilityStatus equal toApproved or Deprecated. An On-Demand Document Entry may be replaced anddeprecated. If an On-Demand Document Entry is deprecated, the retrieval of thatuniqueID may not have the most recent information and should return an error.

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The uniqueID associated with an On-Demand Document Entry will never represent an
actual document. A retrieve request specifying an On-Demand Document Entry uniqueID
will return content identified by a uniqueID different than the specified uniqueID.
Every On-Demand Document Entry with the same uniqueID will refer to the samepotential content. Actual content depends on the time of retrieval. The On-Demand
Document Entry uniqueID is valid for as long as the entry has availabilityStatus equal toApproved. The holder of the uniqueID may re-use it in a retrieve request to get the latest
information, without the need for an additional query.

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When a retrieve request is received specifying an On-Demand Document Entry
uniqueID, the responder may choose to persist the document generated as a result andallow the requestor future access to the metadata and document. This capability is
declared through the Persistence of Retrieved Documents Option on the On-Demand
Document Source and Responding Gateway Actors. The persistence refers not only to thesaving of the content for re-use, but more specifically, to the ability of the requester to
use retrieve to access that exact, possibly now historic, content and use a query to get
metadata about the content.

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Unless otherwise specified in a transaction, On-Demand DocumentEntry objects shall not
be included in the transaction.
4.1.2 Association Types
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Associations represent a link from the source object to a target object. Association objects
describe all aspects of this link including references to source and target objects, the specificvariant or name of the Association, and status and version information.
There are two types of Associations: HasMember and Relationship.
•

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HasMember- defines a membership relationship between two objects. There are four
variants of the HasMember Association depending on the types of the source and target
object, see Figure 4.1-1.

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SS-FD HasMember: An association from a SubmissionSet to a Folder identifies the
Folder as a member of that SubmissionSet. It identifies the Submission Set that
contained the initial creation of the Folder.
FD-DE HasMember: An association from a Folder to a DocumentEntry identifies that
DocumentEntry as a member of that Folder. Folders have a many-to-many
relationship to DocumentEntries (i.e., one folder may be linked to many
DocumentEntries, and one DocumentEntry may be linked to many folders).

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SS-HM HasMember: An association from a SubmissionSet to a FD-DE HasMember
Association identifies that FD-DE HasMember as a member of that
SubmissionSet. This makes it possible to identify the Submission Set in which thelink between the Folder and the DocumentEntry was created.

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SS-DE HasMember: An association from a SubmissionSet to a DocumentEntry identifies
the DocumentEntry as a member of that SubmissionSet. The association between
the SubmissionSet and the DocumentEntry provides information about thesubmission of the Documents. With this association of a DocumentEntry, you canfind the Submission Set and know when the document was submitted, who theauthor of the submission was, and other information contained in the attributes ofthat SubmissionSet.

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•

Relationship – defines an association between two DocumentEntry objects. There are
five variants based on the type of relationship between the DocumentEntry objects.
Replace – indicates the replacement of a previous document with a new document.
Transform - indicates the transformation of a previous document into a new document.
Append – indicates a new document that appends to the contents of a previous document.
Transform and Replace – indicates a transformed replacement of a previous documentwith a new document.

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Signs – indicates a new document is a signature for a previous document, as in new
document signs previous document.
4.1.3 Metadata Attributes
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Each metadata object holds attributes used for a variety of purposes. This section outlines thevariety of purposes metadata attributes serve as well as a general description of each attribute.
Detail about the coding of attributes is described in Section 4.2.3.
4.1.3.1

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The Purpose of Metadata Attributes (Informative)

Metadata attributes can be categorized according to specific document-handling purposes. Eachmetadata attribute typically has more than one purpose, although some have only one. Metadata
in the Document Sharing profiles has one or more of these purposes.
•

Patient Identity – Attributes that describe the subject of the document. This includes
patient Id, patient name, and other demographics.

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Provenance – Attributes that describe where the document comes from. These items arehighly influenced by medical records regulations. This includes human author,
identification of system that authored, the organization that authored, predecessor
documents, successor documents, and the pathway that the document took.

•

Security & Privacy – Attributes that are used by Privacy and Security rules toappropriately control the document. These values enable conformance to Privacy andSecurity regulations. These characteristics would be those referenced in Privacy or
Security rules. These characteristics would also be used to protect against security risks to
confidentiality, integrity, and availability.

•

Descriptive – Attributes that are used to describe the clinical value, so they are expressly
healthcare-specific. These values are critical for query models and enable workflows inall exchange models. The number of attributes in this category is kept to minimum so themetadata doesn't simply duplicate the document, and to keep disclosure risk to aminimum. Thus the metadata attribute values tend to be from a small set of codes.
Because this category is close to the clinical values it tends to have few mandatory
attributes, allowing policy to choose to not populate. For healthcare documents, this is
typically very closely associated with the clinical workflows but also must recognize
other uses of healthcare documents such as quality reporting, public health reporting,authorized clinical research, patient access, etc.

•

Object Lifecycle – Attributes that describe the current lifecycle state of the document
including relationships to other documents. This would include classic lifecycle states ofcreated, published, replaced, transformed, and deprecated.

•

Exchange -- Attributes that enable the transfer of the document for both push typetransfers, and pull type transfers. These attributes are used for low-level automatedprocessing of the document. These attributes are not the workflow routing, but rather theadministrative overhead necessary to make the transfer. This includes the document
unique Id, location, size, MIME types, and document format.

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Figure 4.1.3.1-1: Pictorial of Overlapping Document Sharing Metadata Purpose

All metadata attributes describe the document and are not a replacement for the document. Not
all metadata attributes are always required; indeed some metadata attributes would be used only
for specific uses. Care has been taken to limit the metadata to the minimum metadata attributes
necessary to achieve the goal. Each metadata element was assessed for risks posed by exposing it
as metadata. All metadata attributes are defined to assure that when the element is needed that it
be consistently assigned and processed.

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4.1.3.2

Table 4.1.3.2-1 provides a conceptual view of the metadata attributes associated with aDocumentEntry object. The table describes each attribute and provides a mapping between theattribute and the purposes that attribute is designed to support. The full DocumentEntry metadata
attribute definition, including data type and coding is in Section 4.2.3.2.

X

X

The humans and/or machines that authored the
document. This attribute contains the sub-attributes:
authorInstitution, authorPerson, authorRole,
authorSpecialty and authorTelecommunication.

availabilityStatus

The lifecycle status of the DocumentEntry

X

classCodeThe code specifying the high-level use classificationof the document type (e.g., Report, Summary,
Images, Treatment Plan, Patient Preferences,
Workflow).

Xcomments

Comments associated with the document.

confidentialityCode

The code specifying the level of confidentiality of the
document.

creationTime

The time the author created the document.

entryUUID

ExchangeXauthorObject Lifecycle

Descriptive

Description

Security&Privacy

DocumentEntry
Metadata
Attribute

Provenance

Table 4.1.3.2-1: DocumentEntry Metadata Attribute Definition
Patient identity

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DocumentEntry Metadata Attributes

X

X
X

X
X
X

X

X

X

A globally unique identifier used to manage theentry.

X

X

X

eventCodeList

This list of codes represents the main clinical acts,
such as a colonoscopy or an appendectomy, being
documented.

X

X

formatCode

The code specifying the detailed technical format ofthe document.

hash

The hash of the contents of the document.

healthcareFacility
TypeCodeThis code represents the type of organizationalsetting of the clinical encounter during which the
documented act occurred.

homeCommunityId

A globally unique identifier for a community.

languageCode

Specifies the human language of character data in the
document.

legalAuthenticator

Represents a participant within an authorInstitution
who has legally authenticated or attested the
document.

X

limitedMetadata

Indicates whether the DocumentEntry was createdusing the less rigorous requirements of metadata as
defined for the Metadata-Limited Document Source.

X

X

X

X

X
X

X

X

X
X
X

X

X

X

X

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mimeType

MIME type of the document.

objectType

The type of DocumentEntry (e.g., On-Demand
DocumentEntry).

patientId

The patientId represents the subject of care of the
document.

practiceSettingCode

The code specifying the clinical specialty where theact that resulted in the document was performed (e.g.,
Family Practice, Laboratory, Radiology).

referenceIdList

A list of identifiers related to the document

repositoryUniqueId

The globally unique identifier of the repository where
the document can be accessed.

X

serviceStartTime

The start time of the service being documented.

X

X

serviceStopTime

The stop time of the service being documented.

X

X

size

Size in bytes of the document.

XsourcePatientId

The sourcePatientId represents the subject of care’s
medical record identifier (e.g., Patient Id) in the local
patient identifier domain of the creating entity.

X

X

sourcePatientInfo

This attribute contains demographic information of
the source patient to whose medical record thisdocument belongs.

X

X

title

The title of the document.

X

typeCode

The code specifying the precise type of documentfrom the user perspective (e.g., LOINC code).

XuniqueId

Globally unique identifier assigned to the documentby its creator.

URIThe URI for the document.

X

Exchange

Object Lifecycle

Descriptive

Security&Privacy

Description

Patient identity

DocumentEntry
Metadata
Attribute

Provenance______________________________________________________________________________

X
X

X

X

X

X

X

X

X

X

X
X

X

X

X

X
X

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4.1.3.3

Table 4.1.3.3-1 provides a conceptual view of the metadata attributes associated with a
SubmissionSet object. The table describes each attribute and provides a mapping between theattribute and the purposes that attribute is designed to support. The full SubmissionSet metadata
attribute definition, including data type and coding is in Section 4.2.3.3.

author

The humans and/or machines that authored theSubmissionSet. This attribute contains the subattributes: authorInstitution, authorPerson,
authorRole, authorSpecialty,
authorTelecommunication.

availabilityStatus

The lifecycle status of the SubmissionSet.

comments

Comments associated with the SubmissionSet.

contentTypeCode

The code specifying the type of clinical activity that
resulted in placing the associated content in the
SubmissionSet.

entryUUID

A globally unique identifier used to manage theentry.

homeCommunityId

A globally unique identifier for a community.

intendedRecipient

The organizations or persons for whom the
SubmissionSet is intended.

limitedMetadata

A flag that the associated SubmissionSet was createdusing the less rigorous metadata requirements as
defined for the Metadata-Limited Document Source.

patientId

The patientId represents the primary subject of careof the SubmissionSet.

sourceId

Identifier of the entity that contributed theSubmissionSet.

submissionTime

Point in time at the creating entity when the
SubmissionSet was created.

title

The title of the SubmissionSet.

uniqueId

Globally unique identifier for the SubmissionSet
assigned by the creating entity.

X

X

X

Exchange

X

Object Lifecycle

Descriptive

Description

Security&Privacy

Submission Set
Metadata
Attribute

Provenance

Table 4.1.3.3-1: SubmissionSet Metadata Attribute Definition
Patient identity

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SubmissionSet Metadata Attributes

X

X
X

X

X

X

X

X
X

X
X

X
X

X
X

X

X

X

X

X

X

X

X

X

X
X

X

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4.1.3.4
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Folder Metadata Attributes

Table 4.1.3.4-1 provides a conceptual view of the metadata attributes associated with a Folder
object. The table describes each attribute and provides a mapping between the attribute and the
purposes that attribute is designed to support. The full Folder metadata attribute definition,
including data type and coding is in Section 4.2.3.4.

The set of codes specifying the type of clinicalactivities that resulted in placing DocumentEntry
objects in the Folder.

comments

Comments associated with the Folder.

entryUUID

A globally unique identifier used to manage theentry.

homeCommunityId

A globally unique identifier for a community.

lastUpdateTime

Most recent point in time that the Folder has been
modified.

limitedMetadata

A flag that the associated Folder was created using
the less rigorous metadata requirements as definedfor the Metadata-Limited Document Source.

patientId

The patientId represents the primary subject of careof the Folder.

title

The title of the Folder.

uniqueId

Globally unique identifier for the Folder.

X

X

X

X

X

X

Exchange

Object Lifecycle

The lifecycle status of the Folder.

codeList

Descriptive

availabilityStatus

Security&Privacy

Description

Patient identity

Folder Metadata
Attribute

Provenance

Table 4.1.3.4-1: Folder Metadata Attribute Definition

X
X

X

X
X

X
X

X

X
X

X

X

X

X
X

X

X

4.1.4 Submission Request
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A Submission Request is a collection of metadata transferred between one Document Sharing
Actor and another. A Submission Request shall contain:
1) One SubmissionSet object
2) At least one of the following:a. One or more DocumentEntry objects

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b. One or more Folder objectsc. One or more FD-DE HasMember Associations
3) For each object in (2), one HasMember Association linking the SubmissionSet in (1) tothat object.
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4) Zero or more Relationship Associations
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Individual transactions or profiles may impose restrictions on the content.

4.2 ebRIM Representation
This section details the representation of the metadata objects and their attributes using classes
provided by OASIS ebXML RegRep 3.0 specification at http://docs.oasisopen.org/regrep/v3.0/regrep-3.0-os.zip.
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The Electronic Business using eXtensible Markup Language (ebXML) Registry and Repository(RegRep) specification describes a way to implement registry and repository servers and clientsusing standard interfaces, protocols and an information model for publishing, management,
discovery and retrieval of arbitrary content and metadata that describes it.
The ebXML RegRep specification is made of two parts:

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ebRIM: The "ebXML Registry Information Model version 3.0" (ebRIM) defines thetypes of metadata and content that can be stored in an ebXML Registry.

•ebRS: The "ebXML Registry Services Specification version 3.0" (ebRS) defines theservices and protocols for an ebXML Registry.

IHE highly constrains the use of ebRIM and ebRS in Document Sharing profiles to fit therequirements for expression of metadata objects and to communicate the objects between actors.
This section focuses on expression of the objects, and IHE transactions and profiles detail thecommunication.
When document sharing was first introduced in IHE, XDS was the only document sharing
model. In the initial XDS Profile, the Document Registry could be implemented as an adaptor toan ebXML Registry. As such, all XDS content is valid in terms of the ebRIM, but XDS
introduces additional restrictions on the data that may be transmitted. Only a limited number ofthe classes in ebRIM are supported by XDS and the contents and semantics of those classes arefurther restricted. While an XDS Registry may be implemented as an adaptor to an ebXML
Registry, or without an underlying ebXML Registry, it should not be assumed that features
available from a pure ebXML Registry are available in an IHE environment. Features of an
ebXML Registry should be considered as not available unless they are explicitly defined byindividual IHE profiles.

360

Now that document sharing in IHE has grown beyond the XDS model, Document Sharing
metadata applies to profiles beyond XDS. In those other environments, it is highly unlikely to be
implemented using an ebXML Registry.

365

IHE excludes the requirements found in ebRIM 3.0 Section 2.5.9 which state that "eachRegistryObject instance MUST have a life cycle status indicator." For some RegistryObjects thelife cycle status indicator is required by IHE, and this requirement is stated within IHE’s
description of use of the object. For other objects, where a requirement is not explicitly stated by
IHE, the life cycle status indicator is optional.
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the “rim:” prefix, for example rim:ExtrinsicObject, rim:RegistryPackage, rim:Slot,
rim:Classification, etc.
Table 4.2-1: ebRIM/Document Sharing Correspondence
Document Sharing
Object/Association
DocumentEntry

ebRIM class
rim:ExtrinsicObject

SubmissionSet

rim:RegistryPackage

FolderMemberOf
Relationship

rim:Association

370
The DocumentEntry object type is modeled through the rim:ExtrinsicObject class.

375

The SubmissionSet and Folder object types are conveyed through the rim:RegistryPackage class.
Since the ebRIM standard does not allow for subclassing the RegistryPackage class, these two
objects are implemented as rim:RegistryPackages. A rim:Classification is used to distinguishbetween the SubmissionSet and Folder object types.
The HasMember and Relationship Association concepts are conveyed through therim:Association class.
4.2.1 Metadata Object Types
4.2.1.1

380

DocumentEntry

The DocumentEntry does not contain the contents of the document; instead it contains attributes
describing the document. Further details regarding the DocumentEntry object type can be foundin Section 4.1.1.
Figure 4.2.1.1-1 represents the DocumentEntry and its attributes. Detailed descriptions of all theattributes of a DocumentEntry are described in Section 4.2.3.2.

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Figure 4.2.1.1-1: DocumentEntry Metadata Attributes (Informative)

The abstract concept of a DocumentEntry is expressed through an ebRIM RegistryPackageclassified as a DocumentEntry.

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390

Figure 4.2.1.1-2: UML diagram for rim:ExtrinsicObject (Informative)

Figure 4.2.1.1-2 represents rim:ExtrinsicObject as a structure made of classes and attributes ofthe ebRIM subset used for Document Sharing. This diagram is read from left to right andrim:ExtrinsicObject is considered as the root class.
395

400

The expression of the DocumentEntry is done by mapping the abstract DocumentEntry metadata
attributes into rim:ExtrinsicObject class attributes, elements and other associated classes. This
mapping uses, wherever possible, the parts of rim:ExtrinsicObject as intended (such as Name,
Description and ExternalIdentifier), and holds the healthcare specific attributes in general
purpose Slots or Classifications.
Requirements for matching SubmissionSet.patientId to included or referenced DocumentEntries’
patientId are detailed in Section 4.2.2.1.1.
4.2.1.1.1 DocumentEntry types

405

As described in Section 4.1.1, there are two DocumentEntry types: Stable Document Entry and
On-Demand Document Entry. A Stable Document Entry is an XDSDocument Entry with
objectType equal to the UUID for Stable (see Section 4.2.5.2 for the UUID). An On-Demand
DocumentEntry has an objectType equal to the UUID for on-demand (see Section 4.2.5.2 for the
UUID). Each Stable DocumentEntry represents a single document which is identified by theuniqueId attribute.

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4.2.1.2
410

SubmissionSet

The abstract concept of a SubmissionSet is expressed through an ebRIM RegistryPackageclassified as a SubmissionSet. The SubmissionSet bundles DocumentEntry, Folder andAssociation objects for submission. Further details regarding the SubmissionSet object type canbe found in Section 4.1.1.

415

Figure 4.2.1.2-1: UML diagram for SubmissionSet (Informative)

This expression is done by mapping the abstract SubmissionSet metadata attributes into,
wherever possible, the parts of RegistryPackage as intended and holding the healthcare-specificattributes in general-purpose Slots and Classification. An ebRIM Classification class is used to
identify a RegistryPackage as a SubmissionSet versus a Folder.
420

A SubmissionSet has a set of attributes that are described in Section 4.1.3.3 SubmissionSet
Metadata.
SubmissionSets exist for two reasons:To support atomic submissions
To provide a permanent record of:425•

the existence and status of the submission•

the Folders and DocumentEntry objects and Associations included in the submission___________________________________________________________________________
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Figure 4.2.1.2-2: SubmissionSet Metadata Attributes (Informative)430

The value of the patientId attribute of the DocumentEntry objects that a SubmissionSet contains
shall match the value of the patientId attribute on the SubmissionSet itself.
Requirements for matching the value of SubmissionSet.patientId to the value of Patient Id inreferenced DocumentEntry objects are detailed in Section 4.2.2.1.1.
Once the SubmissionSet has been submitted, no further associations to or from the
SubmissionSet shall be created later on.

435

4.2.1.2.1 Creating a SubmissionSet object from a RegistryPackage element

440

A SubmissionSet object shall be created from a RegistryPackage element by labeling it with aClassification of type urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd. A receiver of
metadata shall accept the Classification element encoded within the RegistryPackage element oron the same level as the RegistryPackage. The following XML example demonstrates these twovalid approaches to encoding the Classification.
Classification encoded inside the RegistryPackage object

445

450

<RegistryPackage id="SubmissionSetId"><rim:Classification
classifiedObject="SubmissionSetId"
classificationNode="urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd"
id="urn:uuid:1d4d08bc-85cc-4596-8fdc-4b5410a6feae"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"/></RegistryPackage>___________________________________________________________________________
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455

460

<RegistryPackage id="SubmissionSetId"></RegistryPackage><rim:Classification
classifiedObject="SubmissionSetId"
classificationNode="urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd"
id="urn:uuid:1d4d08bc-85cc-4596-8fdc-4b5410a6feae"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"/>
Item
Classification/@classifiedObject

The @id attribute of the RegistryPackage being classified.

Classification/@classificationNode

A fixed value identifying the type of object the RegistryPackage represents.
Accepted values:
urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd

Classification/@id
Classification/@objectType

4.2.1.3
465

Description

Symbolic id or UUID identifying this Classification. See Section 4.2.3.1.5 for details.

Fixed value as specified by ebRIM. Optional upon submission of objects, required
upon retrieval. If set, the value shall be "urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification".

Folder

The abstract concept of a Folder is expressed through an ebRIM RegistryPackage classified as
Folder (see the UML representation of the ebRIM RegistryPackage, Figure 4.2.1.2-1). A Folder
is used to bundle DocumentEntry objects. Further details regarding the Folder object type can befound in Section 4.1.1.

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470

Figure 4.2.1.3-1: UML diagram for Folder (Informative)

This expression is done by mapping the abstract Folder metadata attributes into, wherever
possible, the parts of RegistryPackage as intended, and holds the healthcare-specific attributes ingeneral purpose Slots and Classifications. An ebRIM Classification class is used to identify a
RegistryPackage as a Folder versus a SubmissionSet.
475

Folders shall not be nested inside other Folders. The value of the patientId attribute of theDocumentEntry objects it contains shall match the value of the patientId attribute on the folder
itself.

Figure 4.2.1.3-2: Folder Metadata Attributes (Informative)480

4.2.1.3.1 Creating a Folder object from a RegistryPackage element
A Folder object shall be created from a RegistryPackage element by labeling it with aClassification of type urn:uuid:d9d542f3-6cc4-48b6-8870-ea235fbc94c2. A receiver of___________________________________________________________________________
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485

metadata shall accept the Classification element encoded within the RegistryPackage element oron the same level. The following XML example demonstrates these two valid approaches to
encoding the Classification.
Classification encoded inside the RegistryPackage object

490

495

<…>
<RegistryPackage id="Fol"><!-- Classify registry package Fol as being a Folder --><Classification
classificationNode="urn:uuid:d9d542f3-6cc4-48b6-8870-ea235fbc94c2"
classifiedObject="Fol"id="IdExample_066"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"/></RegistryPackage><…>

500
Classification encoded outside the RegistryPackage object

505

510

<RegistryPackage id="Fol">…
</RegistryPackage><!-- Classify registry package as Folder --><Classification
classificationNode="urn:uuid:d9d542f3-6cc4-48b6-8870-ea235fbc94c2"
classifiedObject="Fol"id="IdExample_066"
objectType="urn:oasis:names:tc:ebXMLregrep:ObjectType:RegistryObject:Classification"
/>
<…>
Item

Description

Classification/@classifiedObject

The @id attribute of the RegistryPackage being classified.

Classification/@classificationNode

A fixed value identifying the type of object the RegistryPackage represents.
Accepted values:
Folder: urn:uuid:d9d542f3-6cc4-48b6-8870-ea235fbc94c2

Classification/@id
Classification/@objectType

Symbolic id or UUID identifying this Classification. See Section 4.2.3.1.5 for details.
Fixed value as specified by ebRIM. Optional upon submission of objects, required
upon retrieval. If set, the value shall be "urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification".

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4.2.1.4

Registry Object List

In submission requests and query responses, a Registry Object List contains a list of Folders,SubmissionSets, DocumentEntry objects and Associations.
520

Figure 4.2.1.4-1 shows in detail the content of the rim:RegistryObjectList used to exchange
Document Sharing metadata; a subset of the ebXML Registry Information Model (ebRIM).

Figure 4.2.1.4-1: Registry Object List (Informative)

525

530

The following XML example demonstrates the encoding of several metadata objects grouped
within a rim:RegistryObjectList:<rim:RegistryObjectList><rim:RegistryPackage id="SubmissionSet01"> ... </rim:RegistryPackage><rim:Association id="Document01InSubmissionSet01" ... /><rim:ExtrinsicObject id="Document01"> ... </rim:ExtrinsicObject></rim:RegistryObjectList>

4.2.1.5 Submission Request
See Section 4.1.4 for a definition of Submission Request. The Submission Request is
implemented as an <lcm:SubmitObjectsRequest>.
535

The <lcm:SubmitObjectsRequest> element shall contain one <rim:RegistryObjectList> element.
The <rim:RegistryObjectList> element shall contain:•

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540•

One rim:ExtrinsicObject for each DocumentEntry in the Submission Request•

One rim:Association for each Association in the Submission Request•

One rim:RegistryPackage for each Folder in the Submission Request

The rim:RegistryObjectList may also contain rim:Classification elements that identify theRegistryPackage elements as a SubmissionSet or Folder. See Sections 4.2.1.2.1 and 4.2.1.3.1.
A full XML Schema Document for the XDS types is available online on the IHE FTP site, see
ITI TF-2x: Appendix W.
545

Any id attributes or references to other objects in the submission may contain valid UUIDs or
symbolic ids (see Section 4.2.3.1.5). References to objects that are not contained in thesubmission request must be in UUID format.
4.2.2 Association Types

550

All relationships between metadata objects are handled through Associations. An Association isan object that describes a named relationship between two metadata objects. These relationships
are used to form submissions and express some query responses. The relationship between theDocumentEntry and the Document it represents is made with the DocumentEntry.uniqueId
attribute, and not an Association since the Document is not a metadata object.
Associations can be used to build relationships between:

555

560

•

A SubmissionSet and a DocumentEntry – SS-DE HasMember•

A SubmissionSet and a Folder – SS-FD HasMember•

A Folder and a DocumentEntry – FD-DE HasMember•

A SubmissionSet and an Association – SS-HM HasMember•

A DocumentEntry and another DocumentEntry – RelationshipOnce deprecated, a DocumentEntry shall not be referenced by future associations.
The abstract concept of a HasMember or Relationship Association is expressed through an
ebRIM Association illustrated in the diagram below. This expression is done by mapping theabstract Association metadata attributes into Association class attributes and other associatedclasses. Further details regarding the Association object type can be found in Section 4.1.2.

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Figure 4.2.2-1: Association (Informative)

570

Figure 4.2.2-1 represents the attributes of an Association. This diagram demonstrates that thevarious HasMember and Relationship Associations inherit the attributes from the Association
class, and that the SS-DE HasMember (SubmissionSet to DocumentEntry) also has thesubmissionSetStatus metadata attribute in addition to the Association class attributes. All
Associations shall have an id (entryUUID) attribute. It may have UUID or symbolic format
depending on where they are used. Symbolic format is allowable only in submissions.
Associations have three other required attributes (see Figure 4.2.2-1):

575•

sourceObject•

targetObject•

associationType

These attributes can be thought to make a small sentence:•580

sourceObject AssociationType targetObject

The sentence is composed of noun-verb-object for example:•

Folder HasMember DocumentEntry

Graphically this example Association looks like:

585

Figure 4.2.2-2: Folder HasMember DocumentEntry (Informative)___________________________________________________________________________
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Association Type formatting
An Association type shall be specified as a URN.
590

The sourceObject and targetObject are UUID or symbolic format depending on where they areused. Symbolic format is allowable only in submissions. The status attribute shall not be
submitted but shall be returned from queries.
The valid Association types are specified in the following table.
Table 4.2.2-1: Association Types
Meaning

595

600

Membership in a Registry Package (SubmissionSet or
Folder)urn:oasis:names:tc:ebxmlregrep:AssociationType:HasMember

Replace

urn:ihe:iti:2007:AssociationType:RPLC

Transformation

urn:ihe:iti:2007:AssociationType:XFRM

Addendum

urn:ihe:iti:2007:AssociationType:APND

Replace with Transformation

urn:ihe:iti:2007:AssociationType:XFRM_RPLC

Digital Signature

urn:ihe:iti:2007:AssociationType:signs

Snapshot of On-Demand document entry

urn:ihe:iti:2010:AssociationType:IsSnapshotOf

Example of basic Association<rim:Association
id=”urn:uuid:95e9115b-3d90-46ae-9610-ed34fd683d96”
status=”urn:oasis:names:tc:ebxml-regrep:StatusType:Approved”
associationType=”urn:ihe:iti:2007:AssociationType:RPLC”
sourceObject=”urn:uuid:3cce0135-cedb-4a26-ba00-8698ee8dde04”
targetObject=”urn:uuid:e0985823-dc50-45a5-a6c8-a11a829893bd”/>

4.2.2.1

605

Association Type

HasMemberIn the Document Sharing abstract metadata model, many different relationships are defined
between SubmissionSet, DocumentEntry and Folder objects. In this section, each of these
relationships is given its own name, like SS-DE HasMember SubmissionSetHasMemberDocumentEntry. In the underlying ebRIM model, all of these
relationships are created using the ebRIM HasMember Association type.
Note: There are four variants of the HasMember Association. See Section 4.1.2 for an overview.

4.2.2.1.1 SS-DE HasMember
610

HasMember - a DocumentEntry shall be submitted as part of a SubmissionSet by connecting theobjects with a HasMember Association. This is shown as SS-DE HasMember in Figure 4.1-1.
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DocumentEntries may be included in a SubmissionSet in two ways: inclusion by value andinclusion by reference.
SubmissionSet Association labeling615

Two types of Association labels are defined: original (submission by value), or reference(Submission by reference). This enables finding the SubmissionSet that first submitted the
document.
Submission of an original Document (inclusion by value)

620

625

When the creating entity has a new document to be submitted, it shall submit a DocumentEntryby value in the SubmissionSet. This means that the DocumentEntry (and corresponding
Document) are part of the submission. The HasMember Association shall contain a Slot with thename SubmissionSetStatus with the value set to Original.
All DocumentEntries submitted in a SubmissionSet, included by value, shall have their patientId
attribute set to the same value. The value of the SubmissionSet.patientId attribute shall match thevalue of the DocumentEntry.patientId attribute. The metadata of this submission contains the
SubmissionSet, the DocumentEntry, and the original SS-DE HasMember Association connecting
them.

Figure 4.2.2.1.1-1: SubmissionSet HasMember DocumentEntry (Informative)

630

When submitting an existing document by value:•

The targetObject shall contain the Id of the DocumentEntry object.

•

The sourceObject shall contain the Id of the SubmissionSet object

The following XML example demonstrates how to encode a submission by value.
635

640

645

<rim:Association
associationType="urn:oasis:names:tc:ebxmlregrep:AssociationType:HasMember"sourceObject="SubmissionSet01"
targetObject="Document01"><rim:Slot name="SubmissionSetStatus"><rim:ValueList><rim:Value>Original</rim:Value></rim:ValueList></rim:Slot></rim:Association>___________________________________________________________________________
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Submission of a reference to an existing Document (inclusion by reference)

650

655

660

Existing documents can be referenced by a SubmissionSet. This means that the DocumentEntry(and corresponding Document) are not part of the submission; they have been previously
submitted and already exist in the receiving actor. Documents that were submitted in a previous
SubmissionSet may be referenced by subsequent SubmissionSets. In this case, the HasMember
Association shall contain a Slot with the name SubmissionSetStatus with the value set toReference.
The value of the SubmissionSet.patientId attribute is not required to match the value of theDocumentEntry.patientId attribute of a DocumentEntry included by reference. The metadata of
this submission contains the SubmissionSet. The SS-DE HasMember Association with the‘Value=Reference’ connects the SubmissionSet to a DocumentEntry already present in thereceiving actor.

Figure 4.2.2.1.1-2: Submission of a reference to an existing Document (Informative)

When submitting a reference to an existing document:

665

670

675

•

The targetObject shall contain the Id of the DocumentEntry object.

•

The sourceObject shall contain the Id of the SubmissionSet object.

The following XML example demonstrates how to encode a submission by reference.
<rim:Association
associationType="urn:oasis:names:tc:ebxmlregrep:AssociationType:HasMember"sourceObject="SubmissionSet01"
targetObject="Document01"><rim:Slot name="SubmissionSetStatus"><rim:ValueList><rim:Value>Reference</rim:Value></rim:ValueList></rim:Slot></rim:Association>___________________________________________________________________________
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4.2.2.1.2 SS-FD HasMember
680

HasMember - Submit a Folder. The submission includes the Folder object and a HasMember
Association linking the Folder to the SubmissionSet. This is shown as SS-FD HasMember inFigure 4.2.2.1.2-1. The value of the SubmissionSet.patientId attribute shall match the value ofthe Folder.patientId attribute.

685

Figure 4.2.2.1.2-1: SubmissionSet HasMember Folder (Informative)

When submitting a Folder:•

The targetObject shall contain the Id of the Folder object.

•

The sourceObject shall contain the Id of the SubmissionSet object.

690

Example SubmissionSet – Folder HasMember Association695<rim:Association
associationType=”urn:oasis:names:tc:ebxml-regrep:AssociationType:HasMember”
sourceObject=”SubmissionSet01”
targetObject=”Folder01”></rim:Association>

The sourceObject and targetObject attributes are shown using symbolic names to reference theother objects in the submission. UUID format values could have been used if those objects werecoded that way.
4.2.2.1.3 FD-DE HasMember
700

705

FD-DE HasMember - a HasMember Association linking a Folder to a DocumentEntry. The
value of the Folder.patientId attribute shall match the value of the DocumentEntry.patientId
attribute.

Figure 4.2.2.1.3-1: Folder HasMember DocumentEntry (Informative)___________________________________________________________________________
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Linking documents to a folder

710

A document can be linked to a Folder to indicate that this document is a member of a particularFolder. This is colloquially called “putting the document into the folder.” Each FD-DE
HasMember Association shall be accompanied by a SS-HM HasMember Association that links
the FD-DE HasMember Association with the SubmissionSet object (see Section 4.2.2.1.4). See
Section 4.2.2.15 for the four ways a DocumentEntry can be added to a Folder.
When adding a DocumentEntry to a Folder:715•

The targetObject shall contain the Id of the DocumentEntry object.

•

The sourceObject shall contain the Id of the Folder object.
Example Folder HasMember Association

720

725

730

<Association
id=”FolderToDocAssoc”
associationType=”urn:oasis:names:tc:ebxml-regrep:AssociationType:HasMember”
sourceObject=”urn:uuid:e0985823-dc50-45a5-a6c8-a11a8298aabb”
targetObject=”urn:uuid:e0985823-dc50-45a5-a6c8-a11a829893bd”/><Association
associationType=”urn:oasis:names:tc:ebxml-regrep:AssociationType:HasMember”
sourceObject=”SubmissionSet”
targetObject=”FolderToDocAssoc”/>

In the first association, since both the sourceObject and targetObject attributes in the example are
in UUID format (and not symbolic id format), the Folder and the DocumentEntry referenced
could be part of this submission or already present in the registry.
The second Association shown is a SS-HM HasMember which is between the SubmissionSet
and the first Association documenting which submission added the DocumentEntry to the
Folder.
4.2.2.1.4 SS-HM HasMember

735

HasMember - a HasMember Association linking a SubmissionSet to a FD-DE HasMember
Association, which is in turn an Association between a Folder and a DocumentEntry. This isshown as SS-HM HasMember in Figure 4.2.2.1.5-1. This shall be used to record theSubmissionSet responsible for adding the DocumentEntry to the Folder. The values ofSubmissionSet.patientId, Folder.patientId, and DocumentEntry.patientId shall all be the same.

740

This kind of Association is used when adding a document to an existing Folder. It is used to
identify the entity that created the link between a particular document and a particular Folder andshall be as follows:•

The targetObject shall contain the Id of the Association that links the DocumentEntry andthe Folder.

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The sourceObject shall contain the Id of the SubmissionSet object.

4.2.2.1.5 Adding DocumentEntries to Folders
A DocumentEntry can be added to a Folder in one of four ways:
1. The DocumentEntry can be submitted as part of the Folder in a single submission.
750

2. The DocumentEntry and Folder are already present. The new submission makes theDocumentEntry a member of the Folder by adding the Association.
3. The DocumentEntry is already present. The new submission includes the Folder and the
Association to make the DocumentEntry part of the Folder.
4. The Folder is already present. The new submission includes the DocumentEntry and the
Association to make the DocumentEntry part of the Folder.

755

Scenario 1 - DocumentEntry submitted as part of the Folder in a single submission.
The simplest scenario submits all related objects in one submission set, as shown below.

760

Figure 4.2.2.1.5-1: Scenario 1 - DocumentEntry submitted as part of the Folder(Informative)

Scenario 2 – Add existing DocumentEntry to existing Folder

765

Documents can be placed in a Folder at a later date and time, as shown in Figures 4.2.2.1.5-2 and4.2.2.1.5-3. In this case, the SubmissionSet SS03 which links to FD-DE HasMember will nothave as member either the DocumentEntry or the Folder that correspond to the referenced
document and Folder.

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Figure 4.2.2.1.5-2: Scenario 2 - Existing DocumentEntry and existing Folder (Informative)

770

Figure 4.2.2.1.5-3: Scenario 2 - Add existing DocumentEntry to existing Folder(Informative)

Scenario 3 – Folder submitted and existing DocumentEntry added to it

775

When a new Folder is submitted, an existing DocumentEntry can be added to that Folder. In thiscase, the SubmissionSet object will not contain the DocumentEntry metadata that correspond to
the referenced document.

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Figure 4.2.2.1.5-4: Scenario 3 - Starting point - Existing DocumentEntry (Informative)

780

Figure 4.2.2.1.5-5: Scenario 3 - Folder submitted and existing DocumentEntry added to it(Informative)

Scenario 4 – DocumentEntry submitted and added to existing Folder
785

When a new DocumentEntry is submitted, it can be added to an existing folder. In this case, theSubmissionSet object will not contain the Folder metadata that correspond to the referenced
Folder.

Figure 4.2.2.1.5-6: Scenario 4 - Starting point - Existing Folder (Informative)___________________________________________________________________________
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Figure 4.2.2.1.5-7: Scenario 4 - DocumentEntry submitted and added to existing Folder(Informative)

4.2.2.2

795

Document RelationshipDocument relationships are association types used to link two DocumentEntry objects anddeclare a semantic relationship between them. Receiving a document relationship Association
triggers specific processing in the receiving actor in some profiles. This is documented in the
Expected Actions section of the relevant transaction in an IHE profile.
A document relationship refers to any of the relationships listed in Table 4.2.2.2-1 Document
Relationships. The document relationship semantics (except Signs) are defined in HL7 ClinicalDocument Architecture (CDA) Release 2.

800

Table 4.2.2.2-1: Document Relationships
Relationship

Definition

APND (append)

The current document is an addendum to the parent document.

RPLC (replace)

The current document is a replacement of the parent document.

XFRM (transform)

The current document is a transformation of the parent document.

XFRM_RPLC (transformwith replace)

The current document is both a transformation and a replacement of the parent
document.

Signs

The current document is a Digital Signature which signs the parent document.

Is Snapshot of

The current document is a snapshot in time of the parent which shall be an ondemand document

Adapted from HL7 CDA Release 2, Committee Ballot 2

To create a document relationship in the registry, a creating entity shall submit:
A new Document (DocumentEntry).
An Association linking the new document to an existing document.
805

The Association type defines the document relationship. The new DocumentEntry and the
Association must be submitted in the same SubmissionSet. The existing DocumentEntry must be___________________________________________________________________________
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an Approved object already in the registry (see Section 4.2.3.2.2,
DocumentEntry.availabilityStatus). The identity (entryUUID) of the existing document will beknown because the creating entity assigned the entryUUID prior to submission or discovered it(e.g., under XDS via Registry Stored Query [ITI-18]).
The targetObject attribute of the Association is the entryUUID representing the existing
DocumentEntry known to the receiving entity. This entryUUID may have been discovered via
Registry Stored Query [ITI-18], or other means.

815

Note to implementers: An XDS Document Source using saved UUIDs in future transactions can run into consistency
problems. A second XDS Document Source can deprecate any document. Once a document is deprecated, new
Associations to that document cannot be accepted by the XDS Document Registry. The saved UUID will point to
the deprecated document and not the replacement document.

A submitting actor creates a document relationship by submitting a SubmissionSet containing:
DocumentEntry – this describes the new document being submitted
820

825

Association – this links the original DocumentEntry (already known to the receiving entity)
with the new DocumentEntry being submitted.
The targetObject attribute of the Association object references the existing
DocumentEntry known to the receiving entity.
The sourceObject attribute of the Association object references the DocumentEntry
contained in the SubmissionSet.
The Association Type is one of the relationships in Table 4.2.2.2-1: Document Relationships.
Document Relationship Associations of may include documentation describing the Association(type of transformation, reason for replacement, etc.). If documentation is included, it shall be
specified as a Classification on the Association as follows:

830

1. Classifications shall be coded following the restrictions set forth in Section 4.2.3.1.2,“Creating Coded Attributes.”
The Classification Scheme shall equal urn:uuid:abd807a3-4432-4053-87b4-fd82c643d1f3,
Association Documentation.
Example of a partial submission request:___________________________________________________________________________
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835

840

845

850

855

860

<rim:Association
associationType="urn:ihe:iti:2007:AssociationType:XFRM"
sourceObject="source"
targetObject="urn:uuid:XXX"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Association"
id="IdExample_042"><rim:Classification
classificationScheme="urn:uuid:abd807a3-4432-4053-87b4-fd82c643d1f3"
classifiedObject="IdExample_042"
id="IdExample_043"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="LanguageExample"><rim:Name><rim:LocalizedString value="Translation into LanguageExample" /></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example translation types</rim:Value></rim:ValueList></rim:Slot></rim:Classification></rim:Association><rim:ExtrinsicObject id=”source”
objectType=” urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1”>. . .
</rim:ExtrinsicObject>865
Since the targetObject always references an object already in the Registry; it shall be coded in
UUID format, as shown.
A stub DocumentEntry is shown to illustrate the id reference coding (Association sourceObject
attribute referencing the id attribute of the DocumentEntry/ExtrinsicObject in the submission).
870

The uniqueId of the new document shall be different than the uniqueId of the existing document,
unless the two documents have identical byte sequences (e.g., when replacing a document with acopy of itself in order to change the metadata). See Section 4.2.3.2.26“DocumentEntry.uniqueId”.
See ITI TF-1: 10.4.10 for further detail on the use and meaning of document relationships.

875

4.2.2.2.1 APND
The submission shall contain a new DocumentEntry and associated Document and an APND
Association linking this new DocumentEntry with an existing DocumentEntry. This newDocument/DocumentEntry forms an addendum to the existing Document/DocumentEntry. The
APND Association may include documentation describing the addendum (e.g., reason for adding___________________________________________________________________________
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the addendum, etc.) The APND relationship leaves the original DocumentEntry with its
availabilityStatus unchanged (Approved).

Figure 4.2.2.2.1-1: Starting Point (Informative)

885

Figure 4.2.2.2.1-2: New DocumentEntry and Document forming an addendum to an
existing DocumentEntry/Document (Informative)

Interactions between XFRM and APND
890

A transformation (connected to original document with XFRM Association) is an alternate formof an original document. Therefore, a transformation shall not be appended (APND).
4.2.2.2.2 XFRM

895

The submission shall contain a new DocumentEntry and associated Document and a XFRM
Association linking this new DocumentEntry with an existing DocumentEntry. This newDocument/DocumentEntry defines a transformation of the existing Document/DocumentEntry.
The XFRM Association may include documentation describing the transformation (e.g., reason
for transformation, etc.). The XFRM relationship leaves the original DocumentEntry with its
availabilityStatus unchanged (Approved).

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900

905

Figure 4.2.2.2.2-1: Starting Point (Informative)

Figure 4.2.2.2.2-2: New DocumentEntry/Document defining a transformation of an
existing DocumentEntry/Document (Informative)

4.2.2.2.3 RPLC

910

The submission shall contain a new DocumentEntry and associated Document and a RPLC
Association linking this new DocumentEntry with an existing DocumentEntry. The newDocumentEntry and Document are considered the approved version of the document; theexisting DocumentEntry and Document become a deprecated version. The RPLC Association
may include documentation describing the replacement (e.g., reason for replacement, etc.).

Figure 4.2.2.2.3-1: Starting Point (Informative)

915___________________________________________________________________________
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Figure 4.2.2.2.3-2: New DocumentEntry and Document replacing existing
DocumentEntry/Document (Informative)

RPLC interactions with other Associations
920

925

The submission of a RPLC relationship shall change the availabilityStatus of the original
DocumentEntry to Deprecated. The availabilityStatus of all DocumentEntry objects that aretransformations (XFRM) or addenda (APND) of the original DocumentEntry shall also bechanged to Deprecated.
Figures 4.2.2.2.3-2 and 4.2.2.2.3-3 show a new DocumentEntry/Document replacing atransformation (XFRM) of an existing DocumentEntry/Document:

Figure 4.2.2.2.3-3: New DocumentEntry/Document defining a transformation of an
existing DocumentEntry/Document – Starting point (Informative)___________________________________________________________________________
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Figure 4.2.2.2.3-4: New DocumentEntry/Document replacing a transformation (XFRM) of
an existing DocumentEntry/Document (Informative)

Figures 4.2.2.2.3-4 and 4.2.2.2.3-5 show a new DocumentEntry/Document replacing an
addendum (APND) of an existing DocumentEntry/Document.

935

Figure 4.2.2.2.3-5: New DocumentEntry and Document forming an addendum to an
existing DocumentEntry/Document – Starting point (Informative)___________________________________________________________________________
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940

Figure 4.2.2.2.3-6: New DocumentEntry/Document replacing an addendum (APND) of an
existing DocumentEntry/Document (Informative)

Only an Approved DocumentEntry is replaceable. The most recent version of a DocumentEntry
carries an availabilityStatus of Approved while older versions carry an availabilityStatus of
Deprecated.
945

A transformation (connected to original DocumentEntry with XFRM Association) is an alternate
form of an original document. Therefore, a transformation is permitted to be replaced (RPLC).

950

When a DocumentEntry is replaced and that DocumentEntry is a member of one or more
Folders, new FD-DE HasMember and SS-HM HasMember Associations shall be created by thereceiving actor, connecting the replacement DocumentEntry to each Folder that held the original
DocumentEntry as a member. The result is that a Folder contains both the original andreplacement DocumentEntry differentiated by their availabilityStatus.

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Figure 4.2.2.2.3-7: DocumentEntry submitted as part of the Folder in a single submission– Starting point (Informative)

955

Figure 4.2.2.2.3-8: Submission of a new DocumentEntry replacing the DocumentEntry
part of an existing Folder (Informative)

4.2.2.2.4 XFRM_RPLC960

The submission contains a new DocumentEntry and associated Document and a XFRM_RPLC
Association linking this new DocumentEntry with an existing DocumentEntry. This newDocument/DocumentEntry defines a transformation of the existing Document/DocumentEntry___________________________________________________________________________
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965

that replaces the existing Document/DocumentEntry. The XFRM_RPLC Association may
include documentation describing the transformation/replacement (e.g., reason, etc.). The
XFRM_RPLC can be thought of as a RPLC followed immediately by a XFRM. All behavior
associated with a RPLC association shall also apply to the XFRM_RPLC association.

Figure 4.2.2.2.4-1: Starting Point (Informative)

970

Figure 4.2.2.2.4-2: New DocumentEntry/Document defining a transformation of an
existing DocumentEntry/Document that replaces this existing DocumentEntry/Document(Informative)

4.2.2.2.5 Signs
975

980

The submission contains a new DocumentEntry and associated Document and a Signs
Association linking this new DocumentEntry with an existing DocumentEntry. This newDocument is a Digital Signature that signs the existing Document.
An ebRIM Association with associationType of signs shall be used to link a DocumentEntry
representing a Digital Signature with the DocumentEntry representing the document being
signed. Details of how Digital Signatures are represented are found in the ITI Document Digital
Signature (DSG) Profile.
In constructing this Association, the attributes are:sourceObject: references the DocumentEntry representing the Digital SignaturetargetObject: references the DocumentEntry representing the document being signed___________________________________________________________________________
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985

associationType: signs

Figure 4.2.2.2.5-1: Starting Point (Informative)

990

Figure 4.2.2.2.5-2: New DocumentEntry/Digital signature document signing the existing
DocumentEntry/Document (Informative)

4.2.2.2.6 IsSnapshotOf
995

When the content of an On-Demand DocumentEntry is retrieved, the retrieved version can besaved in a Document Repository as a Document and recorded in the Document Registry as aStable DocumentEntry. When this happens, the saved version is linked to the On-Demand
DocumentEntry through the IsSnapshotOf Association.

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Example IsSnapshotOf Association

1000

1005

<rim:Association
associationType=”urn:ihe:iti:2010:AssociationType:IsSnapshotOf”
sourceObject=”Snapshot”
targetObject=”urn:uuid:e0985823-dc50-45a5-a6c8-a11a829893bd”/><rim:ExtrinsicObject id=”Snapshot”
objectType=”urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1”>. . .
</rim:ExtrinsicObject>
Note: this example does not show the SubmissionSet object or the SubmissionSet to DocumentEntry HasMember
association.

1010

This Association shall be submitted together with the Stable DocumentEntry representing thesnapshot of the On-Demand Document. The sourceObject attribute references the snapshot andthe targetObject references the On-Demand DocumentEntry already in the Document Registry.
4.2.3 Metadata Attributes

1015

This section details the coding of metadata attributes using in Document Sharing profiles.
4.2.3.1

General Information about Metadata Attributes

4.2.3.1.1 Attribute Value Length
All attribute value lengths are limited by the size specifications of ebRIM version 3.0. For
example, rim:Slot/rim:ValueList/rim:Value is limited to a maximum length of 256 characters.
1020

4.2.3.1.2 Creating Coded Attributes
Many attributes of DocumentEntry, SubmissionSet, Folder, and Association objects are codedattributes defined as ebRIM Classifications. Three details are required to describe a coded value:
1. Code Value – contains the assigned value of the code.

1025

2. Code Display Name - The display name used to represent the code (code values are notnecessarily human-friendly). Must be non-zero length.
3. Coding Scheme - The name/identification of the coding scheme that the code comes
from.
These three values combine to define a single coded element. An example of a coded attribute ina submission request is:___________________________________________________________________________
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1030

1035

1040

1045

<rim:Classification
classificationScheme="urn:uuid:41a5887f-8865-4c09-adf7e362475b143a"classifiedObject="ExampleDocument"
id="IdExample_046"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="10160-0"><rim:Name><rim:LocalizedString value="History of Medication Use"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>2.16.840.1.113883.6.1</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

A code is constructed as a Classification object. The relevant parts of this classification are
described in Table 4.2.3.1.2-1 below.
1050

Table 4.2.3.1.2-1: Classifications and Descriptions
Item

Description

Classification/@classificationScheme

This UUID defines which metadata attribute this Classification is supplying avalue for. See Section 4.2.5 for a list of all values for this attribute. In the example
above, this attribute indicates that the Classification contains a value for theDocumentEntry.classCode metadata attribute.

Classification/@classifiedObject

This references the object in metadata being classified. In the example thisreferences the DocumentEntry object that the classCode value is for. Note that theClassification must also be embedded within the referenced object, thus providing
dual context.
This value must match the @id attribute of the containing Association,
ExtrinsicObject or RegistryPackage.

Classification/@id

Symbolic id or UUID identifying this Classification. See Section 4.2.3.1.5 fordetails.

Classification/@objectType

Fixed value as specified by ebRIM. Optional upon submission of objects; required
upon retrieval. If set, the value shall be “urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification”
The code value. Required. The example above shows a code value of“10160-0”.

Classification/@nodeRepresentation
Name/LocalizedString/@value
Slot/@nameSlot/ValueList/Value/text()

The code displayName. The example above shows a display name of"History of Medication Use ".
Fixed value that must always be the string “codingScheme”.
The code codingScheme. Shall have exactly one value. In the example above it is"2.16.840.1.113883.6.1".

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The creating entity defines the local configuration for each coded metadata attribute.
Specifically, it defines for each code:
Name of the coding scheme – shall be used in the codingScheme Slot.
1055

1060

1065

Value for the code – shall be used in the nodeRepresentation attribute.
displayName for the code – shall be used in the Name element. It is expected that the name besemantically consistent with the code value. The same code value may have multiple valid
human-readable representations in different languages or in different, but semanticallyequivalent, wording. The displayName is a convenience provided by the actor that creates themetadata (“metadata creator”), indicating the meaning of the code in a local language used at the“metadata creator”. It is the responsibility of the actor that consumes the metadata (“metadata
consumer”) to resolve code values in metadata into human-readable display values. A “metadata
consumer” may use the displayName found in the metadata provided by the “metadata creator”,
or it may choose another local designation for the code, for example to translate it from English
into French.
Some coded attributes allow multiple values. EventCodeList is an example. These attributes may
contain the letters ‘List’ in their name. These codes are XML encoded identically to the above
example except the entire Classification element may be repeated to specify additional values.

1070

Note: The attribute DocumentEntry.languageCode is not encoded as a coded attribute as shown above. See Table 4.2.3.1.72 for details.

4.2.3.1.3 Creating External Identifiers

1075

Several attributes of DocumentEntry, SubmissionSet and Folder (Table 4.2.3.2-1, Table, 4.2.3.31 and Table 4.2.3.4-1) are identifiers defined as ebRIM ExternalIdentifiers. These identifiers,
such as patient IDs or document unique IDs are considered to be real-world identifiers that haveglobal meaning external to an ebXML registry or other transaction.
The identifiers consist of a single, opaque string stored in the value attribute of anExternalIdentifier element. The meaning and format depend on the particular identifier. An
example of an identifier in a submission request is:

1080

1085

1090

<rim:ExternalIdentifier
identificationScheme="urn:uuid:6b5aea1a-874d-4603-a4bc-96a0a7b38446"
value="6578946^^^&amp;1.3.6.1.4.1.21367.2005.3.7&amp;ISO"
id="IdExample_051"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"registryObject="DocumentEntry01"><rim:Name><rim:LocalizedString value="XDSDocumentEntry.patientId"/></rim:Name></rim:ExternalIdentifier>___________________________________________________________________________
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Table 4.2.3.1.3-1: Identifiers and Descriptions
Item
ExternalIdentifier/@identificationScheme

Description
Fixed value denoting the specific identifier. See Section 4.2.5 for a list of valid
values.

ExternalIdentifier/@value

The identifier value.

ExternalIdentifier/@id

Symbolic id or UUID identifying this ExternalIdentifier. See Section 4.2.3.1.5 fordetails.

ExternalIdentifier/@objectType

Fixed value as specified by ebRIM. Optional upon submission of objects; required
upon retrieval. If set, the value shall be "urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"This references the object in metadata being identified. In the example thisreferences the DocumentEntry object that the patient identifier value is for. Note that
the ExternalIdentifier element must also be embedded within the referenced object,thus providing dual context.
This value must match the @id attribute of the containing ExtrinsicObject orRegistryPackage.

ExternalIdentifier/@registryObject

Name/LocalizedString/@value

The readable name for the identifier. Fixed value according to the particular
identifier.

4.2.3.1.4 Creating Author Attribute
1095

1100

The author attributes of DocumentEntry and SubmissionSet represent the humans and/or
machines that authored the document or SubmissionSet. The author attribute defines a structure
to hold its sub-attributes that are individually defined in Sections 4.2.3.1.4.1 through 4.2.3.1.4.5.
•

authorPerson – zero or one•

authorInstitution – zero or more•authorRole – zero or more•authorSpecialty – zero or more•authorTelecommunication – zero or more

At least an authorPerson, authorTelecommunication or authorInstitution sub-attribute shall bepresent when the author attribute is included in the metadata.
1105

1110

Coding:
The author attribute is as an ebRIM Classification which contains sub-attributes in ebRIM Slots.
An instance of the author Classification shall be considered a single author. Multiple authors arevalid and are represented by multiple author ebRIM Classification objects. For the author
metadata attribute, the value of classificationScheme is different for DocumentEntries andSubmissionSets; see Sections 4.2.3.2.1 and 4.2.3.3.1 respectively. The nodeRepresentation
attribute shall be empty.
The @classifiedObject attribute references the object being classified, either ExtrinsicObject orRegistryPackage. The Classification must be embedded within the referenced object and the___________________________________________________________________________
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1115@classifiedObject attribute must match the @id attribute of the referenced object, thus providing
dual context. In the example below, the Classification references the DocumentEntry object thatthe author value is associated with.
The following example shows the definition of a single author for a DocumentEntry.

1120

1125

1130

1135

1140

1145

1150

<rim:Classification
classificationScheme="urn:uuid:93606bcf-9494-43ec-9b4e-a7748d1a838d"classifiedObject="ExampleDocument"
id="IdExample_045"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation=""><!-- nodeRepresentation intentionally left blank--><rim:Slot name="authorPerson"><rim:ValueList><rim:Value>^Welby^Marcus^^MD^Dr</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorInstitution"><rim:ValueList><rim:Value>Some Hospital^^^^^^^^^1.2.3.5.8.9.1789.45</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorRole"><rim:ValueList><rim:Value>name of role</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorSpecialty"><rim:ValueList><rim:Value>specialty of author</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorTelecommunication"><rim:ValueList><rim:Value>^^Internet^john.doe@healthcare.example.org</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

The following example shows the definition of a single author for a SubmissionSet.

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1160

1165

1170

1175

1180

1185

<rim:Classification
classificationScheme="urn:uuid:a7058bb9-b4e4-4307-ba5b-e3f0ab85e12d"classifiedObject="theSubmission"
id="Id_045"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation=""><!-- nodeRepresentation intentionally left blank--><rim:Slot name="authorPerson"><rim:ValueList><rim:Value>^Welby^Marcus^^MD^Dr</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorInstitution"><rim:ValueList><rim:Value>Some Hospital^^^^^^^^^1.2.3.5.8.9.1789.45</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorRole"><rim:ValueList><rim:Value>name of role</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorSpecialty"><rim:ValueList><rim:Value>specialty of author</rim:Value></rim:ValueList></rim:Slot><rim:Slot name="authorTelecommunication"> <!-- may be multivalued --><rim:ValueList><rim:Value>^^Internet^john.doe@healthcare.example.org</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

4.2.3.1.4.1 authorInstitution
Description:
1190

Represents a specific healthcare facility under which the human and/or machines authored the
document or SubmissionSet. This is a sub-attribute of the author attribute.
Coding:
The format of the authorInstitution value is XON. See Table 4.2.3.1.7-2 for description of XON
format.

1195

The value is coded as an optional ebRIM Slot within an author Classification. See Section
4.2.3.1.4 for an example of author Classification. There may be multiple values within theebRIM Slot.
This example shows the authorInstitution Slot with two elements reflecting two names for thesame organization.
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1200

1205

<rim:Slot name="authorInstitution"><rim:ValueList><rim:Value>MercyHospital</rim:Value><rim:Value>NY Mercy Hospital^^^^^^^^^1.2.3.9.1789.45</rim:Value></rim:ValueList></rim:Slot>

4.2.3.1.4.2 authorPerson
Description:
1210

Represents the humans and/or machines that authored the document or SubmissionSet within theauthorInstitution. The author may be the patient itself. This is a sub-attribute of the author
attribute.
Coding:
The format of the authorPerson value is XCN; see Table 4.2.3.1.7-2 for description of XCNformat.

1215

The value is coded as a required ebRIM Slot within an author Classification; see Section
4.2.3.1.4 for an example of author Classification. There may be only a single value within theebRIM Slot.
This example shows the authorPerson Slot holding the required single value.

1220<rim:Slot name="authorPerson"><rim:ValueList><rim:Value>^Welby^Marcus^^MD^Dr</rim:Value></rim:ValueList></rim:Slot>1225
4.2.3.1.4.3 authorRole
Description:

1230

A string that represents the role of the author with respect to the patient at the time the document
or SubmissionSet was created. This is a sub-attribute of the author attribute. If this is a codedvalue, it should follow the CX encoding in Table 4.2.3.1.7-2
Coding:
The format of the authorRole value is String.

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The value is coded as an optional ebRIM Slot within an author Classification. See Section
4.2.3.2.1 for an example of author Classification. There may be multiple values within theebRIM Slot.
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1240<rim:Slot name="authorSpecialty"><rim:ValueList><rim:Value>Cardiologist</rim:Value></rim:ValueList></rim:Slot>

4.2.3.1.4.4 authorSpecialty
Description:
1245

Represents a specific specialty within a healthcare facility under which the human and/or
machines authored the document or SubmissionSet. This is a sub-attribute of the author attribute.
If this is a coded value, it should follow the CX encoding in Table 4.2.3.1.7-2.
Coding:
The format of the authorSpecialty value is String.

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1255

1260

The value is coded as an optional ebRIM Slot within an author Classification. See Section
4.2.3.2.1 for an example of author Classification. There may be multiple values within theebRIM Slot.
<rim:Slot name="authorSpecialty"><rim:ValueList><rim:Value>Cardiology</rim:Value><rim:ValueList></rim:Slot>

4.2.3.1.4.5 authorTelecommunication
Description:
Represents the telecommunications address (e.g., email) of the document or SubmissionSet
author. This is a sub-attribute of author.
Coding:

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The format of the authorTelecommunication value is XTN; see Table 4.2.3.2-1 for descriptionof XTN format.
The value is coded as an optional ebRIM Slot within an author Classification. See Section
4.2.3.2.1 for an example of author Classification. There may be multiple values within theebRIM Slot.

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1275<rim:Slot name="authorTelecommunication"><rim:ValueList><rim:Value>^^Internet^john.doe@healthcare.example.org</rim:Value></rim:ValueList></rim:Slot>

4.2.3.1.5 UUIDs

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UUIDs shall be formatted according to RFC4122. Furthermore, values 10 through 15 shall beformatted in hexadecimal using only lower case ‘a’-‘f’. An example of a properly formatted
UUID is:urn:uuid:10b545ea-725c-446d-9b95-8aeb444eddf3

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Alternatively, symbolic Ids may be used when referencing objects in the same submission
request. A symbolic Id is any string which does not start with urn:uuid:. For example, in XDS, a
Document Source may create a submission request using symbolic Ids; the Document Registry
replaces these with assigned properly formatted UUIDs upon acceptance of the submission.
Once a UUID-format Id value is assigned to a Registry Object, that value is permanent and shallnot be changed.
4.2.3.1.6 Extra Metadata Attributes

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The term “Extra Metadata Attributes” refers to ebRIM Slots on any DocumentEntry,
SubmissionSet, Folder, or Association that are not defined in the Technical Framework.
An actor that creates metadata may add Extra Metadata Attributes. An actor that receives
metadata shall not generate an error due to the presence of Extra Metadata Attributes.
Some IHE transactions require that a receiving actor take specific actions if the submission
contains Extra Metadata Attributes. Otherwise, the receiving actor may ignore them.

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The ‘name’ attribute of the ebRIM Slot for an Extra Metadata Attribute shall conform to thefollowing rules:•

The value of ‘name’ shall be a valid URN.

•

The prefix 'urn:ihe:' shall not be used.

Note that ebRIM requires that the name of a Slot be unique within the containing object(DocumentEntry, SubmissionSet, Folder, or Association).
An example of coding an Extra Metadata Attribute for DocumentEntry is shown below:___________________________________________________________________________
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1305

1310

<rim:ExtrinsicObject id="urn:uuid:3ddfef0d-d586-4914-8f87-da599a363fd2"
mimeType="text/plain" objectType="urn:uuid:7edca82f-054d-47f2-a0329b2a5b5186c1"><!--Other valid elements--><rim:Slot name="urn:example:extraMetadataSlot"><rim:ValueList><rim:Value>important data</rim:Value></rim:ValueList></rim:Slot></rim:ExtrinsicObject>

4.2.3.1.7 Metadata Attribute Data types
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Several data types are used in the tables below describing the Document Entry, Folder andSubmission Set metadata. These data types are derived from other standards, and encoded as
described in Table 4.2.3.1.7-2.
For the data types derived from HL7 standards, IHE Document Sharing Profiles require that thedata be encoded according to HL7 encoding rules and that the default HL7 separators in Table
4.2.3.1.7-1 be used to represent the structure of HL7 v2.5 data types:

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Table 4.2.3.1.7-1: HL7 Separators
HL7 Separators
Field Separator|

Component Separator^

Subcomponent Separator&

Repetition Separator~

Escape Character\

The special character escape sequences (\F\, \S\, \R\, \T\, and \E\) shall be used to encode HL7
separators and the escape character. The escape sequences for formatting (\H\, \N\) and locallydefined escape sequences (\Zdddd\) shall not be included for these data types.
1325

Table 4.2.3.1.7-2: Data Types (previously Table 4.1-3)
Data Type

Source Standard

Encoding Specification

Code

ITI TFSee Section 4.2.3.1.2

CX

HL7 V2.5 IdentifierThis is an identifier. HL7 Identifier type CX consists of several components,
but this specification restricts them to the use of two components, the Id
Number, and the Assigning Authority (AA). The Assigning Authority
identifies the "domain" over which the Id Number represents a unique entity.
Furthermore, the AA is characterized by a Universal Id and Universal Id
Type. In Document Sharing profiles, ISO Object Identifiers (see OID below)
must be used as Universal Id. Therefore, Universal Id Type is always ISO.
The required format is:
IdNumber^^^&OIDofAA&ISO
No other values/modifications in other components or subcomponents areallowed. Specifically, components 2 and 3 shall be empty as listed above.

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Data Type

CXi

Source Standard

HL7 V2 Identifier

Encoding Specification

An example is:543797436^^^&1.2.840.113619.6.197&ISO
Note that the '&' character must be properly encoded in the XML content.
This is an identifier of a reference object, distinct from the use of CX for
Patient Identifiers. HL7 Identifier type CX consists of several components.
•
CXi.1 shall be present and hold the identifier value. This
component may exceed the HL7 conformance length of 15
characters.
•
CXi.2 and CXi.3 shall be empty.
•
CXi.4 (Assigning Authority) shall be present when the identifierin CXi.1 is not globally unique and holds the identifier of the"domain" over which the ID Number represents a unique entity.
Either Universal ID with Universal ID Type or Namespace ID ispermitted.
•
CXi.5 (Identifier Type Code) shall be present and chosen fromeither a URN defined by IHE, or a locally defined value.
•
No other components shall be present.
The following IHE values for CXi.5 (Identifier Type Codes) are defined:
urn:ihe:iti:xds:2013:uniqueId
This code shall be used when the identifier is a uniqueID from
Document Sharing metadata attribute.
For example if uniqueID equals “1.3.6367.3.7^11379”, then the CXivalue is11379^^^&1.3.6367.3.7&ISO^urn:ihe:iti:xds:2013:uniqueId
urn:ihe:iti:xds:2013:accession
This code shall be used when the identifier is an accession number. It
shall contain•
The accession number and•for accession values that are not globally unique, the Assigning
Authority shall be included.
For example when the accession number has a value of “2013001” andthe assigning authority is “1.2.3.4.5.6” then the CXi value is2013001^^^&1.2.3.4.5.6&ISO^urn:ihe:iti:xds:2013:
accession
urn:ihe:iti:xds:2013:referral
Referral number and assigning authority shall be present.
For example:
201300001^^^1.2.3.4.5.6^urn:ihe:iti:xds:2013:referral
urn:ihe:iti:xds:2013:order
Order number and assigning authority shall be present.
For example:
134467653^^^&1.2.3.4.5.42.1&ISO^urn:ihe:iti:xds:
2013:order___________________________________________________________________________
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Data Type

Source Standard

Encoding Specification

urn:ihe:iti:xdw:2013:workflowInstanceId
This code shall be used when the identifier is an XDW workflow
identifier. The workflow identifier shall be an OID. Only the CXi.1 andCXi.5 components shall be present:
For example, if the workflow identifier is “2.16.840.1” the CXi valueis:2.16.840.1^^^^urn:ihe:iti:xdw:2013:workflowInsta
nceId
urn:ihe:iti:xds:2016:studyInstanceUID
This code shall be used when the identifier is a DICOM Study Instance
UID.
CXi.1 shall contain the value of Study Instance UID. Only the CXi.1
and CXi.5 components shall be present.
For example when the Study Instance UID has a value of“1.2.3.45.678” then the CXi value is
1.2.3.45.678^^^^urn:ihe:iti:xds:2016:studyInstan
ceUID
urn:ihe:iti:xds:2015:encounterId
Encounter identifier (also known as visit number) and assigningauthority shall be present.
For example:
245348841^^^&1.2.840.113619.6.197&ISO^urn:ihe:it
i:xds:2015:encounterId
Note that the '&' character must be properly encoded in the XML content.

DTM

HL7 V2.5
Date Time

This is a date/time value, represented as precisely as possible. All date timevalues in the registry are stored using Coordinated Universal Time [UTC].
"UTC" implies that time shall be converted from/to the local time.
The format of these values is defined as the following regular expression:
YYYY[MM[DD[hh[mm[ss]]]]]
Where:YYYY is the four digit year i.e., 2006
MM is the two digit month 01-12, where Jan is 01, Feb is 02, etc.
DD is the two digit day of the month 01-31
HH is the two digit hour, 00-23, where 00 is midnight, 01 is 1 am, 12 isnoon, 13 is 1 pm, etc.
mm is the two digit minute, 00-59
ss is the two digit seconds, 00-59
The following are legal date time values with increasing precision
representing the date and time January 2, 2005, 3:04:05am
2005
200501
20050102
2005010203
200501020304
20050102030405

Field

HL7 V2.5 Message
Segment

Specified as the Field identifier, followed by a pipe (|) and then the data
value characterized as a corresponding HL7 V2.5 data type as defined in
HL7 standard. Note that if a Document Sharing data type is based on an
HL7 data type, then the Document Sharing data type is used to represent the___________________________________________________________________________
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Data Type

Source Standard

Encoding Specification

value.
An example of field Patient Identifier List (the third field of PID segment) is
as follows:
PID-3|DTP-1^^^&1.3.6.1.4.1.21367.2005.3.7&ISO
Note that the '&' character must be properly encoded in the XML content.

Integer

W3C XML Schema Part
2

XML Schema Part 2: Data Types Section 3.3.13

MIME Type

RFC2046https://www.iana.org/assignments/media-types

OID

ISO Object Identifier

An ISO Object identifier. Limited in length to 64 characters, and made up ofcharacters from the set [0-9.]. It must start with an integer, and is followed
by one or more additional integer values, separated by periods. Integers arecharacterized without leading 0 digits unless the value is zero.
(e.g.,1.3.6.1.4.1.21367.2005.3.7)
In the attribute tables below, when an OID format is specified, it shall follow
the assignment and format rules defined for document UID in ITI TF-2x:
Appendix B

OID URN

RFC3061. OID in URN
syntaxSee RFC3061. An example is urn:oid: 1.3.6.1.4.1.21367.2005.3.7.

Predefined URN

RFC2141

Specific URNs are defined and assigned in this framework. An example isurn:ihe:iti:2007:ResponseStatusType:PartialSuccess

SHA1

RFC3174

Document hash calculated with SHA1 algorithm. The encoding is the
Lexical Representation of hexBinary ([0-9a-fA-F]).

StringXML

XML Schema Part 2: Data Types Section 3.2.1

URI

RFC2616

Uniform Resource Identifier

UTF-8

RFC3629

Unicode standard

UUID

RFC4122

A DCE Universally Unique Identifier, represented in registry attributes
using the URN syntax for UUIDs
e.g.,urn:uuid:9e0110f8-4748-4f1e-b0a8-cecae32209c7
Some Document Sharing profiles may allow use of symbolic Ids in certain
conditions or locations.

XCN

HL7 V2.5 Extended
Person Name

This data type describes a person along with the identifier by which he is
known in some domain (e.g., the XDS affinity domain), using the HL7 v2.5
XCN data type. This data type contains, amongst others:
Identifier
Last NameFirst Name
Second and Further Given Names
SuffixPrefixAssigning Authority
All of the HL7 v2.5 fields may be specified as optional components with thefollowing restrictions:
Either name or an identifier shall be present. Inclusion of other components
is optional provided the slot value length restrictions imposed by
ebXML3.0, 256 characters, is not exceeded.
If component 1 (Id Number) is specified, component 9 (Assigning
Authority) shall be present if available.
The XCN Component 9 is subject to the same the restrictions as defined for
the CX data type component 4. Thus: the first subcomponent shall be empty,___________________________________________________________________________
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Data Type

XON

Source Standard

HL7 V2.5 Organization
Name

Encoding Specification

the second subcomponent must be an ISO OID (e.g., 1.2.840.113619.6.197),
and the third subcomponent shall read ‘ISO’.
Any empty component shall be treated by the Document Registry as not
specified. This is in compliance with HL7 v2.5.
Trailing delimiters are recommended to be trimmed off. Receiving actors
shall ignore trailing delimiters. This is in compliance with HL7 v2.5.
An example of person name with Id number using this data type is asfollows:
11375^Welby^Marcus^J^Jr. MD^Dr^^^&1.2.840.113619.6.197&ISO
Note that the '&' character must be properly encoded in the XML content.
This type provides the name and identification of an organization. This
specification restricts the coding to the following fields:
XON.1 – Organization Name – this field is required
XON.6.2 – Assigning Authority Universal Id – this field is required if
XON.10 is valued and not an OID
XON.6.3 – Assigning Authority Universal Id Type – this field is required if
XON.10 is valued and not an OID and shall have the value "ISO"XON.10 – Organization Identifier – this field is optional
No other fields shall be specified. The XON data type in Document Sharing
metadata results in a valid encoding of an HL7 v2.5 XON encoding, with the
exception of length limitations. Component length restrictions areunobserved; however, the total length including delimiters shall not exceed
the limit of the ebXML Slot Value.
It is common for organizations to be uniquely identified by an OID. In suchcases, the Organization (Identifier component 10) may contain theorganization’s OID. If the Organization Identifier is not an OID, themetadata use assumes that it has been assigned so that the composite Id
created by combining components 6 and 10 is a unique identifier for theorganization.
Examples:Some HospitalSome Hospital^^^^^^^^^1.2.3.4.5.6.7.8.9.1789.45
Some Hospital^^^^^&1.2.3.4.5.6.7.8.9.1789&ISO^^^^45
Note that the '&' character must be properly encoded in the XML content.

XTN

HL7 V2.5
Extended
Telecommunications
Number
Chapter 2A Section 89

This type provides the telecommunications address of an entity (for example
author, intended recipient). This specification restricts the use to thefollowing fields:
For phone numbers:
XTN.2 – Indicates the type of phone number (Optional)
XTN.3 – The type of telecommunication address (Required)
XTN.5 – Country Code (Optional)
XTN.6 – Area/City Code (Optional)
XTN.7 – Subscriber Number (Required)
XTN.8 – Extension (Optional)
For email addresses:
XTN.2 – Optional. If present, SHALL have the value "NET".
XTN.3 –SHALL have the value "Internet".
XTN.4 – the telecommunications address, e.g., name@example.com(Required)No other fields shall be specified. The XTN data type in Document Sharing___________________________________________________________________________
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Data Type

Source Standard

Encoding Specification

metadata results in a valid encoding of an HL7 V2.5 XTN data type.
Use of ITU E.123 notation for telephone numbers is recommended.
Example:^^Internet^radiology@healthcare.example.org org (e-mail address)^PRS^PH^^31^^(042) 1123 4567 (national phone number)^PRS^PH^^^^+31 42 1123 4567 (international phone number)

4.2.3.1.8 General format of DocumentEntry, Folder and SubmissionSet attributetablesThe metadata attribute definition tables each have five columns:
1330

a. The first column contains the name used to refer to the attribute in IHE documentation. It
is not always related to the way the attribute is coded in ebRIM.
b. The second column contains a brief description of the attribute.

1335

c. The third column identifies how the value of the attribute is coded. Table 4.2.3.1.7-2 lists
all the possible types of data. In isolated instances a value may be complex enough torequire a separate section to describe, in which case a reference to that section is
included. For example, author.
d. The fourth column describes where to find the encoding of the attribute within theDocumentEntry/Folder/SubmissionSet. In other words, how the value of the attribute isheld within the enclosing object. The possible values in this column are:

1340

1345

•

ebRIM Classification – indicates that the attribute is coded as a classification object,see Section 4.2.3.1.2.

•

XML attribute – indicates that the attribute is the value of an XML attribute of theenclosing object. For example:<rim:ExtrinsicObject ... id="urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a96f6"... >Showing the entryUUID attribute coded as a value of the id XML attribute of theExtrinsicObject representing the DocumentEntry. Note that the name of the attribute –entryUUID – is not referenced in its actual representation.
1350

1355

•

ebRIM Slot– indicates that the attribute is encoded within a slot. For example:<rim:ExtrinsicObject ...>
<rim:Slot name="creationTime"><rim:ValueList><rim:Value>20041225212010</rim:Value></rim:ValueList></rim:Slot>Showing the creationTime attribute within a Slot of the ExtrinsicObject representing
the Document Entry. In this case the name of the slot is the attribute name.

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ebRIM ExternalIdentifier– indicates the value is held within an ExternalIdentifier
object, using the XML element rim:ExternalIdentifier, providing an additional
identifier to a registry object (see Section 4.2.3.1.3).

•

ebRIM Name– indicates this attribute is held in an ebRIM Name object. For example
the title attribute is:

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1365

<rim:Name><rim:LocalizedString value="ExampleTitle"/></rim:Name>.

•

1370

ebRIM Description– indicates this attribute is held in an ebRIM Description object.
For example the comment attribute is:<rim:Description><rim:LocalizedString value="ExampleComment"/></rim:Description>.

e. The fifth column links to a section which describes the attribute in more detail, including
further detail and examples regarding its use and its coding.
4.2.3.1.9 Metadata Attribute Cardinality
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Metadata attributes have several dimensions of cardinality.
One dimension is whether or not any value is required, or the attribute is optional. Thisdimension is dependent on the profile, actor and transaction in which the attribute is being
specified and is detailed in Sections 4.2.3.2, 4.2.3.3, and 4.2.3.4.

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1385

Another dimension is the required handling of the receiving actor. This is specified within eachtransaction.
The last dimension of cardinality is whether the attribute can contain multiple values and, when
multiple values are allowed, how multiple values are expressed. This is specified within the text
explaining each of the attributes in Sections 4.2.3.2.1 through 4.2.3.2.27 for DocumentEntry,
Sections 4.2.3.3.1 through 4.2.3.3.12 for SubmissionSet, and Sections 4.2.3.4.1 through 4.2.3.4.9
for Folder. The text indicates whether multiple values are allowed and, if they are allowed, how
to express them. For example, for codes expressed using a Classification element, if multiple
values are allowed they are coded by specifying multiple Classification elements.
4.2.3.1.10

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classificationScheme vs. classificationNode

Classification elements in ebRIM use one of two attributes: classificationScheme andclassificationNode.
The attributes serve two different purposes:•

classificationScheme
As the name suggests, the classificationScheme attribute specifies the category("scheme") by which the referenced object is being classified. For example,___________________________________________________________________________
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classificationScheme="urn:uuid:cccf5598-8b07-4b77-a05e-ae952c785ead" indicates thata DocumentEntry is being classified by practiceSetting. The classificationScheme does
not indicate WHICH practiceSetting applies; that information is recorded elsewhere in
the Classification element.
The use of classificationScheme corresponds with "external classifications", as describedin ebRIM. This is the predominant type of classification in Document Sharing.

1400•

classificationNode
The classificationNode attribute provides an actual classification for the referenced
object. For example, classificationNode="urn:uuid:a54d6aa5-d40d-43f9-88c5b4633d873bdd" indicates that a RegistryPackage is a SubmissionSet.

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1410

The use of classificationNode corresponds with "internal classifications", as described in
ebRIM. Document Sharing metadata uses this type of classification for three purposes:•

To label a RegistryPackage as a SubmissionSet•

To label a RegistryPackage as a Folder•

To label a SubmissionSet, Folder, or DocumentEntry as containing Limited Metadata

4.2.3.2

DocumentEntry Attributes

The following metadata attributes shall be used to describe a Document Sharing DocumentEntry.
Optionality is determined by specific transaction requirements; see Section 4.2.3.1.9.

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Each attribute shown below is an attribute on the DocumentEntry object. The attribute name isdefined with a prefix of the object type of DocumentEntry when referenced by other objects, forexample DocumentEntry.patientId.
See Section 4.2.3.1.8 for the general format of DocumentEntry, Folder and SubmissionSet
attribute tables.
Table 4.2.3.2-1: DocumentEntry Metadata Attribute Definition (previously Table 4.1-5)
DocumentEntry
Metadata
Attribute

Description

Data Type(Table4.2.3.1.7-2)

Coding(Section
4.2.3.1.8)

Detail(See
Section)author

The humans and/or machines that authored the
document. This attribute contains the subattributes: authorInstitution, authorPerson,
authorRole, authorSpecialty andauthorTelecommunication.

See Section
4.2.3.2.1

ebRIM
Classification

4.2.3.2.1

availabilityStatus

The lifecycle status of the DocumentEntry

Predefined
URN

XML attribute

4.2.3.2.2

classCodeThe code specifying the high-level use
classification of the document type (e.g., Report,
Summary, Images, Treatment Plan, Patient
Preferences, Workflow).

Code

ebRIM
Classification

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DocumentEntry
Metadata
Attribute

Description

Data Type(Table4.2.3.1.7-2)

Coding(Section
4.2.3.1.8)

Detail(See
Section)comments

Comments associated with the document.

StringebRIM
Description

4.2.3.2.4

confidentialityCode

The code specifying the level of confidentiality ofthe document.

Code

ebRIM
Classification

4.2.3.2.5

creationTime

The time the author created the document.

DTM

ebRIM Slot

4.2.3.2.6

entryUUID

A globally unique identifier used to identify theentry.

UUID

XML attribute

4.2.3.2.7

eventCodeList

This list of codes represents the main clinical acts,
such as a colonoscopy or an appendectomy, being
documented.

Code

ebRIM
Classification

4.2.3.2.8

formatCode

The code specifying the detailed technical formatof the document.

Code

ebRIM
Classification

4.2.3.2.9

hash

The hash of the contents of the document.

SHA1 hashebRIM Slot

4.2.3.2.10

healthcareFacility
TypeCodeThis code represents the type of organizationalsetting of the clinical encounter during which the
documented act occurred.

Code

ebRIM
Classification

4.2.3.2.11

homeCommunityId

A globally unique identifier for a community.

OID URN

home XMLattribute

4.2.3.2.12

languageCode

Specifies the human language of character data inthe document.

StringebRIM Slot

4.2.3.2.13

legalAuthenticator

Represents a participant within an
authorInstitution who has legally authenticated orattested the document.

XCN

ebRIM Slot

4.2.3.2.14

limitedMetadata

Indicates whether the DocumentEntry was createdusing the less rigorous requirements of metadata as
defined for the Metadata-Limited Document
Source.

4.2.3.2.29

ebRIM
Classification

4.2.3.2.29

mimeType

MIME type of the document.

MIME typeXML attribute

4.2.3.2.15

objectType

The type of DocumentEntry (e.g., On-Demand
DocumentEntry).

UUID

XML attribute

4.2.3.2.30

patientId

The patientId represents the subject of care of the
document.

CX

ebRIM
ExternalIdentifier

4.2.3.1.3

practiceSettingCode

The code specifying the clinical specialty where
the act that resulted in the document was
performed (e.g., Family Practice, Laboratory,
Radiology).

Code

ebRIM
Classification

4.2.3.2.17

referenceIdList

A list of identifiers related to the document.

CXi

ebRIM Slot

4.2.3.2.28

repositoryUniqueId

The globally unique identifier of the repository
where the document can be accessed.

OID

ebRIM Slot

4.2.3.2.18

serviceStartTime

The start time of the service being documented.

DTM

ebRIM Slot

4.2.3.2.19

serviceStopTime

The stop time of the service being documented.

DTM

ebRIM Slot

4.2.3.2.20

sizeSize in bytes of the document.

Integer

ebRIM Slot

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DocumentEntry
Metadata
Attribute

Description

Data Type(Table4.2.3.1.7-2)

Coding(Section
4.2.3.1.8)

Detail(See
Section)sourcePatientId

The sourcePatientId represents the subject ofcare’s medical record identifier (e.g., Patient Id) inthe local patient identifier domain of the creating
entity.

CX

ebRIM Slot

4.2.3.2.22

sourcePatientInfo

This attribute contains demographic information of
the patient to whose medical record this document
belongs.

Field

ebRIM Slot

4.2.3.2.23

title

The title of the document.

UTF-8

ebRIM Name

4.2.3.2.24

typeCode

The code specifying the precise type of documentfrom the user perspective (e.g., LOINC code).

Code

ebRIM
Classification

4.2.3.2.25

uniqueId

Globally unique identifier assigned to the
document by its creator.

OID

ebRIM
ExternalIdentifier

4.2.3.1.3

URI

The URI for the document.

URI

ebRIM Slot

4.2.3.2.27

4.2.3.2.1 DocumentEntry.author
1420

Description:
Represents the humans and/or machines that authored the document. See Section 4.2.3.1.4 fordetails on creating the structure.
The classificationScheme shall be urn:uuid:93606bcf-9494-43ec-9b4e-a7748d1a838d
4.2.3.2.2 DocumentEntry.availabilityStatus

1425

Description:
Represents the status of the DocumentEntry. A DocumentEntry shall have one of two availability
statuses:

1430

Approved

The document is available for patient care.

Deprecated

The document is obsolete.

This attribute is typically omitted in a submission of new documents. If present in a submission,
the submitted value is ignored. It is always set to Approved as a result of the successful
submission of new documents. It may be changed to Deprecated under the primary responsibilityof the creating entity.
Coding:

1435

The format of the availabilityStatus value is a URN.
In a query response the value is coded in the status attribute of the ExtrinsicObject representing
the DocumentEntry and shall be urn:oasis:names:tc:ebxml-regrep:StatusType:Approvedor urn:oasis:names:tc:ebxml-regrep:StatusType:Deprecated. The example below shows
the status attribute.
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<ExtrinsicObject
id="urn:uuid:fbeacdb7-5421-4474-9267-985007cd8855"
objectType="urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1"
status="urn:oasis:names:tc:ebxml-regrep:StatusType:Approved">...

4.2.3.2.3 DocumentEntry.classCode
Description:
1450

1455

The code specifying the high-level use classification of the document type (e.g., Report,
Summary, Images, Treatment Plan, Patient Preferences, Workflow). The typeCode specifies theprecise type of document from the user perspective. Valid values for classCode attribute are
specified by the policies of the creating entity. It is recommended that the creating entity draws
these values from a coding scheme providing a coarse level of granularity (about 10 to 100
entries). For example, XDS specifies that the XDS Affinity Domain will establish this list.
Coding:

1460

There shall be exactly zero or one ebRIM Classification containing a classCode for any
DocumentEntry. See Section 4.2.3.1.2 for a description of coding an ebRIM Classification. For
the classCode metadata attribute, the classificationScheme shall be
urn:uuid:41a5887f-8865-4c09-adf7-e362475b143a.
The following example specifies classCode=10160-0 with display name "History of Medication
Use" and coding scheme "2.16.840.1.113883.6.1" for the DocumentEntry labeled"ExampleDocument".

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1470

1475

1480

<rim:Classification
classificationScheme="urn:uuid:41a5887f-8865-4c09-adf7-e362475b143a"classifiedObject="ExampleDocument"
id="IdExample_046"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="10160-0"><rim:Name><rim:LocalizedStringvalue="History of Medication Use"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>2.16.840.1.113883.6.1</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

4.2.3.2.4 DocumentEntry.comments
1485

Description:
Contains comments associated with the document.
Coding:Max length is unbounded.

1490

The value of the comments attribute is coded in XML as the "value" attribute of the
LocalizedString element within the ebRIM Description structure. There can be at most one
ebRIM Description structure per DocumentEntry.
The following example shows a comment for the document.

1495<rim:Description><rim:LocalizedString value = "comment associated with the Document"/></rim:Description>

4.2.3.2.5 DocumentEntry.confidentialityCode
Description:
1500

The code specifying the security and privacy tags of the document. These codes are set by policyof the participants in the exchange, e.g., XDS affinity domain. confidentialityCode is part of a
codification scheme.
The confidentialityCode can carry multiple vocabulary items. HL7 has developed anunderstanding of security and privacy tags that might be desirable in a Document Sharing___________________________________________________________________________
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1510

1515

1520

environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The
following specification is recommended but not mandated by IHE, as the vocabulary bindings
are an administrative domain responsibility. The use of this method is up to the policy domainsuch as the XDS Affinity Domain or other Trust Domain where all parties including sender andrecipients are trusted to appropriately tag and enforce.
•[1…1] Confidentiality Security Classification Label Field•[0…*] Sensitivity Security Category Label Field•[0…*] Compartment Security Category Label Field•[0…*] Integrity Security Category Label Field•[0…*] Handling Caveat Security Category Field

In the HL7 Healthcare Privacy and Security Classification System In the HL7 Healthcare
Privacy and Security Classification (HCS) there are code systems specific to Confidentiality,
Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary
as they are related to workflow roles and special projects.
The decision to include a code is the responsibility of the publisher/sender (e.g., Access Control
decision) and is dependent on the Policy rules and Trust Framework in place for the exchange.
Use of Sensitivity tags expose the nature of the sensitivity and should be used only when theend-to-end confidentiality of the tags can be assured.
When using the HL7 Healthcare Privacy and Security Classification System (HCS):

1525

•

The confidentialityCode SHALL contain exactly one value from the HL7 code system
V:Confidentiality (@codeSystem=”2.16.840.1.113883.5.25” i.e., U, L, M, N, R, or V), toindicate the Confidentiality coding of the content.
•

1530

•

The confidentialityCode MAY contain values from the HL7 code system
V:InformationSensitivityPolicy (@codeSystem=”2.16.840.1.113883.1.11.20428”), toindicate the Sensitivity coding of the content.
•

1535

•

The value represents the most restrictive content in the identified document (aka.
High water mark).

Multiple values are all applicable to the content. This means that a consuming
system/user must have rights to all Sensitivity classes indicated.

The confidentialityCode MAY contain values from the HL7 code system V:Compartment(@codeSystem=”2.16.840.1.113883.1.11.20478”), to indicate the Compartment of thecontent.
•

Multiple values are all applicable to the content. This means that a consuming
system/user must have rights to all Compartments indicated.

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1540

•

The confidentialityCode MAY contain values from the HL7 code system
V:SecurityIntegrityObservationValue (@codeSystem=”2.16.840.1.113883.1.11.20469”),
to indicate the Integrity of the content.
•

•
1545

The confidentialityCode MAY contain values from the HL7 code system
V:SecurityControlObservationValue (@codeSystem=”2.16.840.1.113883.1.11.20471”),
to address the Handling Caveats that must be applied to the use of the content.
•

•
1550

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1560

Multiple values are all applicable to the content.

Multiple values all applicable to the content. A consuming system must enforce all
Handling Caveats indicated.

Other value-sets and codesystems MAY be used as agreed between the communicating
partners.

Coding:Each confidentialityCode is coded within an ebRIM Classification object. See Section 4.2.3.1.2
for a description of coding an ebRIM Classification. There shall be zero or more ebRIM
Classification containing a confidentiality code (some profiles require at least one). Multiple
values of confidentialityCode are coded by specifying multiple classification objects. For theconfidentialityCode metadata attribute, the classificationScheme shall be
urn:uuid:f4f85eac-e6cb-4883-b524-f2705394840f.
The following example shows two confidentialityCode values. It specifies normal confidentiality
with code “N”, display name “Normal Clinical Data”, and coding scheme“2.16.840.1.113883.5.25”, and an obligation not to reuse with code ”NOREUSE”, display name“prohibit use beyond purpose of use”, and coding scheme “2.16.840.1.113883.1.11.20471", for
the DocumentEntry labeled “ExampleDocument”.

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1570

1575

1580

1585

1590

1595

<rim:Classification
classificationScheme="urn:uuid:f4f85eac-e6cb-4883-b524-f2705394840f"
classifiedObject="ExampleDocument"
id="IdExample_046"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="N"<rim:Name><rim:LocalizedStringvalue="Normal Clinical Data"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>2.16.840.1.113883.5.25</rim:Value></rim:ValueList></rim:Slot></rim:Classification><rim:Classification
classificationScheme="urn:uuid:f4f85eac-e6cb-4883-b524-f2705394840f"
classifiedObject="ExampleDocument"
id="IdExample_046"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="NOREUSE"><rim:Name><rim:LocalizedString value="prohibit reuse beyond purpose of use"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>2.16.840.1.113883.1.11.20471</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

4.2.3.2.6 DocumentEntry.creationTime
1600

Description:
Represents the time the author created the document.
Coding:Max length is 256 characters. The format of the creationTime value is DTM; see Table 4.2.3.1.72 for a description of DTM format.

1605

The value is coded as a single value within an ebRIM Slot in the DocumentEntry.
The following example shows a creationTime of December 25, 2004 21:20:10 Coordinated
Universal Time (UTC).
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1610<rim:Slot name="creationTime"><rim:ValueList><rim:Value>20041225212010</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.7 DocumentEntry.entryUUID
1615

Description:
entryUUID is a globally unique identifier primarily intended for internal document management
purposes. In contrast, the uniqueId attribute is used for external references (e.g., links, etc.).
Coding:1620

Max length is unbounded. The format of the entryUUID value is UUID. Certain Document
Sharing transactions may allow symbolic Ids (anything that does not have the urn:uuid: prefix) tobe used in certain conditions.
The value of the entryUUID is coded in the id XML attribute on the ExtrinsicObject representing
the DocumentEntry. In the example below, the entryUUID is urn:uuid:a6e06ca8-0c75-40649e5c-88b9045a96f6

1625<rim:ExtrinsicObject mimeType="application/pdf"
id="urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a96f6"
objectType="urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1"
> …

1630
4.2.3.2.8 DocumentEntry.eventCodeList
Description:

1635

This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy,
being documented. In some cases, the event is inherent in the typeCode, such as a "History andPhysical Report" in which the procedure being documented is necessarily a "History andPhysical" act. An event can further specialize the act inherent in the typeCode, such as where it issimply "Procedure Report" and the procedure was a "colonoscopy". When defining the value setsfor eventCodes, they should not conflict with the values inherent in the classCode,practiceSettingCode or typeCode as such a conflict would create an ambiguous situation.

1640

Coding:

1645

The eventCodeList is coded with ebRIM Classification objects. See Section 4.2.3.1.2 for a
description of coding an ebRIM Classification. There may be zero or more ebRIM
Classifications containing a code and additional eventCode entries are coded by specifying
multiple classification objects. For the eventCodeList metadata attribute, theclassificationScheme shall be urn:uuid:2c6b8cb7-8b2a-4051-b291-b1ae6a575ef4.
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The following example specifies an eventCode="ExampleeventCode" with display name"eventCodeDisplayName" and coding scheme "Example Event Code Scheme" for theDocumentEntry labeled "ExampleDocument".
1650

1655

1660

1665

<rim:Classification
classificationScheme="urn:uuid:2c6b8cb7-8b2a-4051-b291-b1ae6a575ef4"
classifiedObject="ExampleDocument"
id="IdExample_048"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="ExampleeventCode"><rim:Name><rim:LocalizedString value="eventCodeDisplayName"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example Event Code Scheme</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

4.2.3.2.9 DocumentEntry.formatCode
1670

Description:
The code specifying the detailed technical format of the document. Along with the typeCode, it
should provide sufficient information to allow potential consumer to know if it will be able toprocess the document.

1675

1680

The mimeType indicates the base format; the formatCode indicates the detailed-level technicalformat. The formatCode shall be sufficiently specific to ensure processing/display by identifying
a document encoding, structure and template (e.g., for a CDA Document, the fact that it complies
with a CDA schema, possibly a template and the choice of a content-specific style sheet). The
formatCode is often an indicator of the IHE Document Content Profile to which the document
conforms.
Format codes may be specified by multiple organizations. Format codes for Document Content
Profiles defined by the ITI domain shall be in URN format and have names with the prefix
urn:ihe:iti:Format codes defined by other IHE domains shall have names with the prefix
urn:ihe:’domain initials’:

1685

Format codes defined by non-IHE domains should be a valid unique URN.

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Coding:

1690

There shall be zero or one ebRIM Classification containing a formatCode. See Section 4.2.3.1.2
for a description of coding an ebRIM Classification. For the formatCode metadata attribute, theclassificationScheme shall be urn:uuid:a09d5840-386c-46f2-b5ad-9c3699a4309d. Any valid
URN may be used as a formatCode.
The following example using the XDS-SD document content profile specifies
formatCode="urn:ihe:iti:xds-sd:pdf:2008" with display name "XDS-Scanned Documents" andcoding scheme "urn" for the DocumentEntry labeled "ExampleDocument".

1695

1700

1705

1710

<rim:Classification
classificationScheme="urn:uuid:a09d5840-386c-46f2-b5ad-9c3699a4309d"
classifiedObject="ExampleDocument"
id="IdExample_049"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="urn:ihe:iti:xds-sd:pdf:2008"><rim:Name><rim:LocalizedString value="XDS-Scanned Documents"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>1.3.6.1.4.1.19376.1.2.3</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

4.2.3.2.10
1715

DocumentEntry.hash

Description:
The hash of the contents of the document.
The hash attribute can be used to identify accidental document corruption, mistaken duplicate
IDs, etc. The SHA1 algorithm and hash attribute should not be used for identifying malicious
alterations.

1720

Note: Environments requiring a higher level of protection against document modification should consider using a digital
signature such as defined in the DSG Profile (see ITI TF-1: 37).

Coding:Max length is 256 characters. The format of the hash value is SHA1 hash; see Table 4.2.3.1.7-2
for a description of SHA1.
1725

The value is coded as a case-insensitive single value within an ebRIM Slot in theDocumentEntry.
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The following example shows a hash of da39a3ee5e6b4b0d3255bfef95601890afd80709.
1730

1735

<rim:Slot name="hash"><rim:ValueList><rim:Value>da39a3ee5e6b4b0d3255bfef95601890afd80709</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.11

DocumentEntry.healthcareFacilityTypeCode

Description:
This code represents the type of organizational setting of the clinical encounter during which the
documented act occurred.
1740

In some cases, the setting of the encounter is inherent in the typeCode, such as "Diabetes Clinic
Progress Note". healthcareFacilityTypeCode shall be equivalent to or further specialize the value
inherent in the typeCode; for example, where the typeCode is simply "Clinic Progress Note" andthe value of healthcareFacilityTypeCode is "private clinic".
Coding:

1745

There shall be zero or one ebRIM Classification containing a healthcareFacilityTypeCode. See
Section 4.2.3.1.2 for a description of coding an ebRIM Classification. For thehealthcareFacilityTypeCode metadata attribute the classificationScheme shall be
urn:uuid:f33fb8ac-18af-42cc-ae0e-ed0b0bdb91e1.

1750

The following example specifies healthcareFacilityTypeCode ="ExamplehealthcareFacilityTypeCode " with display name"healthcareFacilityTypeCodeDisplayName " and coding scheme "Example Healthcare Facility
Scheme" for the DocumentEntry labeled "ExampleDocument".

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1760

1765

<rim:Classification
classificationScheme="urn:uuid:f33fb8ac-18af-42cc-ae0e-ed0b0bdb91e1"
classifiedObject="ExampleDocument"
id="IdExample_050"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="ExamplehealthcareFacilityTypeCode"><rim:Name><rim:value="healthcareFacilityTypeCodeDisplayName"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example Healthcare Facility Scheme</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

1770
4.2.3.2.12

DocumentEntry.homeCommunityId

Description:
A globally unique identifier for a community where the DocumentEntry and document can beaccessed.
1775

Coding:Max length is unbounded. Contained in the ebRS ExtrinsicObject home attribute for the
ExtrinsicObject that corresponds to the DocumentEntry. It is an OID URN (see Table 4.2.3.1.72).
See ITI TF-2a: 3.18.4.1.2.3.8 and ITI TF-2b: 3.38.4.1.2.1.

1780

1785

<rim:ExtrinsicObject home="urn:oid:1.2.3" ...>...
</rim:ExtrinsicObject>

4.2.3.2.13

DocumentEntry.languageCode

Description:
Specifies the human language of character data in the document.
Coding:1790

Max length is 256 characters. The values of the attribute are language identifiers as described by
the IETF (Internet Engineering Task Force) RFC5646.
The value is coded as a single value within an ebRIM Slot in the DocumentEntry.
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The following example shows a languageCode of en-CA.
1795

1800

<rim:Slot name="languageCode"><rim:ValueList><rim:Value>en-CA</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.14

DocumentEntry.legalAuthenticator

Description:
Represents a participant within an authorInstitution who has legally authenticated or attested the
document. Legal authentication implies that a document has been signed manually orelectronically by the legalAuthenticator.
1805

Coding:Max length is 256 characters. This attribute shall be absent if not applicable. The value is coded
as a single value within an ebRIM Slot in the DocumentEntry. The format of thelegalAuthenticator value is XCN; see Table 4.2.3.1.7-2 for description of XCN format.
The following example shows a legalAuthenticator of ^Welby^Marcus^^^ Dr^MD.

1810

1815

<rim:Slot name="legalAuthenticator"><rim:ValueList><rim:Value>^Welby^Marcus^^^Dr^MD</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.15

DocumentEntry.mimeType

Description:
MIME type of the document in the Repository
1820

Coding:Max length is unbounded. Shall have only a single value. Encoded in the ebRS ExtrinsicObject
mimeType attribute for the ExtrinsicObject that corresponds to the DocumentEntry. See ebRS
Schema RIM.XSD.
In this example the MIME type is “application/pdf”.

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id="ExampleDocument"
objectType="urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1">

1830

4.2.3.2.16

DocumentEntry.patientId

Description:
The patientId represents the subject of care of the document. For XDS the patient identifier
domain is the XDS Affinity Domain Patient Identifier Domain (XAD-PID).
1835

Within a submission request, the value of patientId of the DocumentEntries shall match that of
the SubmissionSet.
Coding:
The format of the patientId value is CX, see Table 4.2.3.1.7-2.
It shall contain two parts:
Assigning Authority Domain Id (organization that issued the Id),

1840

An Id from the above Assigning Authority.
No other values are allowed, as specified for the CX type. Using HL7 terminology, no othervalues are allowed in the components of the coded value, nor are further subcomponents
allowed.

1845

Coded as an ebRIM ExternalIdentifier. See Section 4.2.3.1.3 for a description of coding an
ebRIM ExternalIdentifier. This element references, and is contained in, the ExtrinsicObject
representing the DocumentEntry. There shall be zero or one patientId value.
In the example below the patientId is 6578946^^^&1.3.6.1.4.1.21367.2005.3.7&ISO where
6578946 is the ID and 1.3.6.1.4.1.21367.2005.3.7 is the assigning authority.

1850

1855

1860

<rim:ExternalIdentifier
identificationScheme="urn:uuid:58a6f841-87b3-4a3e-92fd-a8ffeff98427"
value="6578946^^^&amp;1.3.6.1.4.1.21367.2005.3.7&amp;ISO"
id="IdExample_051"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"registryObject="DocumentEntry01"><rim:Name><rim:LocalizedString value="XDSDocumentEntry.patientId "/></rim:Name></rim:ExternalIdentifier>___________________________________________________________________________
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4.2.3.2.17

DocumentEntry.practiceSettingCode

Description:
1865

The code specifying the clinical specialty where the act that resulted in the document was
performed (e.g., Family Practice, Laboratory, Radiology). It is suggested that the creating entity
draws these values from a coding scheme providing a coarse level of granularity (about 10 to 100
entries).
Coding:

1870

1875

1880

1885

1890

There shall be zero or one ebRIM Classification containing a practiceSettingCode. See Section
4.2.3.1.2 for a description of coding an ebRIM Classification. For the practiceSettingCode
metadata attribute, the classificationScheme shall be
urn:uuid:cccf5598-8b07-4b77-a05e-ae952c785ead.
The following example specifies practiceSettingCode="ExamplepracticeSettingCode" withdisplay name "ExamplepracticeSettingCodeDisplayName" and coding scheme "Example
Practice Setting Code Scheme" for the DocumentEntry labeled "ExampleDocument".
<rim:Classification
ClassificationScheme="urn:uuid:cccf5598-8b07-4b77-a05e-ae952c785ead"classifiedObject="ExampleDocument"
id="IdExample_052"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="ExamplepracticeSettingCode"><rim:Name><rim:LocalizedStringvalue="ExamplepracticeSettingCodeDisplayName"/></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example Practice Setting Code Scheme</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

1895
4.2.3.2.18

DocumentEntry.repositoryUniqueId

Description:

1900

The globally unique, immutable, identifier of the repository where the document referenced by
the Document Entry can be accessed. This unique identifier for the repository may be used to
identify and connect to the specific repository to access the document.
Coding:Max length is 64 characters. The format of the repositoryUniqueId value is OID.
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The following example shows a repositoryUniqueId of 1.3.6.1.4.5.
1905

1910

<rim:Slot name="repositoryUniqueId"><rim:ValueList><rim:Value>1.3.6.1.4.5</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.19

DocumentEntry.serviceStartTime

Description:
1915

Represents the start time of the service being documented (clinically significant, but notnecessarily when the document was produced or approved). This may be the same as theencounter time in case the service was delivered during an encounter. Encounter time is notcoded in metadata but may be coded within the document.
Note: If needed, other times associated with the document, such as time of approval, are to berecorded within the document.

1920

Coding:Max length is 256 characters. The format of the serviceStartTime value is DTM; see Table
4.2.3.1.7-2 for a description of DTM format.
The value is coded as a single value within an ebRIM Slot Attribute in the DocumentEntry.

1925

1930

The following example shows a serviceStartTime of December 25, 2004 21:20:10 Coordinated
Universal Time (UTC).
<rim:Slot name="serviceStartTime"><rim:ValueList><rim:Value>20041225212010</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.20

DocumentEntry.serviceStopTime

Description:
1935

Represents the stop time of the service being documented (clinically significant, but notnecessarily when the document was produced or approved). This may be the same as theencounter time in case the service was delivered during an encounter. Encounter time is notcoded in metadata but may be coded within the document.
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1940

If the service happens at a point in time, this attribute shall contain the same value as theserviceStartTime.
Coding:Max length is 256 characters. The format of the serviceStopTime value is DTM; see Table
4.2.3.1.7-2 for a description of DTM format.
The value is coded as a single value within an ebRIM Slot Attribute in the DocumentEntry.

1945

1950

The following example shows a stop time of December 25, 2004 21:20:10 Coordinated
Universal Time (UTC).
<rim:Slot name="serviceStopTime"><rim:ValueList><rim:Value>20041225232010</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.21
1955

DocumentEntry.size

Description:
Size in bytes of the byte stream that comprises the document.
Coding:Max length of the encoded size is 256 characters. Coded as an ebRIM Slot. Shall have only asingle value.

1960

1965

The following example shows a size value of 3654 bytes.
<rim:Slot name="size"><rim:ValueList><rim:Value>3654</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.22

DocumentEntry.sourcePatientId

Description:
1970

The sourcePatientId represents the subject of care’s medical record identifier (e.g., Patient Id) inthe local patient identifier domain of the creating entity.
Coding:Max length is 256 characters. Coded as an ebRIM Slot with the value encoded according the CX
datatype (see Table 4.2.3.1.7-2). Shall contain zero or one value.
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1975<rim:Slot name="sourcePatientId"><rim:ValueList><rim:Value>j98789^^^&amp;1.2.3.4.343.1&amp;ISO</rim:Value></rim:ValueList></rim:Slot>

1980
4.2.3.2.23

DocumentEntry.sourcePatientInfo

Description:
This attribute contains demographics information at the time of submission of the patient towhose medical record this document belongs.
1985

1990

This information typically includes: the patient first and last name, sex, and birth date. Policies atthe creating entity may require more or less specific information and format.
This patient information is not intended to be updated once the document is registered (just as the
document content and metadata itself will not be updated without replacing the previous
document). As sourcePatientInfo may have been updated by the source actor, it may no longer be
in use within the Document Source (EHR-CR). It is only intended as an audit/checking
mechanism and has occasional use for Document Consumer Actors.
Coding:Coded as an ebRIM Slot. If present, each rim:Value contains a Field (see Table 4.2.3.1.7-2 for a
description of the Field datatype).

1995

Maximum length of each rim:Value is 256 characters.sourcePatientInfo should include valuesfor:•

PID-3 (source patient identifier list)
A rim:Value shall contain one or more patient identifiers separated by the repetition
separator ~.
Multiple rim:Value elements for PID-3 may be coded.

2000

2005

•

PID-5 (source patient name)•

PID-7 (source patient date of birth)•

PID-8 (source patient gender)

sourcePatientInfo should not include values for PID-2 (patient id), PID-4 (alternate patient id),
PID-12 (country code), or PID-19 (social security number).
Example:2010<rim:Slot name="sourcePatientInfo"><rim:ValueList><rim:Value>PID-3|D\E\ID1-1^^^&amp;1.3.6&amp;ISO~ID2^^^&amp;1.3.11&amp;ISO</rim:Value><rim:Value>PID-3|YZP-2^^^&amp;1.3.42&amp;ISO~ABC-3^^^&amp;1.3.3.14&amp;ISO</rim:Value><rim:Value>PID-5|DICTAPHONE^ONE^^^</rim:Value><rim:Value>PID-7|19650120</rim:Value><rim:Value>PID-8|M</rim:Value>___________________________________________________________________________
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2015<rim:Value>PID-11|100 Main St^^BURLINGTON^MA^01803^USA</rim:Value></rim:ValueList></rim:Slot>

This example illustrates several of the encoding rules above:

2020

•

In the first PID-3 entry, the use of the HL7 escape sequence \E\ (representing the ”\”
character•

The encoding of two patient identifiers in the first PID-3 entry and a third patient
identifier in the second PID-3 entry•

In the PID-3.4 values, the XML encoding of the "&" subcomponent separators

4.2.3.2.24
2025

DocumentEntry.title

Description:
Represents the title of the document.
Clinical documents often do not have a title; in such case the classCode (e.g., a "consultation" or"progress note") is often used as the title. In that case, the title is usually omitted.
Coding:

2030

The format of DocumentEntry.title shall be any string of length less than 128 characters.
DocumentEntry.title is represented in ebXML as the "value" attribute of the LocalizedString
element within the ebRIM Name structure. There can be only one ebRIM Name structure perDocumentEntry.
The following example shows a title for the DocumentEntry.

2035

2040

<rim:ExtrinsicObject
id="ExampleDocument"
objectType="urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1"
mimeType="application/pdf"><rim:Name><rim:LocalizedString value="Example Document Title"/></rim:Name>...
</rim:ExtrinsicObject>2045
4.2.3.2.25

DocumentEntry.typeCode

Description:

2050

The code specifying the precise type of document from the user’s perspective. It is recommended
that the creating entity draw these values from a coding scheme providing a fine level of
granularity such as LOINC.
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Coding:Coded as an ebRIM classification. See Section 4.2.3.1.2 for a description on creatingclassifications. Shall have zero or one value.
2055

2060

2065

2070

2075

The following example specifies typeCode="ExampletypeCode" with display name"typeCodeDisplayName " and coding scheme " Example Type Code Scheme " for theDocumentEntry labeled "ExampleDocument".
<rim:Classification
classificationScheme="urn:uuid:f0306f51-975f-434e-a61c-c59651d33983"
classifiedObject="ExampleDocument"
nodeRepresentation="ExampletypeCode"
id="IdExample_053"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"><rim:Name><rim:LocalizedString value="typeCodeDisplayName" /></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example Type Code Scheme</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

4.2.3.2.26

DocumentEntry.uniqueId

Description:
Globally unique identifier assigned to the document by its creator.

2080

A DocumentEntry representing a single document is identified by the uniqueId attribute; thelinkage between DocumentEntry and the document it represents is made with the uniqueId
attribute.
This unique identifier may be used in other documents to reference this document.

2085

2090

Two documents MAY be assigned the same uniqueId if the documents have the same byte
sequence, but they SHALL NOT be assigned the same uniqueId if the documents have different
byte sequences when communicated via a Document Sharing protocol. The size and hashmetadata attributes allow for a quick comparison, so it is adequate to treat two documents as
having the same byte sequence if their size and hash attributes are the same.
For formats where different byte sequences can be functionally equivalent (XML, for example,
where whitespace between elements is ignored), it is important to note that documents withdifferent byte sequences SHALL have different uniqueIds even if they are functionallyequivalent when communicated via a Document Sharing protocol.
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Coding:
The format of the DocumentEntry.uniqueId value is OID see Table 4.2.3.1.7-2.

2095

Coded as an ebRIM ExternalIdentifier (see Section 4.2.3.1.3 for a description of coding an
ebRIM ExternalIdentifier) which references, and is contained in, the ExtrinsicObject
representing the DocumentEntry. There shall be only a single uniqueId value.

2100

The structure and format of this Id shall be consistent with the specification corresponding to theformatCode attribute. (e.g., for a DICOM standard document a 64 character numeric UID, for an
HL7 CDA format a serialization of the CDA Document Id extension and root in the formoid^extension, where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID iscoded without the extension then the '^' character shall not be included.)

2105

2110

<rim:ExternalIdentifier
identificationScheme="urn:uuid:2e82c1f6-a085-4c72-9da3-8640a32e42ab"
value="1.2.3.4.5.6.78901.2345.6.7^123456"
id="IdExample_054"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"registryObject="DocumentEntry01"><rim:Name><rim:LocalizedString value="XDSDocumentEntry.uniqueId"/></rim:Name></rim:ExternalIdentifier>4.2.3.2.27
2115

DocumentEntry.URI

Description:
The URI attribute contains the URI for the document.
Coding:Max length is 256 characters. Coded as an ebRIM Slot. Shall have only a single value.

2120<rim:Slot name="URI"><rim:ValueList><rim:Value>DOC001.XML</rim:Value></rim:ValueList></rim:Slot>

2125
4.2.3.2.28

DocumentEntry.referenceIdList

Description:
This list contains zero or more Identifiers. These Identifiers may be internal or external
identifiers, e.g., Identifiers may be Accession Numbers, Order Numbers, Referral Request___________________________________________________________________________
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2130

Identifiers, XDW Workflow Instance Identifiers, etc. The referenceIdList contains Identifiers
CXi encoded, as specified in Table 4.2.3.1.7-2.
Coding:Max length is 256 characters. Coded as an ebRIM Slot. May have multiple values.
The name of the slot in the metadata shall be urn:ihe:iti:xds:2013:referenceIdList.

2135

2140

2145

For example encoding two values in the referenceIdList:<rim:Slot name="urn:ihe:iti:xds:2013:referenceIdList "><rim:ValueList><rim:Value>
2013001^^^&1.2.3.4.5.6&ISO^urn:ihe:iti:xds:2013:accession</rim:Value><rim:Value>
1.2.3.12.78.23^^^&1.2.3.4&ISO^urn:ihe:iti:xds:2013:uniqueId^&1.2.3.4&ISO</rim:Value></rim:ValueList></rim:Slot>

4.2.3.2.29

DocumentEntry.limitedMetadata

Description:
2150

Indicates whether the Document Entry was created using the less rigorous requirements ofmetadata as defined for the Metadata-Limited Document Source.
Coding:
The Document Entry is flagged using an ebRIM Classification with a classificationNode of
urn:uuid:ab9b591b-83ab-4d03-8f5d-f93b1fb92e85.

2155

2160

The following example marks the “DocEntry” Document Entry as created via the less rigorous
metadata requirements.
<ExtrinsicObject id="DocEntry">(…)<Classification classifiedObject="DocEntry"
classificationNode="urn:uuid:ab9b591b-83ab-4d03-8f5d-f93b1fb92e85”/>(…)</ExtrinsicObject>___________________________________________________________________________
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4.2.3.2.30

DocumentEntry.objectType

Description:

2170

2175

The objectType attribute reflects the type of DocumentEntry. As described in Section 4.1.1, there
are two DocumentEntry types: Stable Document Entry and On-Demand Document Entry. A
Stable Document Entry contains metadata about an already created document available for
retrieval is a Document Entry and is designated by setting objectType equal to the UUID for
Stable (see Section 4.2.5.2 for the UUID). An On-Demand DocumentEntry contains metadata
which can be used to create an on-demand document which collects the latest, most recent
available information at the time of retrieval. It is designed by setting an objectType equal to the
UUID for on-demand (see Section 4.2.5.2 for the UUID).
Coding:Max length is unbounded. The format of the objectType value is UUID.
The value of the objectType is coded in the objectType XML attribute on the ExtrinsicObject
representing the DocumentEntry. In the example below, the objectType is urn:uuid:7edca82f054d-47f2-a032-9b2a5b5186c1 and reflects a stable DocumentEntry.

2180<rim:ExtrinsicObject mimeType="application/pdf"
id="urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a96f6"
objectType="urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1"
> …

2185
4.2.3.3

SubmissionSet Attributes

The following metadata elements shall be used to describe a SubmissionSet.

2190

Each attribute shown is an attribute on the RegistryPackage object defining the SubmissionSet.
The attribute name is defined with a prefix of the object type of SubmissionSet when referenced
by other objects, for example SubmissionSet.sourceId.
See Section 4.2.3.1.8 for the General format of DocumentEntry, Folder and SubmissionSet
attribute tables.
Table 4.2.3.3-1: Submission Set Metadata Attribute Definitions (previously Table 4.1-6)
SubmissionSet
Metadata
Attribute

Description

Form

Coding

Detailauthor

The humans and/or machines that authored theSubmissionSet. This attribute contains the subattributes: authorInstitution, authorPerson,
authorRole, authorSpecialty,
authorTelecommunication.

4.2.3.3.1

ebRIM
Classification

4.2.3.3.1

availabilityStatus

The lifecycle status of the SubmissionSet.

PredefinedURN

XML
attribute

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SubmissionSet
Metadata
Attribute

2195

Description

Form

Coding

Detailcomments

Comments associated with the SubmissionSet.

StringebRIM
Description

4.2.3.3.3

contentTypeCode

The code specifying the type of clinical activity
that resulted in placing the accociated content in
the SubmissionSet.

Code

ebRIM
Classification

4.2.3.3.4

entryUUID

A globally unique identifier used to identify theentry.

UUID

XML
attribute

4.2.3.3.5

homeCommunityId

A globally unique identifier for a community.

OID URN

home XMLattribute

4.2.3.3.6

intendedRecipient

The organizations or persons for whom the
SubmissionSet is intended.

See 4.2.3.3.7

ebRIM Slot

4.2.3.3.7

limitedMetadata

A flag that the associated SubmissionSet was
created using the less rigorous metadata
requirements as defined for the Metadata-Limited
Document Source.

See 4.2.3.3.13

ebRIM
Classification

4.2.3.3.13

patientId

The patientId represents the primary subject ofcare of the SubmissionSet.

CX

ebRIM
ExternalIdent
ifier

4.2.3.3.8

sourceId

Identifier of the entity that contributed theSubmissionSet.

OID

ebRIM
ExternalIdent
ifier

4.2.3.3.9

submissionTime

Point in time at the creating entity when the
SubmissionSet was created.

DTM

ebRIM Slot

4.2.3.3.10

title

The title of the SubmissionSet.

UTF-8

ebRIM Name

4.2.3.3.11

uniqueId

Globally unique identifier for the SubmissionSet
assigned by the creating entity.

OID

ebRIM
ExternalIdent
ifier

4.2.3.3.12

4.2.3.3.1 SubmissionSet.author
Description:
Represents the humans and/or machines that authored the SubmissionSet. See Section 4.2.3.1.4
for details on creating the structure.
The classificationScheme shall be urn:uuid:a7058bb9-b4e4-4307-ba5b-e3f0ab85e12d

2200

4.2.3.3.2 SubmissionSet.availabilityStatus
Description:
Represents the status of the SubmissionSet. Since the deprecation of SubmissionSets is notallowed, this value shall always be Approved.

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Coding:2205

The availabilityStatus value shall be2210<rim:RegistryPackage
id="urn:uuid:fbeacdb7-5421-4474-9267-985007cd8855"
status="urn:oasis:names:tc:ebxml-regrep:StatusType:Approved"> ...

urn:oasis:names:tc:ebxml-regrep:StatusType:Approved.

4.2.3.3.3 SubmissionSet.comments
Description:
2215

Contains comments associated with the SubmissionSet.
Coding:Max length is unbounded. The value of the comments attribute is coded in XML as the "value"
attribute of the LocalizedString element within the ebRIM Description structure. There can be at
most one ebRIM Description structure per SubmissionSet.

2220

The following example shows a comment for the SubmissionSet.
<rim:Description><rim:LocalizedString value = "comment associated with SubmissionSet"/></rim:Description>

2225
4.2.3.3.4 SubmissionSet.contentTypeCode
Description:

2230

The code specifying the type of clinical activity that resulted in placing these DocumentEntries,
Folders, and/or Associations in this SubmissionSet. These values are to be drawn from a
vocabulary defined by the creating entity that contributed the SubmissionSet.
Coding:Coded as an ebRIM Classification. See Section 4.2.3.1.2 for a description of coding an ebRIM
Classification. Shall have zero or one value

2235

The following example specifies contentTypeCode="ExamplecontentTypeCode" with display
name "Example contentTypeCodeDisplayName" and coding scheme "Example
contentTypeCode Scheme" for the SubmissionSet labeled "ExampleSubmissionSet".

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2240

2245

2250

<rim:Classification
classificationScheme="urn:uuid:aa543740-bdda-424e-8c96-df4873be8500"
classifiedObject="ExampleSubmissionSet"
id="IdExample_056"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="ExamplecontentTypeCode"><rim:Name><rim:LocalizedString value="Example contentTypeCodeDisplayName" /></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example Specific Value</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

2255
4.2.3.3.5 SubmissionSet.entryUUID
entryUUID is a globally unique identifier primarily intended for internal document management
purposes. In contrast, the uniqueId attribute is used for external references (e.g., links, etc.).
Coding:
2260

The format of the entryUUID value is UUID. Certain Document Sharing transactions may allow
symbolic Ids (any string that does not have the urn:uuid: prefix) to be used.
The value of the entryUUID is coded in the id XML attribute on the RegistryPackage
representing the Submission Set. In the example below, the entryUUID is
urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a96f6.

2265

2270

<rim:RegistryPackage
id="urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a96f6"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:RegistryPackage"> …

4.2.3.3.6 SubmissionSet.homeCommunityId
Description:
2275

A globally unique identifier for a community.
Coding:
The ebRIM RegistryPackage home attribute for the RegistryPackage that corresponds to the
SubmissionSet. It is an OID URN. See Table 4.2.3.1.7-2.
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See ITI TF-2a: 3.18.4.1.2.3.8 and ITI TF-2b: 3.38.4.1.2.1.
2280

2285

<rim:RegistryPackage home="urn:oid:1.2.3" ...>...
</rim:RegistryPackage>

4.2.3.3.7 SubmissionSet.intendedRecipient
Description:

2290

Represents the organization(s) or person(s) for whom the SubmissionSet is intended at time ofsubmission. Each slot value shall include at least one of the organization, person, or
telecommunications address fields described below. It is highly recommended to define theorganization for all the persons, avoiding errors in the transmission of the documents.
Coding:2295

Max length is 256. The format of the SubmissionSet.intendedRecipient value is XON|XCN|XTN
where XON identifies the organization, XCN identifies a person and XTN identifies thetelecommunications, see Table 4.2.3.1.7-2 for description of XON, XCN and XTN format. Thereis a "|" character separator between the organization and the person, and between the person andthe telecommunications address, which is required when the person or the telecommunications
address information is present.
The value is coded as zero or more values within a single ebRIM Slot in the SubmissionSet.

2300

2305

2310

2315

The following example shows two doctors from the same organization, another doctor without
the organization details and another organization without the person details, and just atelecommunications address.
<rim:Slot name="intendedRecipient"><rim:ValueList><rim:Value>Some
Hospital^^^^^^^^^1.2.3.9.1789.45|^Wel^Marcus^^^Dr^MD|^^Internet^mwel@healthca
re.example.org</rim:Value><rim:Value>
Some Hospital^^^^^^^^^1.2.3.9.1789.45|^Peirre^LaPointe^^^Dr^MD</rim:Value><rim:Value>|12345^LaShawn^James^^Dr^MD</rim:Value><rim:Value>MainHospital^^^^^^^^^1.2.3.4.5.6.7.8.9.1789.2364</rim:Value><rim:Value>||^^Internet^dr.oz@healthcare.example.org</rim:Value></rim:ValueList></rim:Slot>___________________________________________________________________________
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4.2.3.3.8 SubmissionSet.patientId
2320

Description:
The patientId represents the primary subject of care of the SubmissionSet.
Coding:
The format of the patientId value is CX (see Table 4.2.3.1.7-2).
It shall contain two parts:

2325

•

Assigning Authority Domain Id (organization that issued the Id).

•

An Id from the above Assigning Authority.

No other values are allowed, as specified for the CX type. Using HL7 terminology, no othervalues are allowed in the components of the coded value, nor are further subcomponents
allowed.
2330

2335

2340

2345

2350

The value is coded within a single ebRIM ExternalIdentifier element (see Section 4.2.3.1.3 for a
description of coding an ebRIM ExternalIdentifier) which references, and is contained in, theRegistryPackage representing the SubmissionSet. There shall be zero or one single patientId
value.
In the example below the patientId is 6578946^^^&1.3.6.1.4.1.21367.2005.3.7&ISO where
6578946 is the ID and 1.3.6.1.4.1.21367.2005.3.7 is the assigning authority.
<rim:ExternalIdentifier
identificationScheme="urn:uuid:6b5aea1a-874d-4603-a4bc-96a0a7b38446"
value="6578946^^^&amp;1.3.6.1.4.1.21367.2005.3.7&amp;ISO"
id="IdExample_057"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"registryObject="SubmissionSet01">><rim:Name><rim:LocalizedString value = "XDSSubmissionSet.patientId"/></rim:Name></rim:ExternalIdentifier>4.2.3.3.9 SubmissionSet.sourceId
Description:
The globally unique, immutable, identifier of the entity that contributed the SubmissionSet.
When a "broker" is involved in sending SubmissionSets from a collection of client systems, it
shall use a different sourceId for submissions from each separate system to allow for tracking.

2355

Coding:
The format of the sourceId value is OID (see Table 4.2.3.1.7-2).
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description of coding an ebRIM ExternalIdentifier) which references, and is contained in, theRegistryPackage representing the SubmissionSet. There shall be only a single sourceId value.
2360

2365

2370

In the example below the sourceId is 1.3.6.1.4.1.21367.2005.3.7.
<rim:ExternalIdentifier
identificationScheme="urn:uuid:554ac39e-e3fe-47fe-b233-965d2a147832"
value="1.3.6.1.4.1.21367.2005.3.7"
id="IdExample_058"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"registryObject="SubmissionSet01"><rim:Name><rim:LocalizedString value = "XDSSubmissionSet.sourceId"/></rim:Name></rim:ExternalIdentifier>4.2.3.3.10
2375

SubmissionSet.submissionTime

Description:
Represents the point in time at the creating entity when the SubmissionSet was created.
This shall be provided by the submitting system.
Coding:2380

Max length is 256. The format of the submissionTime value is DTM. See Table 4.2.3.1.7-2 for a
description of DTM format.
The value is coded as a single value within an ebRIM Slot Attribute in the SubmissionSet.
The following example shows a submissionTime of December 25, 2004 21:20:10 Coordinated
Universal Time (UTC).

2385<rim:Slot name="submissionTime"><rim:ValueList><rim:Value>20041225212010</rim:Value></rim:ValueList></rim:Slot>

2390
4.2.3.3.11

SubmissionSet.title

Description:
Shall contain the title of the SubmissionSet.
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Coding:
2395

The format of SubmissionSet.title shall be any string of length less than 256 characters.
SubmissionSet.title is represented in ebXML as the "value" attribute of the LocalizedString
element within the ebRIM Name structure. There can be only one ebRIM Name structure per
SubmissionSet.
The following example shows a title for the SubmissionSet.

2400

2405

<rim:Name><LocalizedString value="Example Submission Set Title"/></rim:Name>

4.2.3.3.12

SubmissionSet.uniqueId

Description:
The globally unique identifier for the SubmissionSet assigned by the entity that contributed theSubmissionSet.
Coding:
2410

The format of the SubmissionSet.uniqueId value is OID (see Table 4.2.3.1.7-2).
The value is coded within a single ebRIM ExternalIdentifier element which references, and iscontained in, the RegistryPackage representing the SubmissionSet. See Section 4.2.3.1.3 for a
description of coding an ebRIM ExternalIdentifier. There shall be only a single uniqueId value.
The following example shows a uniqueId of 1.2.3.4.5.

2415

2420

2425

<rim:ExternalIdentifier
identificationScheme="urn:uuid:96fdda7c-d067-4183-912e-bf5ee74998a8"
id="IdExample_059"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"value="1.2.3.4.5"
registryObject="SubmissionSet01"><rim:Name><rim:LocalizedString value = "XDSSubmissionSet.uniqueId"/></rim:Name></rim:ExternalIdentifier>4.2.3.3.13

SubmissionSet.limitedMetadata

Description:
2430

Indicates whether the SubmissionSet was created using the less rigorous requirements ofmetadata as defined for the Metadata-Limited Document Source Actor.
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Coding:The SubmissionSet is flagged using an ebRIM Classification with a classificationNode of
urn:uuid:5003a9db-8d8d-49e6-bf0c-990e34ac7707. Zero or one may be present.
2435

2440

2445

The following example marks the “SubmissionSet” SubmissionSet as created via the lessrigorous metadata requirements.
<RegistryPackage id="SubmissionSet">(…)<Classification classifiedObject="SubmissionSet"
classificationNode="urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd"/><Classification classifiedObject="SubmissionSet"
classificationNode="urn:uuid:5003a9db-8d8d-49e6-bf0c-990e34ac7707"/>(…)</RegistryPackage>

4.2.3.4

2450

Folder Attributes

The following metadata elements shall be used to describe a Folder. Each attribute shown below
is an attribute on the RegistryPackage object defining the Folder. The attribute name is definedwith a prefix of the object type of Folder when referenced by other objects, for example
Folder.patientId. See Section 4.2.3.1.8 for the general format of DocumentEntry, Folder andSubmissionSet attribute tables.
Table 4.2.3.4-1: Folder Metadata Attribute Definitions (previously Table 4.1-7)
Folder Metadata
Attribute

Description

Form

Coding

Detail(See
Section)availabilityStatus

The lifecycle status of the Folder.

Predefined
URN

XML attribute

4.2.3.4.1

codeList

The set of codes specifying the type of clinicalactivities that resulted in placing DocumentEntry
objects in the Folder.

Code

ebRIM
Classification

4.2.3.4.2

comments

Comments associated with the Folder.

StringebRIM
Description

4.2.3.4.3

entryUUID

A globally unique identifier used to identify theentry.

UUID

XML attribute

4.2.3.4.4

homeCommunityId

A globally unique identifier for a community.

OID URN

XML attribute

4.2.3.4.5

lastUpdateTime

Most recent point in time that the Folder has been
modified.

DTM

ebRIM Slot

4.2.3.4.6

limitedMetadata

A flag that the associated Folder was created using
the less rigorous metadata requirements as definedfor the Metadata-Limited

4.2.3.4.10

ebRIM
Classification

4.2.3.4.1
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Folder Metadata
Attribute

Description

Form

Coding

Detail(See
Section)patientId

Represents the primary subject of care of the
Folder.

CX

ebRIM
ExternalIdentifi
er

4.2.3.4.7

title

The title of the Folder.

StringebRIM Name

4.2.3.4.8

uniqueId

Globally unique identifier for the Folder.

OID

ebRIM
ExternalIdentifi
er

4.2.3.4.9

4.2.3.4.1 Folder.availabilityStatus
2455

Description:
Represents the status of the Folder. Since the deprecation of Folders is not allowed, this value
shall always be Approved.
Coding:2460

Max length is unbounded. The availabilityStatus value shall beurn:oasis:names:tc:ebxml-regrep:StatusType:Approved.

The example below shows the status attribute; however, this attribute is only returned on query,
not set during any transaction.
2465<rim:RegistryPackage
id="urn:uuid:fbeacdb7-5421-4474-9267-985007cd8855"
status="urn:oasis:names:tc:ebxml-regrep:StatusType:Approved"> ...

4.2.3.4.2 Folder.codeList
2470

Description:
Shall contain the set of codes specifying the type of clinical activity that resulted in placing
DocumentEntry objects in this Folder. These values shall be drawn from a vocabulary or coding
scheme defined by the creating entity.
Coding:

2475

2480

Coded as an ebRIM classification. See Section 4.2.3.1.2 for a description of coding an ebRIM
Classification. Shall have zero or more values. Code multiple values by creating multiple
classification objects.
The following example specifies contentTypeCode="ExamplecontentTypeCode" with display
name "ExamplecodeList CodeDisplayName" and coding scheme "Example coding scheme" forthe Folder labeled "ExampleFolder".
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2485

2490

2495

<rim:Classification
classificationScheme= "urn:uuid:1ba97051-7806-41a8-a48b-8fce7af683c5"
classifiedObject="ExampleFolder"
id="IdExample_062"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"
nodeRepresentation="Examplecode"><rim:Name><rim:LocalizedStringvalue="ExamplecodeList CodeDisplayName" /></rim:Name><rim:Slot name="codingScheme"><rim:ValueList><rim:Value>Example coding scheme</rim:Value></rim:ValueList></rim:Slot></rim:Classification>

2500
4.2.3.4.3 Folder.comments
Description:
Comments associated with the Folder. Free form text or IHE profile-specified usage.
2505

Note: Prior to the availability of the Folder.title attribute, the comments attribute might have been used to hold the title ofthe folder (folder name). With the addition of the title attribute, the comments attribute shall not hold the folder
name.

Coding:
The format of Folder.comments is any string. Max length is unbounded.
2510

The value of the comments attribute is coded in XML as the "value" attribute of the
LocalizedString element within the ebRIM Description structure. There can be at most one
ebRIM Description structure per DocumentEntry.
The following example shows a comment for the Folder.

2515<rim:Description><rim:LocalizedString value = "comments"/></rim:Description>___________________________________________________________________________
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4.2.3.4.4 Folder.entryUUID
Description:
2520

This globally unique identifier is primarily intended for use as a document registry management
identifier. It is not meant to be an external reference (e.g., outside of the Document Registry) for
documents (e.g., in links within other documents).
Coding:2525

Max length is unbounded. The format of the entryUUID value is UUID. Certain Document
Sharing transactions may allow symbolic Ids (anything that does not have the urn:uuid: prefix) tobe used.
The value of the entryUUID is coded in the id XML attribute on the ExtrinsicObject representing
the DocumentEntry. In the example below, the entryUUID is
urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a9ab6

2530

2535

<rim:RegistryPackage
id="urn:uuid:a6e06ca8-0c75-4064-9e5c-88b9045a9ab6"> ...

4.2.3.4.5 Folder.homeCommunityId
Description:
A globally unique identifier for a community.
Coding:2540

Max length is unbounded. The ebRS RegistryPackage home attribute for the RegistryPackagethat corresponds to the Folder. It is an OID URN (see Table 4.2.3.1.7-2).
See ITI TF-2a: 3.18.4.1.2.3.8 and ITI TF-2b: 3.38.4.1.2.1.

2545<rim:RegistryPackage home="urn:oid:1.2.3" ...>...
</rim:RegistryPackage>

4.2.3.4.6 Folder.lastUpdateTime
Description:
2550

Most recent point in time that the Folder has been modified by changing which DocumentEntry
objects are associated with the Folder, or by changing the Folder’s metadata attributes. If the
Folder has not been modified since creation, the lastUpdateTime contains the creation time.
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Coding:Max length is 256 characters. The format of the lastUpdateTime value is DTM and shall have atleast “second” precision. See Table 4.2.3.1.7-2 for a description of DTM format.
2555

The value is coded as a single value within an ebRIM Slot Attribute in the DocumentEntry.
The following example shows a last update of December 25, 2004 21:20:10 Coordinated
Universal Time (UTC).

2560

2565

<rim:Slot name="lastUpdateTime"><rim:ValueList><rim:Value>20041225212010</rim:Value></rim:ValueList></rim:Slot>

4.2.3.4.7 Folder.patientId
Description:
The patientId represents the primary subject of care of the Folder.
The value of the patientId shall be the same for all new documents of a SubmissionSet. All
DocumentEntries placed in a Folder shall have the same patiendId as the Folder.

2570

Coding:Max length unbounded. The format of the patientId value is CX (see Table 4.2.3.1.7-2).
It shall contain two parts:

2575

•

Assigning Authority Domain Id (organization that issued the Id).

•

An Id from the Assigning Authority.

No other values are allowed, as specified for the CX type in Table 4.2.3.1.7-2 above. Using HL7
terminology, no other values are allowed in the components of the coded value, nor are further
subcomponents allowed.

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2580

2585

<rim:ExternalIdentifier
identificationScheme="urn:uuid:f64ffdf0-4b97-4e06-b79f-a52b38ec2f8a"
value="6578946^^^&amp;1.3.6.1.4.1.21367.2005.3.7&amp;ISO"
id="IdExample_057"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"><rim:Name><rim:LocalizedString value = "XDSFolder.patientId"/></rim:Name></rim:ExternalIdentifier>2590
4.2.3.4.8 Folder.title
Description:
Shall contain the title of the Folder.
2595

Note: Prior to the availability of this attribute, the comments attribute might have been used to hold the title of the folder.
With the addition of this attribute, the comments attribute shall not hold the folder title.

Coding:Max length is 256 characters. Encoded in the name element within the ebRS ExtrinsicObject forthe document (see ebRS Schema RIM.XSD). Shall have only a single value.
In this example the title is “title”.
2600

2605

<Name><LocalizedString value="title"/></Name>4.2.3.4.9 Folder.uniqueId
Description:
Globally unique identifier for the folder instance assigned by the creating entity.
Coding:2610

Max length is 256 characters. Encoded as the ExternalIdentifier. See Section 4.2.3.1.3 for a
description of coding an ebRIM ExternalIdentifier. Shall have only a single value. Shall be of
OID format.

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2615

2620

2625

<rim:ExternalIdentifier
identificationScheme="urn:uuid:75df8f67-9973-4fbe-a900-df66cefecc5a"
id="IdExample_059"
objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:ExternalIdentifier"value="1.3.6.1.4.1.21367.2005.3.7.3670984664"
registryObject="Folder01"><rim:Name><rim:LocalizedString value = "XDSFolder.uniqueId"/></rim:Name></rim:ExternalIdentifier>4.2.3.4.10

Folder.limitedMetadata

Description:
Indicates whether the Folder was created using the less rigorous requirements of metadata as
defined for the Metadata-Limited Document Source Actor.
Coding:
2630

The Folder is flagged using an ebRIM Classification with a classificationNode of
urn:uuid:2c144a76-29a9-4b7c-af54-b25409fe7d03. Zero or one may be present.
The following example marks the “Folder” Folder as created via the less rigorous metadata
requirements.

2635<RegistryPackage id="Folder">
(…)

2640

<Classification classifiedObject=”Folder”
classificationNode=”urn:uuid:d9d542f3-6cc4-48b6-8870-ea235fbc94c2”
id=”ID_061" objectType="urn:oasis:names:tc:ebxmlregrep:ObjectType:RegistryObject:Classification"/>

2645<Classification classifiedObject="Folder"classificationNode="urn:uuid:2c144a76-29a9-4b7c-af54-b25409fe7d03"/>(…)</RegistryPackage>

4.2.4 Success and Error Reporting
2650

The ebXML RegistryResponse (for submission transactions) or ebXML AdhocQueryResponse(for query transactions) element will contain the status of the requested operation. The status
attribute reflects the status of the operation and shall be one of the following values:___________________________________________________________________________
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2655

urn:oasis:names:tc:ebxml-regrep:ResponseStatusType:Success
urn:oasis:names:tc:ebxml-regrep:ResponseStatusType:Failure
urn:ihe:iti:2007:ResponseStatusType:PartialSuccessA response to a Submission Request that indicates success with no warnings is:<rs:RegistryResponse
status="urn:oasis:names:tc:ebxml-regrep:ResponseStatusType:Success"/>

2660
A response to a query request that indicates success with no warnings and no documents found
is:
2665

2670

<query:AdhocQueryResponse
status="urn:oasis:names:tc:ebxml-regrep:ResponseStatusType:Success"><rim:RegistryObjectList/></query:AdhocQueryResponse >If the transaction resulted in warnings or errors, the ebXML RegistryResponse or ebXML
AdhocQueryResponse shall contain an ebXML RegistryErrorList, which shall containcorresponding RegistryError elements.
The highestSeverity attribute may be present in a RegistryErrorList. If present, it shall containthe severity of the most severe of the RegistryErrors in the RegistryErrorList. See Section 4.2.4.2
for more details.

2675

4.2.4.1

RegistryError Element

Registry Services schema (ebRS 3.0) defines the RegistryError element for reporting details oferrors or warnings.
The RegistryError element contains the attributes in Table 4.2.4.1-1.
2680

All IHE transactions that carry the RegistryError element shall return these attributes with eacherror reported.
The body of all RegistryError elements shall be empty.
Table 4.2.4.1-1: RegistryError Element Attributes
Attribute

Optionality

ValueerrorCodeR

Shall be taken from Table 4.2.4.1-2 when one of those codes isappropriate. All extensions to the list of error codes shall be unique.

codeContext

R

Supplies additional detail for the errorCode___________________________________________________________________________
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Attribute

Optionality

severityR

locationO

Value
Indicates the severity of the error. Shall be one of:oasis:names:tc:ebxmlregrep:ErrorSeverityType:Error
urn:oasis:names:tc:ebxmlregrep:ErrorSeverityType:Warning

Supplies the location of the error module name and line number orstack trace if appropriate.

An example response to a Submission Request that reports two errors and one warning is:
2685

2690

2695

2700

2705

<rs:RegistryResponse
status="urn:oasis:names:tc:ebxml-regrep:ResponseStatusType:Failure"><rs:RegistryErrorList
highestSeverity="urn:oasis:names:tc:ebxmlregrep:ErrorSeverityType:Error"><rs:RegistryError
errorCode="XDSPatientIdDoesNotMatch"
codeContext="Patient Id in Document (Document1) does not match
SubmissionSet"
location=""severity="urn:oasis:names:tc:ebxml-regrep:ErrorSeverityType:Error"/><rs:RegistryError
errorCode="XDSRegistryMetadataError"
codeContext="RegistryPackage (SubmissionSet) is not labeled as
SubmissionSet or Folder"
location=""severity="urn:oasis:names:tc:ebxml-regrep:ErrorSeverityType:Error"/><rs:RegistryError
errorCode="XDSExtraMetadataNotSaved"
codeContext="Extra Metadata – localinfo – not saved"
location=""severity="urn:oasis:names:tc:ebxmlregrep:ErrorSeverityType:Warning"/></rs:RegistryErrorList></rs:RegistryResponse>2710
An example response to a query request that reports two errors is:___________________________________________________________________________
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2715

2720

2725

2730

<query:AdhocQueryResponse
status="urn:oasis:names:tc:ebxml-regrep:ResponseStatusType:Failure"><rs:RegistryErrorList
highestSeverity="urn:oasis:names:tc:ebxmlregrep:ErrorSeverityType:Error"><rs:RegistryError
errorCode="XDSStoredQueryMissingParam"
codeContext="Required parameter $XDSDocumentEntryStatus is missing"location=""severity="urn:oasis:names:tc:ebxml-regrep:ErrorSeverityType:Error"/><rs:RegistryError
errorCode="XDSStoredQueryParamNumber"codeContext="$XDSDocumentEntryServiceStartTimeFrom contains multiple
entries and is restricted to a single entry"
location=""severity="urn:oasis:names:tc:ebxml-regrep:ErrorSeverityType:Error"/></rs:RegistryErrorList></query:AdhocQueryResponse >Table 4.2.4.2-1 through Table 4.2.4.2-4 control the reporting of errors for transactions that use
the Document Sharing metadata attributes.
Table 4.2.4.1-2: Error Codes (previously Table 4.1-11)
Error Code 3

Discussion

Transaction(See Note 1)

DocumentQueued

An XDR Recipient queued the document for future
manual matching to a patientP

InvalidDocumentContent

The recipient has rejected this submission because it
detected that one of the documents does not matchthe metadata (e.g., formatCode) or has failed otherrequirements for the document content.

P

When the RegistryError element contains this error
code, the @codeContext shall contain theDocumentUniqueID of the document in error.
If multiple documents are in error, there shall be a
separate RegistryError element for each document
in error.
PartialAppendContentNotProcessed

An XDR Document Recipient did not process somepart of the content. Specifically the parts notprocessed are Append semantics

P

PartialFolderContentNotProcessed

An XDR Document Recipient did not process somepart of the content. Specifically the parts notprocessed are Folder semantics

P

The ‘XDS Metadata Update’ and ‘Remove Metadata and Documents’ Trial Implementation Supplements add error
codes to this table.

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Error Code 3

Discussion

Transaction(See Note 1)

PartialReplaceContentNotProcessed

An XDR Document Recipient did not process somepart of the content. Specifically the parts notprocessed are Replacement semantics

P

PartialTransformNotProcessed

An XDR Document Recipient did not process somepart of the content. Specifically the parts notprocessed are Transform semantics

P

PartialTransformReplaceNotProcessed

An XDR Document Recipient did not process somepart of the content. Specifically the parts notprocessed are Transform and Replace semantics

P

UnresolvedReferenceException

The recipient cannot resolve an entryUUID
reference in the transaction.

P, R

XDSDocumentUniqueIdError

The document associated with the uniqueId is notavailable. This could be because the document is
not available, the requestor is not authorized toaccess that document or the document is no longer
available.

RS, XGRXDSDuplicateUniqueIdInRegistry

UniqueId received was not unique. UniqueId could
have been attached to SubmissionSet or Folder.
codeContext shall indicate which and the value ofthe non-unique uniqueId. This error cannot be
thrown for DocumentEntry. See
XDSNonIdenticalHash and XDSNonIdenticalSize.

P, R

XDSExtraMetadataNotSaved

This warning is returned if extra metadata waspresent but not saved.

P, R

XDSMissingDocument

DocumentEntry exists in metadata with nocorresponding attached documentP

XDSMissingDocumentMetadata

MIME package contains MIME part with ContentId header not found in metadataP

XDSMissingHomeCommunityId

A value for the homeCommunityId is required andhas not been specified

SQ, XGQ, RS, XGR

XDSNonIdenticalHash

Document being registered was a duplicate(uniqueId already in Document Registry) but hashdoes not match. codeContext indicates UniqueId.

R

XDSNonIdenticalSize

Document being registered was a duplicate(uniqueId already in Document Registry) but size
does not match. CodeContext indicates UniqueId.

R

XDSPatientIdDoesNotMatch

This error is thrown when the patient Id is required
to match and does not. The codeContext shallindicate the value of the Patient Id and the nature of
the conflict.

P, R

XDSRegistryBusy
XDSRepositoryBusy

Too much activity

P, R, SQ, XGQ
P, RS, XGR

XDSRegistryDeprecatedDocumentError

The transaction was rejected because it submitted
an Association referencing a deprecated document.

P, R

XDSRegistryDuplicateUniqueIdInMessage
XDSRepositoryDuplicateUniqueIdInMessage

A UniqueId value was found to be used more thanonce within the submission. Error code indicateswhere error was detected. codeContext shallindicate the duplicate UniqueId.

P, R___________________________________________________________________________
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Error Code 32735

Discussion

Transaction(See Note 1)

XDSRegistryError
XDSRepositoryError

Internal Error
The error codes XDSRegistryError or
XDSRepositoryError shall be returned if and only if
a more detailed code is not available from this table
for the condition being reported.
If one of these error codes is returned, the attributecodeContext shall contain details of the error
condition that may be implementation-specific.

P, R, SQ, XGQ
P, RS, XGR

XDSRegistryMetadataError
XDSRepositoryMetadataError

Error detected in metadata. Actor name indicateswhere error was detected. (Document Recipient
uses Repository error). codeContext indicates natureof problem.

P, R

XDSRegistryNotAvailable

Repository was unable to access the RegistryP

XDSRegistryOutOfResources
XDSRepositoryOutOfResources

Resources are low.

P, R, SQ, XGQ
P, RS, XGR

XDSReplaceFailed
Note: This error code is deprecated. See ITI
TF-2b: 3.42.4.1.3.5.

Error detected by the Document Registry during a
document replacement.

P, R

XDSResultNotSinglePatientThis error signals that a single request would havereturned content for multiple Patient Ids

SQ, RS, XGQ, XGR

XDSStoredQueryMissingParamA required parameter to a stored query is missing.

SQ, XGQXDSStoredQueryParamNumber

A parameter which only accepts a single value iscoded with multiple values

SQ, XGQ

XDSTooManyResults

Query resulted in too many results.

SQ, XGQXDSUnavailableCommunity

A community which would have been contacted
was not available. See Note 2.

SQ, RSXDSUnknownCommunity

A value for the homeCommunityId is notrecognized

SQ, XGQ, RS, XGR

XDSUnknownPatientId

Patient Id referenced in metadata is not known by
the receiving actor. The codeContext shall include
the value of patient Id in question.

P, R, XGQ
Note: this error code
is not used in the
response to Registry
Stored Query [IIT18]

XDSUnknownRepositoryId

The repositoryUniqueId value could not be resolved
to a valid document repository or the value does notmatch the repositoryUniqueId.

RS, XGRXDSUnknownStoredQueryThe Query Id provided in the request is notrecognized.

SQ, XGQ

Note 1:
P = Provide and Register-b
R = Register-b
SQ = Stored Query
RS = Retrieve Document Set

2740

XGQ = Cross Gateway Query___________________________________________________________________________
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Note 2:
Two examples of the use of error code XDSUnavailableCommunity are:2745

A Cross Gateway Query or Cross Gateway Retrieve fails because the community identified by a homeCommunityId could
not be contacted.
A Cross Gateway Query based on Patient ID could not contact some known communities to relay the query.
The error would be generated by the Initiating Gateway and returned in the Registry Stored Query or Retrieve Document
Set. This would only apply when XDS Affinity Domain Option was used.

4.2.4.2
2750

Error responses

The following tables explain the meaning of the status attribute in RegistryResponse andAdhocQueryResponse. Tables 4.2.4.2-1, 4.2.4.2-2, 4.2.4.2-3 and 4.2.4.2-4 below indicate
whether the RegistryErrorList element shall be present and what other content shall be part of the
response.
Table 4.2.4.2-1: [ITI-41] Provide and Register Document Set-b Responses

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RegistryResponse status

RegistryErrorList element

Resulturn:oasis:names:tc:ebxmlregrep:ResponseStatusType:Success

May be present. If present willcontain one or more RegistryError
elements with warning severity, none
with error severity.

All metadata defined in this volume, anddocuments were successfully registered.
Extra metadata may or may not be saved,
based on the presence of the
XDSExtraMetadataNotSaved warning.

urn:oasis:names:tc:ebxmlregrep:ResponseStatusType:
FailurePresent, contains one or more
RegistryError elements. At least one
has error severity others may havewarning severity.

Metadata and documents not stored

Table 4.2.4.2-2: [ITI-42] Register Document Set-b Responses
RegistryResponse status

RegistryErrorList element

Resulturn:oasis:names:tc:ebxmlregrep:ResponseStatusType:Success

May be present. If present willcontain one or more RegistryError
elements with warning severity, none
with error severity

All metadata defined in this volume was
successfully registered Extra metadata
may or may not be saved, based on thepresence of the
XDSExtraMetadataNotSaved warning.

urn:oasis:names:tc:ebxmlregrep:ResponseStatusType:
FailurePresent, contains one or more
RegistryError elements. At least one
has error severity, others may havewarning severity.

Metadata not stored___________________________________________________________________________
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Table 4.2.4.2-3: [ITI-18] Stored Query and [ITI-38] Cross Gateway Query Responses
AdhocQueryResponse status

RegistryErrorList element

Resulturn:oasis:names:tc:ebxmlregrep:ResponseStatusType:SuccessMay be present. If present willcontain one or more RegistryError
elements with warning severity; none
with error severity

Results shall be returned.
Results may contain zeroor more entries.

urn:ihe:iti:2007:ResponseStatusType:PartialSuccess

Present, contains one or more
RegistryError elements. At least one
has error severity; others may havewarning severity.

Results shall be returned.
Results may contain zeroor more entries.

urn:oasis:names:tc:ebxmlregrep:ResponseStatusType:Failure

Present, contains one or more
RegistryError elements. At least one
has error severity; others may havewarning severity.

Results not returned

Table 4.2.4.2-4: [ITI-43] Retrieve Document Set and [ITI-39] Cross Gateway Retrieve
Responses
Registry Response status

RegistryErrorList element

Resulturn:oasis:names:tc:ebxmlregrep:ResponseStatusType:SuccessMay be present. If present willcontain one or more RegistryError
elements with warning severity; none
with error severity

All documents weresuccessfully retrieved

urn:ihe:iti:2007:ResponseStatusType:PartialSuccess

Present, contains one or more
RegistryError elements. At least one
has error severity; others may havewarning severity.

Some documents weresuccessfully retrieved

urn:oasis:names:tc:ebxmlregrep:ResponseStatusType:Failure

Present, contains one or more
RegistryError elements. At least one
has error severity; others may havewarning severity.

No documents weresuccessfully retrieved

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4.2.5 Metadata Vocabulary
The UUIDs in the following tables shall be used in constructing and interpreting Document
Sharing metadata.
4.2.5.1

Submission Set Object UUIDs
UUID

Use/meaning

urn:uuid:a54d6aa5-d40d-43f9-88c5-b4633d873bdd

SubmissionSet ClassificationNode

urn:uuid:aa543740-bdda-424e-8c96-df4873be8500

contentTypeCode External
Classification Scheme

urn:uuid:6b5aea1a-874d-4603-a4bc-96a0a7b38446

patientId External Identifier

urn:uuid:a7058bb9-b4e4-4307-ba5b-e3f0ab85e12d

author External Classification Scheme___________________________________________________________________________
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Use/meaning

urn:uuid:554ac39e-e3fe-47fe-b233-965d2a147832
urn:uuid:96fdda7c-d067-4183-912e-bf5ee74998a8

sourceId External Identifier
uniqueId External Identifier

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4.2.5.2

Document Entry Object
UUID

Use/meaning

urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1

DocumentEntry objectType for Stable
Document Entries

urn:uuid:34268e47-fdf5-41a6-ba33-82133c465248

DocumentEntry objectType for On
Demand Document Entries

urn:uuid:93606bcf-9494-43ec-9b4e-a7748d1a838d

author External Classification Scheme

urn:uuid:41a5887f-8865-4c09-adf7-e362475b143aclassCode External Classification
Schemeurn:uuid:f4f85eac-e6cb-4883-b524-f2705394840f

confidentialityCode External
Classification Scheme

urn:uuid:2c6b8cb7-8b2a-4051-b291-b1ae6a575ef4

eventCodeList External Classification
Schemeurn:uuid:a09d5840-386c-46f2-b5ad-9c3699a4309d

formatCode External Classification
Schemeurn:uuid:f33fb8ac-18af-42cc-ae0e-ed0b0bdb91e1

healthCareFacilityTypeCode External
Classification Scheme

urn:uuid:58a6f841-87b3-4a3e-92fd-a8ffeff98427

patientId ExternalIdentifier

urn:uuid:cccf5598-8b07-4b77-a05e-ae952c785ead

practiceSettingCode External
Classification Scheme

urn:uuid:f0306f51-975f-434e-a61c-c59651d33983

typeCode External Classification
Schemeurn:uuid:2e82c1f6-a085-4c72-9da3-8640a32e42ab

uniqueId ExternalIdentifier

4.2.5.3

Folder Object
UUID

Use/meaning

urn:uuid:d9d542f3-6cc4-48b6-8870-ea235fbc94c2

Folder ClassificationNode

urn:uuid:f64ffdf0-4b97-4e06-b79f-a52b38ec2f8apatientId External Identifier

urn:uuid:1ba97051-7806-41a8-a48b-8fce7af683c5

codeList External Classification Scheme

urn:uuid:75df8f67-9973-4fbe-a900-df66cefecc5a

uniqueId External Identifier

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4.2.5.4

Association Object
UUID

Use/meaning

urn:uuid:abd807a3-4432-4053-87b4-fd82c643d1f3

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Association Documentation
ClassificationNode

4.3 Additional Document Sharing Requirements
This section includes profile specific requirements.
4.3.1 Submission Metadata Attribute Optionality
This section lists which metadata attributes an actor shall provide when initiating a Submission
Type Transaction.

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The Actor/Transaction pairs addressed by this section are as follows:
Table 4.3.1-1: Sending Actor/Transaction Pairs
Actor

Transaction

ShortnameXDS Document Source

ITI-41 Provide and Register Document Set-b

XDS DSXDS Document Repository

ITI-42 Register Document Set-b

XDS DRXDM Portable Media Creator

ITI-32 Distribute Document Set on MediaXDM MCXDR Document Source

ITI-41 Provide and Register Document Set-b

XDR DSXDR Metadata-Limited Document Source

ITI-41 Provide and Register Document Set-b

XDR MSXDS On-Demand Document Source

ITI-61 Register On-Demand Document Entry

XDS ODFor each actor/transaction pair across the top of Table 4.3.1-3, and each metadata attribute row,
the cell indicates the requirement for that actor when creating a submission request using thepaired transaction. The requirements are expressed through these codes:
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Table 4.3.1-2: Sending Actor Metadata Attribute Optionality Code Definitions
Code

MeaningR

Required – A value for the attribute shall be supplied by the sending actor when sending thesubmission

R2

Required if Known – A value for the attribute shall be supplied by the sending actor whensending the submission unless the actor does not have any value for the attribute

O

Optional – The sending actor may or may not supply a value for this attribute

X

Prohibited – when sending a submission, a value for the attribute shall not be supplied by
the sending actor.

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Table 4.3.1-3: Sending Actor Metadata Attribute Optionality
Metadata
Element

Metadata Attribute

XDS
DS

XDS
DR

XDM
MC

XDR
DS

XDR
MS

XDS
OD

DocumentEntry

author

R2

R2

R2

R2

R2

R2

DocumentEntry

availabilityStatus

O

O

O

O

O

O

DocumentEntry

classCode

R

R

R2

R

R2

R

DocumentEntry

comments

O

O

O

O

O

O

DocumentEntry

confidentialityCode

R

R

R2

R

R2

R

DocumentEntry

creationTime

R

R

R2

R

R2

X

DocumentEntry

entryUUID

R

R

R

R

R

R

DocumentEntry

eventCodeList

O

O

O

O

O

O

DocumentEntry

formatCode

R

R

R2

R

R2

R

DocumentEntry

hash

O

R

R

O

O

X

DocumentEntry

healthcareFacility
TypeCode

R

R

R2

R

DocumentEntry

homeCommunityId

O

O

O

O

O

O

DocumentEntry

languageCode

R

R

R2

R

R2

R

DocumentEntry

legalAuthenticator

O

O

O

O

O

O

DocumentEntry

limitedMetadata

X

X

O

X

R

X

DocumentEntry

mimeType

R

R

R

R

R

R

DocumentEntry

objectType

R

R

R

R

R

R

DocumentEntry

patientId

R

R

R2

R

R2

R

DocumentEntry

practiceSettingCode

R

R

R2

R

R2

R

DocumentEntryreferenceIdList

O

O

O

O

O

O

DocumentEntry

repositoryUniqueId

O

R

O

O

O

R

DocumentEntry

serviceStartTime

R2

R2

R2

R2

R2

O

DocumentEntry

serviceStopTime

R2

R2

R2

R2

R2

O

DocumentEntry

size

O

R

R

O

O

X

DocumentEntry

sourcePatientId

R

R

R2

R

R2

R

R2

R

DocumentEntry

sourcePatientInfo

O

O

R2

O

R2

O

DocumentEntry

title

O

O

O

O

O

O

DocumentEntry

typeCode

R

R

R2

R

R2

R

DocumentEntry

uniqueId

R

R

R

R

R

R

DocumentEntry

URI

O

O

R

O

O

O

SubmissionSet

author

R2

R2

R2

R2

R2

R2

SubmissionSet

availabilityStatus

O

O

O

O

O

O

SubmissionSet

comments

O

O

O

O

O

O

SubmissionSet

contentTypeCode

R

R

R2

R

R2

R

SubmissionSet

entryUUID

R

R

R

R

R

R

SubmissionSet

homeCommunityId

O

O

O

O

O

O

SubmissionSet

intendedRecipient

O

O

R2

R2

R2

O

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Metadata
Element

Metadata Attribute

XDS
DS

XDS
DR

XDM
MC

XDR
DS

XDR
MS

XDS
OD

SubmissionSet

limitedMetadata

X

X

O

X

R

X

SubmissionSet

patientId

R

R

R2

R

R2

R

SubmissionSet

sourceId

R

R

R

R

R

R

SubmissionSet

submissionTime

R

R

R

R

R

R

SubmissionSet

title

O

O

O

O

O

O

SubmissionSet

uniqueId

R

R

R

R

R

R

FolderavailabilityStatus

O

O

O

O

O

O

FoldercodeList

R

R

R2

R

R2

R

Foldercomments

O

O

O

O

O

O

FolderentryUUID

R

R

R

R

R

R

FolderhomeCommunityId

O

O

O

O

O

O

FolderlastUpdateTime

O

O

O

O

O

O

FolderlimitedMetadata

X

X

O

X

R

X

FolderpatientId

R

R

R2

R

R2

R

Folder

title

R

R

O

R

O

R

FolderuniqueId

R

R

R

R

R

R

4.3.2 Requirements on Query Type Transactions
4.3.2.1
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Query Type Metadata Attribute Optionality

This section lists which attributes shall contain content in a response to a query transaction. The
query transactions covered in Table 4.3.2.1-1. The content of the query request can be foundwithin the referenced transaction.
Table 4.3.2.1-1: Responding Actor/Transaction Pairs
Actor

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Transaction

ShortnameXDS Document RegistryITI-18 Registry Stored QueryXDS DRXCA Initiating Gateway

ITI-18 Registry Stored Query

XCA IGXCA Responding Gateway

ITI-38 Cross-Gateway Query

XCA RGMPQ Document RegistryITI-51 Multi-Patient Stored QueryMPQ DRFor each actor/transaction pair across the top of the table, and each metadata attribute row, thecells indicates the requirement for that actor when creating a query response to the paired
transaction. The requirements are expressed through these codes:
Table 4.3.2.1-2: Responding Actor Metadata Attribute Optionality Code Definitions
Code
R

Meaning
Required – A value for the attribute shall be supplied by the responding actor when
responding to a query___________________________________________________________________________
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Code

Meaning

R2

Required if Known – A value for the attribute shall be supplied by the responding actor
when responding to the query if a value is available to the actor. For the Document
Registry it must supply the value specified in the submission request.

O

Optional – The responding actor may or may not supply a value for this attribute. For theDocument Registry it must supply the value specified in the submission request.

X

Prohibited – When responding to a query, a value for the attribute shall not be supplied by
the responding actor.

R3

Required for Stable DocumentEntries and not allowed for On-Demand DocumentEntries.

Table 4.3.2.1-3: Responding Actor Metadata Attribute Optionality
Metadata
Element

Metadata Attribute

XDS
DR

XCA
IG

XCA
RG

MPQ
DR

DocumentEntry

author

R2

R2

R2

R2

DocumentEntry

availabilityStatus

R

R

R

R

DocumentEntry

classCode

R

R

R

R

DocumentEntry

comments

O

O

O

O

DocumentEntry

confidentialityCode

R

R

R

R

DocumentEntry

creationTime

R3

R3

R3

R3

DocumentEntry

entryUUID

R

R

R

R

DocumentEntry

eventCodeList

O

O

O

O

DocumentEntry

formatCode

R

R

R

R

DocumentEntry

hash

R3

R3

R3

R3

DocumentEntry

healthcareFacility
TypeCode

R

R

R

R

DocumentEntry

homeCommunityId

O

R

R

O

DocumentEntry

languageCode

R

R

R

R

DocumentEntry

legalAuthenticator

O

O

O

O

DocumentEntry

limitedMetadata

X

X

X

X

DocumentEntry

mimeType

R

R

R

R

DocumentEntry

objectType

R

R

R

R

DocumentEntry

patientId

R

R

R

R

DocumentEntry

practiceSettingCode

R

R

R

R

DocumentEntryreferenceIdList

O

O

O

O

DocumentEntry

repositoryUniqueId

R

R

R

R

DocumentEntry

serviceStartTime

R2

R2

R2

R2

DocumentEntry

serviceStopTime

R2

R2

R2

R2

DocumentEntry

size

R3

R3

R3

R3

DocumentEntry

sourcePatientId

R

R

R

R

DocumentEntry

sourcePatientInfo

O

O

O

O

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Metadata
Element

Metadata Attribute

XDS
DR

XCA
IG

XCA
RG

MPQ
DR

DocumentEntry

title

O

O

O

O

DocumentEntry

typeCode

R

R

R

R

DocumentEntry

uniqueId

R

R

R

R

DocumentEntry

URI

O

O

O

O

SubmissionSet

author

R2

R2

R2

R2

SubmissionSet

availabilityStatus

R

R

R

R

SubmissionSet

comments

O

O

O

O

SubmissionSet

contentTypeCode

R

R

R

R

SubmissionSet

entryUUID

R

R

R

R

SubmissionSet

homeCommunityId

O

R

R

O

SubmissionSet

intendedRecipient

O

O

O

O

SubmissionSet

limitedMetadata

X

X

X

X

SubmissionSet

patientId

R

R

R

R

SubmissionSet

sourceId

R

R

R

R

SubmissionSet

submissionTime

R

R

R

R

SubmissionSet

title

O

O

O

O

SubmissionSet

uniqueId

R

R

R

R

FolderavailabilityStatus

R

R

R

R

FoldercodeList

R

R

R

R

Foldercomments

O

O

O

O

FolderentryUUID

R

R

R

R

FolderhomeCommunityId

O

R

R

O

FolderlastUpdateTime

O

O

O

O

FolderlimitedMetadata

X

X

X

X

FolderpatientId

R

R

R

R

Folder

title

R

R

R

R

FolderuniqueId

R

R

R

R

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5.0 IHE Content Specifications
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This section follows the documentation pattern found in the IHE PCC Technical Framework.
The reader should be familiar with the IHE PCC Technical Framework.

5.1 Basic Patient Privacy Consents ModuleThis section describes the encoding requirements for the Basic Patient Privacy Consents
Document Content.
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The BPPC document has two possible document templates, one without a scanned document
part, and one in Section 5.1.2 defines the requirements of the BPPC document without a scanned
document part; Section 5.1.3 explains with a scanned document part.
5.1.1 References
•

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HL7 CDA Release 2.0 (denoted HL7 CDA R2, or just CDA, in subsequent text)

5.1.2 Patient Privacy Consent Acknowledgment Document Specification
1.3.6.1.4.1.19376.1.5.3.1.1.7 – With no Scanned Document Part
A patient acknowledgement of a Patient Privacy Consent Policy is a document that contains
machine readable indication. This specification describes the BPPC document without a scanned
part. When the Patient Privacy Consent Acknowledgment Document contains a Scanned
Document (XDS-SD), it will conform to Section 5.1.3.
5.1.2.1 XDS Metadata
5.1.2.1.1 XDS DocumentEntry Metadata
BPPC leverages the XDS DocumentEntry Metadata requirements in PCC TF-2: 4.1.1 unlessotherwise specified below.

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5.1.2.1.1.1 XDSDocumentEntry.classCode
The LOINC code for these documents is “57016-8” “Privacy Policy Acknowledgement
Document” and the codeSystem is 2.16.840.1.113883.6.1.
For backward compatibility historic documents may be registered with:

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•

classCode -- This attributes may have been set to the value "Consent".

•

classCodeDisplayName -- This attributes may have been set to the value "Consent".

5.1.2.1.1.2 XDSDocumentEntry.eventCodeList•

eventCodeList -- the eventCodeList shall be populated using the Patient Privacy Policy
Identifiers that have been acknowledged to within the document.

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•

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•

eventCodeDisplayNameList -- The eventCodeDisplayNameList shall be populated using
the display names for those policies.
•

2835/ClinicalDocument/documentationOf/serviceEvent[templateId/@root='1.3.6.1.4.1.193
76.1.5.3.1.2.6']/code/@code/ClinicalDocument/documentationOf/serviceEvent[templateId/@root='1.3.6.1.4.1.193
76.1.5.3.1.2.6']/code/@displayName

5.1.2.1.1.3 XDSDocumentEntry.formatCode
The XDSDocumentEntry format code for this content shall be urn:ihe:iti:bppc:2007. The
formatCode codeSystem shall be 1.3.6.1.4.1.19376.1.2.3.
5.1.2.1.1.4 XDSDocumentEntry.uniqueId

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This value shall be the ClinicalDocument/id in the HL7 CDA R2 header. The root attribute isrequired, and the extension attribute is optional. The total length is limited to 256 characters.
Additionally see PCC TF-2: 4.1.1, for further content specification.
5.1.2.1.2 XDS SubmissionSet Metadata
No additional constraints. For more information, see PCC TF-2: 4.1.2
5.1.2.1.3 XDS Folder Metadata

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No additional requirements. For more information, see PCC TF-2: 4.1.3
5.1.2.2 Specification

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CDA Release 2.0 documents that conform to the requirements of this content module shallindicate their conformance by the inclusion of the appropriate <templateId> elements in theheader of the document. This is shown in the sample document below. A CDA Document may
conform to more than one template. This content module inherits from the Medical Document
content module, and so must conform to the requirements of that template as well, thus all<templateId> elements shown in the example below shall be included.

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<ClinicalDocument xmlns='urn:hl7-org:v3'><typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/><templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.1'/><templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.7'/><id root=' ' extension=' '/><code code='57016-8' displayName='PATIENT PRIVACY ACKNOWLEDGEMENT'
codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/><title>Consent to Share Information</title><effectiveTime value='20070619012005'/><confidentialityCode code='N' displayName='Normal'
codeSystem='2.16.840.1.113883.5.25' codeSystemName='Confidentiality' /><languageCode code='en-US'/>:<component><structuredBody></structuredBody></component></ClinicalDocument>

Figure 5.1.2.2-1: Sample Consent to Share Information Document

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A Patient Privacy Acknowledgement Document shall contain a text description of what thepatient consented to, a list of codes indicating the policy(s) agreed to, and a time range indicating
the effective time of the consent. It may be attested to using an electronic digital signature,
conforming to the ITI Digital Signature Profile.
A Patient Privacy Acknowledgement Document shall have one or more <serviceEvent> elementsin the header identifying the policies acknowledged by the document (see Section 4.2.3.4 of
CDA R2). Each <serviceEvent> element indicates an acknowledgement of a Patient Privacy
Policy. More than one policy may be acknowledged to within a given document.

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Data Element Name

Opt

Patient Privacy Acknowledgement Service EventAt least one, and possibly more than one acknowledgement can be provided within the
document.

R

Template ID
1.3.6.1.4.1.19376.1.5.3.1.2.6

5.1.2.2.1 Patient Privacy Acknowledgement Service Events
1.3.6.1.4.1.19376.1.5.3.1.2.6
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Within a Patient Privacy Acknowledgement Document, there shall be a Patient Privacy
Acknowledgement Service Event with the effective time of the consent shall be specified within
the documentationOf/serviceEvent element.

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<documentationOf typeCode='DOC'><serviceEvent classCode='ACT' moodCode='EVN'><templateId root='1.3.6.1.4.1.19376.1.5.3.1.2.6'/><id root='1.2.3.4.5.6'/><code code='9.8.7.6.5.4.3.2.1' displayName='Chicken Costume Consent'
codeSystem='9.8.7.6.5.4.3.2.2' codeSystemName='Silly Policy Land'/><effectiveTime><low value='20101130'/></effectiveTime></serviceEvent></documentationOf>

Figure 5.1.2.2-2: Patient Privacy Acknowledgement Service Events Example

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5.1.2.2.2 <documentationOf typeCode='DOC'>
At least one <documentationOf> element shall exist, describing the service event. This element
shall have a typeCode attribute with the value DOC.
5.1.2.2.3 <serviceEvent classCode='ACT' moodCode='EVN'>2905

One <serviceEvent> shall exist for each Patient Privacy Policy acknowledged. This element shallhave a classCode attribute set to ACT, and a moodCode attribute of EVN.
5.1.2.2.4 <templateId root='1.3.6.1.4.1.19376.1.5.3.1.2.6'/>
The <templateId> element shall be recorded exactly as shown above, and identifies this<serviceEvent> as recording the acknowledgement of a Patient Privacy Policy.
5.1.2.2.5 <id root=' ' />2910

The service event shall have one <id> element, providing an identifier for the service event. The
root attribute of this element shall be present, and shall be a GUID or OID. The extension
attribute shall not be present.
5.1.2.2.6 <code code=' ' displayName=' ' codeSystem=' ' codeSystemName=' '/>

2915

2920

The <code> element shall be present, and shall indicate the Patient Privacy Policy
acknowledged. The code attribute indicates the Patient Privacy Policy Identifier, and thecodeSystem attribute indicates the code system for the Patient Privacy Policy Domain fromwhich this Patient Privacy Policy Identifier is assigned. The displayName attribute may bepresent, and describes the Patient Privacy Policy acknowledgement. The codeSystemName
attribute may be present, and describes the Patient Privacy Policy Domain code system.
5.1.2.2.7 <effectiveTime><low value=' '/><high value=' '/></effectiveTime>The <effectiveTime> element shall be present, and shall indicate the effective time range overwhich acknowledgement is given. The low value must be provided. The high value may bepresent. If present, it shall indicate the maximum effective time of the consent. The___________________________________________________________________________
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effectiveTime must be the same for all ServiceEvents in one Patient Privacy Acknowledgement
Document. If different effectiveTimes are needed then different documents should be generated.
5.1.3 Patient Privacy Consent Acknowledgment Document Specification
1.3.6.1.4.1.19376.1.5.3.1.1.7.1 – With Scanned Document

2930

A patient acknowledgement of a Patient Privacy Consent Policy is a document that contains
machine-readable indication. This section specifies the BPPC document with a scanned
document part.
5.1.3.1 XDS Metadata
The BPPC document shall conform to the requirements in Section 5.1.2.1 with the formatCode
exception listed below
5.1.3.1.1 XDS DocumentEntry Metadata

2935

The BPPC document shall conform to the DocumentEntry Metadata requirements in the IHE
PCC TF-2: 5.1.1.1.1 unless otherwise specified below.
5.1.3.1.1.1 XDSDocumentEntry.formatCode
The XDSDocumentEntry format code for this content is urn:ihe:iti:bppc-sd:2007. The
formatCode codeSystem shall be 1.3.6.1.4.1.19376.1.2.3.

2940

5.1.3.1.2 XDS SubmissionSet Metadata
No additional constraints. For more information, see PCC TF-2: 5.1.1.1.2
5.1.3.1.3 XDS Folder Metadata
No additional requirements. For more information, see PCC TF-2: 5.1.1.1.3
5.1.3.2 Specification

2945

This BPPC document shall conform to the XDS-SD (Section 5.2) specification and shall havethe additional requirements stated in Section 5.1.2.3.
5.1.3.3 Conformance
See Section 5.1.2.2.

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2950

2955

2960

2965

5.2

Scanned Documents Content ModuleThis section outlines the content of the HL7 CDA R2 constraints for the document. We note herethat requirements specified below are to ensure the presence of a minimum amount of wrapper
data in order to enhance description and facilitate sharing of the document. Implementers of thisprofile can and should make use of additional annotation within the CDA header to provide
richer context. The examples in the following sections contain the minimal amount of wrapper
data, as specified, and in many cases do make use of additional CDA header elements forenriched context.
Assumptions and Definitions: We assume that the scanning facility and equipment within it areassigned an OID and that the scanning facility assembles the wrapped scanned content. Moreinformation regarding the construction of OIDs can be found in ITI TF-2x: Appendix B. We
define the following nomenclature for entity roles concerned in forming the wrapper content.
•

Original content – Legacy paper or electronic document intended for wrapping.

•

Scanned content – Scanned or appropriately converted/encoded electronic version of theoriginal content.

•

Original author – Author of the original content.

•(Scanner) Operator – Person assembling the scanned content.

5.2.1 Referenced Standards

2970

•

PDF RFC3778, The application/pdf Media Type (informative)•

PDF/A ISO 19005-1b. Document management - Electronic document file format for
long-term preservation - Part 1: Use of PDF (PDF/A)•

HL7 CDA Release 2.0 (denoted HL7 CDA R2, or just CDA, in subsequent text)•

RFC5646, Tags for the identification of languages

5.2.1.1 Discussion of Content Standards
2975

2980

PDF and plaintext documents intended for wrapping can consist of multiple pages. Encoding ofmultiple page PDF documents are subject to the PDF/A standard. This ISO standard, PDF/A, is asubset of Adobe PDF version 1.4 intended to be suitable for long-term preservation of pageoriented documents. PDF/A attempts to maximize:•

Device independence•

Self-containment•

Self-documentation

The constraints imposed by PDF/A include:•

Audio and video content are forbidden•

JavaScript and executable file launches are prohibited___________________________________________________________________________
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2985

2990

2995

3000

3005

•

All fonts must be embedded and also must be legally embeddable for unlimited, universal
rendering•

Colorspaces specified in a device-independent manner•

Encryption is disallowed (although the enclosing document and transport may provide
encryption external to the PDF content)•

Compression methods are restricted to a standard list

The PDF/A approach has several advantages over TIFF or JPEG. First, there are more image
compressions and format flexibility in PDF, so that the image files sizes can be kept smaller.
There are many simple programs available for converting TIFF and JPEG into PDF with various
other features for improving compression or adding other information. The PDF/A enables
devices that produce vectorized output. Unlike TIFF, JPEG, or BMP, a PDF/A image has theability to provide several "layers" of information. This allows the creation of PDF searchable
images.
A PDF searchable image is a PDF document with an exact bitmapped replica of the scanned
paper pages and with text information stored behind the bitmap image of the page. This approachretains the look of the original pages while enabling text searchability and computer analysis.
This approach is especially suitable for documents that have to be searchable while retaining theoriginal scan details. The text layer is created by an Optical Character Recognition (OCR)
application that scans the text on each page. It then creates a PDF file with the recognized text
stored in a layer beneath the image of the text. Unrecognized graphics areas and annotations arepreserved with full fidelity in the image. The text form may be incomplete or the OCR confusedby some words, but the original image is preserved and available.
Plaintext as well as PDF/A documents shall be base-64 encoded before wrapped in a HL7 CDA
R2 header. The PDF/A documents shall conform to PDF/A-1b. Creators are encouraged toconform to PDF/A-1a to the maximum extent possible, but a simple document scanner may beunable to fully conform to PDF/A-1a. Other profiles may require PDF/A-1a conformance.

3010

HL7 CDA R2 header schema is constrained so that pertinent metadata values and scanningfacility, technology and operator information shall be present (see Section 5.2.3).
Medical imagery and photographs are outside the scope of this profile. Diagnostic or intervention
medical imagery will be supported through DICOM (which includes the use of JPEG andMPEG). Additionally audio and video recorded content is not covered by this profile.

3015

5.2.2 XDS Metadata
XDS-SD is a CDA R2 document and thus conforms to the XDS Metadata requirements in the
PCC TF-2:4 unless otherwise specified below.
5.2.2.1 XDS DocumentEntry Metadata3020

XDS-SD leverages the XDS DocumentEntry Metadata requirements in the PCC TF-2: 4.1.1
unless otherwise specified below.
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5.2.2.1.1 XDSDocumentEntry.formatCode
The XDSDocumentEntry.formatCode shall be urn:ihe:iti:xds-sd:pdf:2008 when the document
is scanned pdf and urn:ihe:iti:xds-sd:text:2008 when the document is scanned text. The
formatCode codeSystem shall be 1.3.6.1.4.1.19376.1.2.3.
3025

5.2.2.1.2 XDSDocumentEntry.uniqueId
This value shall be the ClinicalDocument/id in the HL7 CDA R2 header. The root
attribute is required, and the extension attribute is optional. In accordance with the XDS Profile,
total length is limited to 256 characters. Additionally see PCC TF-2: 4.1.1, for further content
specification.

3030

3035

5.2.2.1.3 Relating instances of XDS-SD documents
In general, most instances of XDS-SD will not have parent documents. It is possible, however, insome specific use cases that instances of XDS-SD documents are related. For example, for aparticular document it may be the case that both the PDF scanned content and somewhat
equivalent plaintext need to be wrapped and submitted. Each document would correspond to
separate XDSDocumentEntries linked via an XFRM Association that indicates one document is
a transform of the other. These can be submitted in a single submission set, or in separate ones.
Other specific examples may exist and this profile does not preclude the notion of a parent
document for these cases.
5.2.2.2 XDS SubmissionSet Metadata

3040

No additional constraints. Particular to this profile, a legitimate use of submission sets would be
to maintain a logical grouping of multiple XDS-SD documents. We encourage such usage. For
more information, see PCC TF-2: 4.1.2
5.2.2.3 XDS Folder Metadata
No additional requirements. For more information, see PCC TF-2: 4.1.3___________________________________________________________________________
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5.2.3 Specification
HL7 CDA R2 header
element

CDA asconstrai
ned byXDS-SD

SectionNumber ofExtended
Discussion

SourceType

ClinicalDocument/typeId

R

5.2.3.1

FM

Fixed, per CDA R2 version inuse.

ClinicalDocument/templateId

R

5.2.3.1

FM

Fixed, per this specification

ClinicalDocument/id

R

5.2.3.1

DS

Computable.

O / FMEntered by operator orappropriately fixed for scanned
content

ClinicalDocument/code

R

5.2.3.1

Source / Value

ClinicalDocument/title

R2

5.2.3.1

SA / OEntered by operator, or possibly
can be taken from the scanned
content.

ClinicalDocument/confidentiality
CodeR

5.2.3.1

O

Assigned by the operator

ClinicalDocument/effectiveTimeR

5.2.3.1

DS

Computed. This is the scantime.

ClinicalDocument/languageCodeR

5.2.3.1

OEntered by operator

ClinicalDocument/recordTarget

R

5.2.3.2

SA / O

Taken from scanned content,
supplemented by operator.

SA / O

Taken from scanned content,
supplemented by operator. Thisis the original author.

DS / FM/O

Can be computed or fixed basedon the scanning device andsoftware. This is theinformation about the scanningdevice.

DS / OCan be computed by thescanner or supplemented byoperator. This is theinformation about the scanner
operator.

DS / FM

Retains original HL7 CDA
Context. To be computed or
fixed appropriately to denote
guardianship of the scanned andwrapped content.

ClinicalDocument/author/assigne
dAuthor/assignedPerson

ClinicalDocument/author/assigne
dAuthor/authoringDevice

ClinicalDocument/dataEnterer

ClinicalDocument/custodian

R2

R

R

R

5.2.3.3

5.2.3.4

5.2.3.5

5.2.3.6

ClinicalDocument/legalAuthenti
cator

O

5.2.3.7

O

Most likely supplemented by
the operator, when applicable ormandated.

ClinicalDocument/documentatio
nOf/serviceEvent/effectiveTimeR

5.2.3.8

SA / O

Denotes the time/date range ofthe original content.

ClinicalDocument/component/no
nXMLBodyR

5.2.3.9SA

The scanned/encoded content.

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5.2.3.1 ClinicalDocument child-less elements
In this section we further discuss id, code, effectiveTime,
confidentialityCode and languageCode elements of the ClinicalDocument.
3050•

The ClinicalDocument/templateId element shall be present. The root attribute shallcontain the oid, ‘1.3.6.1.4.1.19376.1.2.20’, to indicate this document is an XDS-SD
document.

•

The ClinicalDocument/id element shall be present. The root attribute shall contain the oid
for the document, in which case the extension attribute shall be empty, or an oid that
scopes the set of possible unique values for the extension attribute, in which case theextension shall be populated with a globally unique identifier within the scope of the rootoid.

•

The ClinicalDocument/code will in most cases be provided by the operator. Values forthis code are dictated by the CDA R2 documentation, but are permissible to extend to fit
the particular use case. Attributes code@code and code@codeSystem shall be present.

•

The ClinicalDocument/title shall be present if known.

•

The ClinicalDocument/effectiveTime shall denote the time at which the original content
was scanned. At a minimum, the time shall be precise to the day and shall include thetime zone offset from GMT.

•

The ClinicalDocument/confidentialityCode shall be assigned by the operator inaccordance with the scanning facility policy. The notion or level of confidentiality in theheader may not be the same as that in the Affinity Domain, but in certain cases could be
used to derive a confidentiality value among those specified by the Affinity Domain.
Attributes confidentialityCode@code and confidentialityCode@codeSystem shall bepresent.

•

The ClinicalDocument/languageCode, in accordance with the HL7 CDA R2
documentation, shall denote the language used in the character data of the wrapper CDA
header. If the scanned content, when rendered, is in a language different than that of theheader, the language context of the CDA will be overwritten at the body level (seeSection 5.2.3.9 ClinicalDocument/component/nonXMLBody for an example). Attributecode@code shall be present. Attribute code@codeSystem shall be IETF (Internet
Engineering Task Force) RFC5646 in accordance with the HL7 CDA R2 documentation.

3055

3060

3065

3070

3075

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Example:<ClinicalDocument xmlns=“urn:hl7-org:v3”><typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/><templateId root=”1.3.6.1.4.1.19376.1.2.20”/><id root=“1.3.6.4.1.4.1.2835.2.7777”/><code code=“34133-9” codeSystem=“2.16.840.1.113883.6.1”
codeSystemName=“LOINC” displayName=“SUMMARIZATION OF EPISODE NOTE”/><title>Good Health Clinic Care Record Summary</title><effectiveTime value=“20050329224411+0500”/><confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/><languageCode code=“en-US”/>

3080

5.2.3.2 ClinicalDocument/recordTarget
The ClinicalDocument/recordTarget contains identifying information about thepatient concerned in the original content. In many cases this will have to be supplied by theoperator. All subelements retain their original definition as defined by the HL7 CDA R2
specification, unless noted below.

3085

•

The ClinicalDocument/recordTarget/patientRole/id element shall include both the root
and the extension attributes. Refer to PCC TF-2: 4.1.1 for more details.

•

At least one ClinicalDocument/recordTarget/patientRole/addr element shall include atleast the country subelement. The addr element has an unbounded upper limit on
occurrences. It can, and should, be replicated to include additional addresses for a patient,each minimally specified by the country sub element.

•

At least one ClinicalDocument/recordTarget/patientRole/ patient/name element shall be
at least one given subelement and one family subelement.

•

The ClinicalDocument/recordTarget/patientRole/patient/ administrativeGenderCode
element shall be present.

•

The ClinicalDocument/recordTarget/patientRole/patient/ birthTime element shall bepresent with precision to the year.

3090

3095

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Example:<recordTarget><patientRole><id extension="12345" root="2.16.840.1.113883.3.933"/><addr><streetAddressLine>17 Daws Rd.</streetAddressLine><city>Blue Bell</city><state>MA</state><postalCode>02368</postalCode><country>USA</country></addr><patient><name><prefix>Mrs.</prefix><given>Ellen</given><family>Ross</family></name><administrativeGenderCode code="F"
codeSystem="2.16.840.1.113883.5.1"/><birthTime value="19600127"/></patient></patientRole></recordTarget>

3100

3105

3110

3115

5.2.3.3 ClinicalDocument/author (original)This ClinicalDocument/author element represents the author of the original content. It
additionally can encode the original author’s institution in the subelement
representedOrganization. Information regarding the original author and his/her institution shallbe included, if it is known. In many cases this will have to be supplied by the operator. All
subelements retain their original definition as defined by the HL7 CDA R2 specification, unless
noted below.
•

The ClinicalDocument/author/templateId element shall be present. The root attributeshall contain the oid, ‘1.3.6.1.4.1.19376.1.2.20.1’, to indicate this is the original author.

•

The ClinicalDocument/author/time represents the day and time of the authoring of theoriginal content. This value is not restricted beyond statements made in the HL7 CDA R2
documentation.

•

The ClinicalDocument/author/assignedAuthor/id element if known shall include both theroot and extension attributes. Refer to PCC TF-2: 4.1.1 for more details.

•

The ClinicalDocument/author/assignedAuthor/representedOrganization/id element if
known shall include both the root and the extension attribute. Refer to PCC TF-2:
4.1.1for more details.

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Example:<author><templateId root=”1.3.6.1.4.1.19376.1.2.20.1”/><time value=“19990522”/><assignedAuthor><id extension=“11111111” root=“1.3.5.35.1.4436.7”/><assignedPerson><name><prefix>Dr.</prefix><given>Bernard</given><family>Wiseman</family><suffix>Sr.</suffix></name></assignedPerson><representedOrganization><id extension=“aaaaabbbbb” root=“1.3.5.35.1.4436.7”/><name>Dr. Wiseman’s Clinic</name></representedOrganization></assignedAuthor></author>3120

5.2.3.4 ClinicalDocument/author (scanner)
This ClinicalDocument/author element shall be present and represent the scanning device andsoftware used to produce the scanned content. All subelements retain their original definition as
defined by the HL7 CDA R2 specification, unless noted below.

3125

•

The ClinicalDocument/author/templateId element shall be present. The root attributeshall contain the oid, ‘1.3.6.1.4.1.19376.1.2.20.2’, to indicate this author is the scanningdevice and software.

•

The ClinicalDocument/author/time shall denote the time at which the original content
was scanned. This value shall be equal to that of ClinicalDocument/effectiveTime. At aminimum, the time shall be precise to the day and shall include the time zone offset fromGMT.

•

The ClinicalDocument/author/assignedAuthor/id element shall be at least the root oid of
the scanning device.

•

The ClinicalDocument/author/assignedAuthor/assignedAuthoringDevice/code element
shall be present. The values set here are taken from appropriate DICOM vocabulary. The
value of code@codeSystem shall be set to “1.2.840.10008.2.16.4”. The value ofcode@code shall be set to “CAPTURE” for PDF scanned content and “WSD” forplaintext. The value of code@displayName shall be set to “Image Capture” for PDF
scanned content and “Workstation” for plaintext.

3130

3135

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•

The
ClinicalDocument/author/assignedAuthor/assignedAuthoringDevice/manufacturerModel
Name element shall be present. The mixed content shall contain string information thatspecifies the scanner product name and model number. From this information, features
like bit depth and resolution can be inferred. In the case of virtually scanned documents(for example, print to PDF), the manufactureModelName referenced here refers to the
makers of the technology that was used to produce the embedded content.

•

The ClinicalDocument/author/assignedAuthor/assignedAuthoringDevice/softwareName
element shall be present. The mixed content shall contain string information that specifies
the scanning software name and version. In the case of virtually scanned documents, thesoftwareName referenced here refers to the technology that was used to produce theembedded content.

•

The ClinicalDocument/author/assignedAuthor/representedOrganization/id element shallbe present. The root attribute shall be set to the oid of the scanning facility.

3145

3150

Example:<author><templateId root=”1.3.6.1.4.1.19376.1.2.20.2”/><time value=“20050329224411+0500”/><assignedAuthor><id root=“1.3.6.4.1.4.1.2835.2.1234”/><assignedAuthoringDevice><code code=“CAPTURE” displayName=“Image Capture” codeSystem=“
1.2.840.10008.2.16.4” /><manufacturerModelName>SOME SCANNER NAME AND MODEL</manufacturerModelName><softwareName>SCAN SOFTWARE NAME v0.0</softwareName></assignedAuthoringDevice><representedOrganization><id root=“1.3.6.4.1.4.1.2835.2”/><name>SOME Scanning Facility</name><addr><streetAddressLine>21 North Ave</streetAddressLine><city>Burlington</city><state>MA</state><postalCode>01803</postalCode><country>USA</country></addr></representedOrganization></assignedAuthor></author>3155___________________________________________________________________________
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5.2.3.5 ClinicalDocument/dataEnterer
This ClinicalDocument/dataEnterer element shall represent the scanner operator who produced
the scanned content. All subelements retain their original definition as defined by the HL7 CDA
R2 specification, unless noted below.
3160•

The ClinicalDocument/dataEnterer/templateId element shall be present. The root attributeshall contain the oid, ‘1.3.6.1.4.1.19376.1.2.20.3’, to indicate this is the scanner operator.

•

The ClinicalDocument/dataEnterer/time shall denote the time at which the originalcontent was scanned. This value shall be equal to that ofClinicalDocument/effectiveTime. At a minimum, the time shall be precise to the day andshall include the time zone offset from GMT.

•

The ClinicalDocument/dataEnterer/assignedEntity/id element shall be both the root andthe extension attributes the root shall be the oid of the scanning facility and the extension
shall be an appropriately assigned, facility unique id of the operator.

3165

Example:<dataEnterer><templateId root=”1.3.6.1.4.1.19376.1.2.20.3”/><time value=“20050329224411+0500”/><assignedEntity><id extension=“22222222” root=“1.3.6.4.1.4.1.2835.2”/><assignedPerson><name><prefix>Mrs.</prefix><given>Bernice</given><family>Smith</family></name></assignedPerson></assignedEntity></dataEnterer>

3170
5.2.3.6 ClinicalDocument/custodian

3175

The ClinicalDocument/custodian shall be present. Its context is left up to the scanning facility torefine in accordance with local policies and to reflect the entity responsible for the scanned
content. In most cases this will be the scanning facility. All subelements retain their original
definition as defined by the HL7 CDA R2 specification, unless noted below.
•

The ClinicalDocument/assignedCustodian/representedOrganization/name shall bepresent.

•

At least one ClinicalDocument/assignedCustodian/representedOrganization/addr element
shall include at least the country sub element.

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Example:<custodian><assignedCustodian><representedCustodianOrganization><id root=“1.3.6.4.1.4.1.2835.2”/><name>SOME Scanning Facility</name><addr><streetAddressLine>21 North Ave</streetAddressLine><city>Burlington</city><state>MA</state><postalCode>01803</postalCode><country>USA</country></addr></representedCustodianOrganization></assignedCustodian></custodian>

5.2.3.7 ClinicalDocument/legalAuthenticator
3185

The ClinicalDocument/legalAuthenticator may be present and its context is left up to thescanning facility to refine in accordance with local policies. All subelements retain their original
definition as defined by the HL7 CDA R2 specification, unless noted below.
•

3190

The ClinicalDocument/legalAuthenticator/assignedEntity/id element if known shall
include both the root and the extension attribute. Refer back to PCC TF-2: 4.1.1 for moredetails.

Example:<legalAuthenticator><time value=“19990522”/><signatureCode code=“S”/><assignedEntity><id extension=“11111111” root=“1.3.5.35.1.4436.7”/><assignedPerson><name><prefix>Dr.</prefix><given>Bernard</given><family>Wiseman</family><suffix>Sr.</suffix></name></assignedPerson></assignedEntity></legalAuthenticator>___________________________________________________________________________
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5.2.3.8 ClinicalDocument/documentationOf

3195

This ClinicalDocument/documentationOf element is used to encode the date/time range ofthe original content. If the original content is representative of a single point in time then theendpoints of the date/time range shall be the same. Information regarding this date/time range
shall be included, if it is known. In many cases this will have to be supplied by the operator. This
profile does not restrict the documentationOf element beyond statements made in the HL7 CDA
R2 documentation.
Example:<documentationOf><serviceEvent ><effectiveTime><low value=“19800127”/><high value=“19990522”/></effectiveTime></serviceEvent></documentationOf>

3200
5.2.3.9 ClinicalDocument/component/nonXMLBody

3205

This ClinicalDocument/component/nonXMLBody element shall be present and used to wrap thescanned content. The nonXMLBody element is guaranteed to be unique; thus the x-path torecover the scanned content is essentially fixed. All subelements of the nonXMLBody retain
their original definition as defined by the HL7 CDA R2 specification, unless noted below.
•

If the human-readable language of the scanned content is different than that of thewrapper (specified in ClinicalDocument/languageCode), thenClinicalDocument/component/nonXMLBody/languageCode shall be present. Attributecode@code shall be present. Attribute code@codeSystem shall be IETF (Internet
Engineering Task Force) RFC 5646 in accordance with the HL7 CDA R2 documentation.

•

The ClinicalDocument/component/nonXMLBody/text element shall be present andencoded using xs:base64Binary encoding and shall contain the scanned content.

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ClinicalDocument/component/nonXMLBody/text@mediaType shall be“application/pdf” for PDF, or “text/plain” for plaintext.

•

When the character encoding of text/plain content is other than UTF-8, the@mediaType shall be text/plain;charset=XXX, where XXX is the name of theencoding as specified by RFC2046.

•

ClinicalDocument/component/nonXMLBody/text@representation shall be present.
The @representation for both PDF and plaintext scanned content will be “B64”,
because this profile requires the base-64 encoding of both formats.

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Example (PDF scanned content is in the same language as the wrapper):<component><nonXMLBody><text mediaType=“application/pdf” representation=“B64”>
JVBERi0xLjMKJcfsj6IKNSAwIG9iago8PC9MZW5ndGggNiAwIFIvRmlsdGVyIC9GbGF0
ZURlY29kZT4+CnN0cmVhbQp4nGWPMWsDMQyFd/8KjfJwqmVbkr0GQqFbg7fQoSRNWuhB
Q/4/1L67TEEYme+9J1s3CMQQRm39NLuXg8H17gK89nN1N8eLAbZ2mmHXuql2QDVUhnZx
a5iBcyQtoMIUM7TZHbH5KZEVDgm//SSUswbFHx/JzBLeu5yYxOIzE8bPcRWqdaGDmcZO
BWc/9bfUNOPfOte44O9jxtcIKskqp0JZouJ5deYqeBn58ZmKtIU+2ptjqWQRJpGyrHDu
K7CXIe2be+/1DzXQP+RlbmRzdHJlYW0KZW5kb2JqCjYgMCBvYmoKMjAxCmVuZG9iago0...
SW5mbyAyIDAgUgovSUQgWzxGNENDN0FFQjU0QjM2RkIyODNDNUMzMjQ3OUFEMjgzRj48
RjRDQzdBRUI1NEIzNkZCMjgzQzVDMzI0NzlBRDI4M0Y+XQo+PgpzdGFydHhyZWYKMzAx
MgolJUVPRgo=</text></nonXMLBody></component></ClinicalDocument>

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Example (PDF scanned content is in a different language than the wrapper):<component><nonXMLBody><languageCode code=“zh-CN”/><text mediaType=“application/pdf” representation=“B64”>
JVBERi0xLjMKJcfsj6IKNSAwIG9iago8PC9MZW5ndGggNiAwIFIvRmlsdGVyIC9GbGF0
ZURlY29kZT4+CnN0cmVhbQp4nGWPMWsDMQyFd/8KjfJwqmVbkr0GQqFbg7fQoSRNWuhB
Q/4/1L67TEEYme+9J1s3CMQQRm39NLuXg8H17gK89nN1N8eLAbZ2mmHXuql2QDVUhnZx
a5iBcyQtoMIUM7TZHbH5KZEVDgm//SSUswbFHx/JzBLeu5yYxOIzE8bPcRWqdaGDmcZO
BWc/9bfUNOPfOte44O9jxtcIKskqp0JZouJ5deYqeBn58ZmKtIU+2ptjqWQRJpGyrHDu
K7CXIe2be+/1DzXQP+RlbmRzdHJlYW0KZW5kb2JqCjYgMCBvYmoKMjAxCmVuZG9iago0...
SW5mbyAyIDAgUgovSUQgWzxGNENDN0FFQjU0QjM2RkIyODNDNUMzMjQ3OUFEMjgzRj48
RjRDQzdBRUI1NEIzNkZCMjgzQzVDMzI0NzlBRDI4M0Y+XQo+PgpzdGFydHhyZWYKMzAx
MgolJUVPRgo=</text></nonXMLBody></component></ClinicalDocument>___________________________________________________________________________
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5.2.4 Complete Example (Wrapped PDF)
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<ClinicalDocument xmlns="urn:hl7-org:v3"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" classCode="DOCCLIN"
moodCode="EVN" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd"><typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/><templateId root=”1.3.6.1.4.1.19376.1.2.20”/><id root=“1.3.6.4.1.4.1.2835.2.7777”/><code code=“34133-9” codeSystem=“2.16.840.1.113883.6.1”
codeSystemName=“LOINC” displayName=“SUMMARIZATION OF EPISODE NOTE”/><title>Good Health Clinic Care Record Summary</title><effectiveTime value=“20050329224411+0500”/><confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/><languageCode code=“en-US”/><recordTarget><patientRole><id extension="12345" root="2.16.840.1.113883.3.933"/><addr><streetAddressLine>17 Daws Rd.</streetAddressLine><city>Blue Bell</city><state>MA</state><postalCode>02368</postalCode><country>USA</country></addr><patient><name><prefix>Mrs.</prefix><given>Ellen</given><family>Ross</family></name><administrativeGenderCode code="F"
codeSystem="2.16.840.1.113883.5.1"/><birthTime value="19600127"/></patient></patientRole></recordTarget><author><templateId root=”1.3.6.1.4.1.19376.1.2.20.1”/><time value=“19990522”/><assignedAuthor><id extension=“11111111” root=“1.3.5.35.1.4436.7”/><assignedPerson><name><prefix>Dr.</prefix><given>Bernard</given><family>Wiseman</family><suffix>Sr.</suffix></name></assignedPerson><representedOrganization><id extension=“aaaaabbbbb”
root=“1.3.5.35.1.4436.7”/><name>Dr. Wiseman’s Clinic</name></representedOrganization>___________________________________________________________________________
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</assignedAuthor></author><author><templateId root=”1.3.6.1.4.1.19376.1.2.20.2”/><time value=“20050329224411+0500”/><assignedAuthor><id root=“1.3.6.4.1.4.1.2835.2.1234”/><assignedAuthoringDevice><code code=“CAPTURE” displayName=“Image Capture” codeSystem=“
1.2.840.10008.2.16.4” /><manufacturerModelName>SOME SCANNER NAME AND MODEL </manufacturerModelName><softwareName>SCAN SOFTWARE NAME v0.0</softwareName></assignedAuthoringDevice><representedOrganization><id root=“1.3.6.4.1.4.1.2835.2”/><name>SOME Scanning Facility</name><addr><streetAddressLine>21 North Ave</streetAddressLine><city>Burlington</city><state>MA</state><postalCode>01803</postalCode><country>USA</country></addr></representedOrganization></assignedAuthor></author><dataEnterer><templateId root=”1.3.6.1.4.1.19376.1.2.20.3”/><time value=“20050329224411+0500”/><assignedEntity><id extension=“22222222” root=“1.3.6.4.1.4.1.2835.2”/><assignedPerson><name><prefix>Mrs.</prefix><given>Bernice</given><family>Smith</family></name></assignedPerson></assignedEntity></dataEnterer><custodian><assignedCustodian><representedCustodianOrganization><id root=“1.3.6.4.1.4.1.2835.2”/><name>SOME Scanning Facility</name><addr><streetAddressLine>21 North Ave</streetAddressLine><city>Burlington</city><state>MA</state><postalCode>01803</postalCode><country>USA</country></addr></representedCustodianOrganization>___________________________________________________________________________
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</assignedCustodian></custodian><legalAuthenticator><time value=“19990522”/><signatureCode code=“S”/><assignedEntity><id extension=“11111111” root=“1.3.5.35.1.4436.7”/><assignedPerson><name><prefix>Dr.</prefix><given>Bernard</given><family>Wiseman</family><suffix>Sr.</suffix></name></assignedPerson></assignedEntity></legalAuthenticator><documentationOf><serviceEvent ><effectiveTime><low value=“19800127”/><high value=“19990522”/></effectiveTime></serviceEvent></documentationOf><component><nonXMLBody><text mediaType=“application/pdf” representation=“B64”>
JVBERi0xLjMKJcfsj6IKNSAwIG9iago8PC9MZW5ndGggNiAwIFIvRmlsdGVyIC9GbGF0
ZURlY29kZT4+CnN0cmVhbQp4nGWPMWsDMQyFd/8KjfJwqmVbkr0GQqFbg7fQoSRNWuhB
Q/4/1L67TEEYme+9J1s3CMQQRm39NLuXg8H17gK89nN1N8eLAbZ2mmHXuql2QDVUhnZx
a5iBcyQtoMIUM7TZHbH5KZEVDgm//SSUswbFHx/JzBLeu5yYxOIzE8bPcRWqdaGDmcZO
BWc/9bfUNOPfOte44O9jxtcIKskqp0JZouJ5deYqeBn58ZmKtIU+2ptjqWQRJpGyrHDu
K7CXIe2be+/1DzXQP+RlbmRzdHJlYW0KZW5kb2JqCjYgMCBvYmoKMjAxCmVuZG9iago0...
SW5mbyAyIDAgUgovSUQgWzxGNENDN0FFQjU0QjM2RkIyODNDNUMzMjQ3OUFEMjgzRj48
RjRDQzdBRUI1NEIzNkZCMjgzQzVDMzI0NzlBRDI4M0Y+XQo+PgpzdGFydHhyZWYKMzAx
MgolJUVPRgo=</text></nonXMLBody></component></ClinicalDocument>

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5.3 Intentionally Left Blank___________________________________________________________________________
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5.4 XDW Workflow Content Module
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This section defines the XDW Workflow Document by providing a schema and explaining its
use. This document does not include clinical information about the patient directly. It shall only
contain information necessary for organizing and defining work tasks. All clinical information
regarding any task shall be provided through separate documents that are referenced from theassociated input or output documents.
5.4.1 Referenced Standards

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HL7 CDA Release 2.0 (denoted HL7 CDA R2, or just CDA, in subsequent text)
Web Services – Human Task (WS-HumanTask) Specification Version 1.1, OASIS
5.4.2 Discussion of Content Standards

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The XDW Workflow Document is a document that incorporates elements from the HL7 CDA
document structure and from the WS-HumanTask structure. The Workflow Document exists tocoordinate the activities of multiple people in different organizations. They agree to share these
documents as a method of exchanging work information. These documents are used by theseorganizations to feed what is often considered their own internal task management systems andhave their own administrative rules for managing activities.
Sharing clinical documents is often accomplished as a normal part of providing healthcare. The
XDW workflow allows the work information to be shared in the same way as other patient
related clinical information. Integrating the internal workflow management systems of
independent organizations with independent administrative rules, and perhaps in different legal
and regulatory systems, is avoided.
The XDW Workflow Document does not contain clinical information about the patient. The
input, output, and other elements of the task data shall contain references to documents(DocumentEntry.uniqueId) that contain the clinical information.
XDW Workflow uses the XDS lifecycle management tools to coordinate updates to theWorkflow Document instead of requiring an integration of all the different task management
systems in the different organizations.

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The XDW Workflow Document builds upon two other standards, HL7 CDA and OASIS WSHuman Task.
The XDW Workflow Document shall comply with the XDW XML Schema that includes
elements from the CDA and OASIS Human Task standards. Access to the schema files fromthose standards will be needed.

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The figure below represents the main level structure of the Workflow Document with the firstlevel of the elements that composed the structure.
It is possible to divide the structured into four parts:•

Part 1: elements derived from HL7 CDA standard (Type of the element: CDA),___________________________________________________________________________
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•

Part 2: two elements, patient and author, defined in the XDWSchema with the structure
derived from HL7 R-MIM standard (Type of the element: tXDWpatient and
tXDWauthor),•

Part 3: elements defined by IHE XDW Profile•

Part 4: the element <TaskList> in which is defined by elements derived from the
OASIS WS-HumanTask standard. In this last section the <TaskList> is a list ofelements <XDWTask> composed of the HumanTask <taskData> (all data that define
the XDWTask) and the HumanTask <taskEventHistory> that contains a list ofelements <taskEvent>.

All the elements of the Figure 5.4.2-1 are described in Section 5.4.3.

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Figure 5.4.2-1: XDW.WorkflowDocument Structure___________________________________________________________________________
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5.4.2.1 XDW Workflow Document Elements from HL7 CDA Standard

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Some elements are incorporated directly from the HL7 CDA standard. This means that theelements, their definitions, and the rules for interpreting them are in the HL7 standard. These aresummarized here for convenience.
<patient> and <author> elements have been defined based upon the HL7 CDA R-MIM.
The XDW schema defines these elements using elements from CDA, and was derived byeliminating all elements that are not needed for workflow identification purposes. The R-MIM
includes elements that are of clinical value. These have been removed for workflow use.

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5.4.2.2 XDW Workflow Document Elements defined by IHE XDW Profile
The XDW Workflow Document also has elements that are defined by IHE (see Table 5.4.3-1):•<workflowInstanceId> Every version of the Workflow Document shall have thesame workflowInstanceId value. This value shall be an OID. It is conveyed in theDocumentEntry.referenceIdList attribute of the workflow document’s metadata. It shallbe globally unique, because it is shared by many organizations.

•<workflowDocumentSequenceNumber> This is used to simplify management of
the changes to the Workflow Document as the workflow is executed. It shall be createdas "1", and be incremented for each update to the Workflow Document.

•<workflowStatus> This shall be either

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OPEN– which means that further updates are expected for this Workflow Document.
These updates could be modifications to existing tasks or addition of new tasks or
update to an existing task. Tasks shall not be deleted.
CLOSED– which means that further updates to this Workflow Document are notexpected. A workflow with a CLOSED workflowStatus may continue to be updated,
after which the value of workflowStatus may be transitioned back to OPEN or remain
CLOSED. These constraints will be defined by the Workflow Definition referenced.

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•
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<workflowStatusHistory> This element represents the history of changes ofstatus of the workflow document. It consists of sub-elements named documentEvent.
Each documentEvent describes a change of status of the workflow document. In case thatthe workflowDefinitionReference describes a type of workflow that can’t change its
status from CLOSED to OPEN, the workflowStatusHistory contain at most two
documentEvent elements, one for the opening of the workflow corresponding to thecreation of the workflow document, and one to track the closing of the process related.
Instead, if the workflowDefinitionReference permits the change of status from CLOSED
to OPEN (e.g., OPEN-->CLOSED-->OPEN…) the element workflowStatusHistory willcontain from 1 to N documentEvent elements to track these changes. A documentEvent is
described by sub-elements defined in Table 5.4.3-5.

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eventTime
workflowStatusHistory

1…∞

documentEvent

1…1

eventTypetaskEventIdentifier

authorpreviousStatusactualStatus

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Figure 5.4.2.2-1: workflowStatusHistory Element

•

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<workflowDefinitionReference>. This is the reference to the workflow
definition. This is usually contained in policy or procedure document or may be definedby IHE as a specific workflow definition profile. This profile places no restriction on thestyle used to document such Workflow definition. It is recommended to assign an OID to
those. It shall be recorded by the creator of the initial Workflow Document and shall bepreserved unchanged in all subsequent versions of the document.

5.4.2.3 XDW Workflow Document Elements from the OASIS Human Task

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The descriptions of a task and of <taskEvent> are taken from the OASIS Human Task
standard. This standard defines a way to describe a human task. It was defined as an extension to
the BPEL and BPMN workflow standards. These standards are in use to manage the workflow of
automated tasks under the control of an integrated task management system. It was recognizedthat while these standards do not have the ability to control human task, they needed a way todescribe tasks to be performed by humans and other organizations.
The element <XDWTask> groups all information about one task in the workflow, the<XDWTask> is structured in two sub elements: <taskData> and <taskEventHistory>.
•<taskData> describes a single task. This is a list of details about the task, adescription, the inputs to the task (e.g., documents), the outputs from the task (e.g.,documents), fault descriptions and comments. The <taskDetails> include elements
like the task ID, description, state, etc. (see Table 5.4.3-8)•<taskEventHistory> contains a list of the <taskEvent> elements that describe
the changes of the task. For each task, there is one or more <taskEvent> that
describes the history of the task. There is a list of the <taskEvent>: an<eventType>, a description, the inputs to the <taskEvent> (e.g., documents), theoutputs from the <taskEvent> (e.g., documents), fault descriptions, comments, andattachments (other documents that do not represent outputs). The details include elements
like the task ID, status, etc. (see Table 5.4.3-10)___________________________________________________________________________
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standard. There are other datatypes and web services also defined in Human Task standard thatare not used by XDW.
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Figure 5.4.2.3-1: XDW Workflow elements derived from OASIS WS-HumanTask

5.4.2.4 Relationship between Task and <taskEvent>
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When a Task is generated it has a first <taskEvent>. A Task can either have only one<taskEvent> if the status of the task is not modifiable and it is born just completed or it canhave more status and so more taskEvents. In this case at any time the task changed a new<taskEvent> is created.

When a new Task is generated, zero or more references to external documents, associated with
the Task, either as input or output, are put in the respective element of the Task. As a Task
changes new input or output documents may be added (cumulative list of references). However,for each Task Event, only the input and output document related to the specific task Event shallbe included. The inputs documents of a <taskEvent> are the documents that have been used
as input for performing the Task change. The Output documents are those that have been createdas a result of the Task Change. As a consequence, all input and output document references,
present one or more times in the task Events list shall be listed (without duplicates) in the Task.
Likewise for output document references.
The clinical documents referenced in the input or output data elements of Tasks and task Events
shall be accessible in the affinity domain (if XDW is used along with XDS) or MediaInterchange (if used along with XDM) or Point-to-point submission set (if used along with
XDR). In anticipation of the use of XDW in a cross-community environment, both the document
uniqueId and homeCommunityId are permitted to be included.
The XDW Workflow Document defines a task list which is a series of task descriptions. The
relationship between the task, the order of the elements in this list and the possible status of atask, all this rules are defined in the Workflow Definition Document.

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The XDW Profiles define the recommended statuses processable in a Task with the<taskEvent>. These statuses are a subset of the HumanTask Standard. There are other task
status values possible, but these are not normally used.

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Table 5.4.2.4-1: Description of Task Status
Task status

Description

CREATEDThe workflow is open, the task is created
but not assigned to an owner

READY

The task created is assigned to an owner
and is ready to be performed

IN_PROGRESS

The task is started and the owner isperforming the task actions

FAILED

The task is completed with fault response(it is not possible conclude the action of
the task)

COMPLETEDThe task is completed with response

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Figure 5.4.2.4-1: Task Status Transition___________________________________________________________________________
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The element <XDWTask> and XDW <taskEvent> is constrained by XDW with a minimal set ofelements required. These elements are fully extensible with any kind of attributes defined by
Human Task standard. This allows specific Workflow Definition profiles to add elements
defined in Human Task to manage for example intertask relationships, additional status, etc. toaddress more advanced specific workflow requirements.
5.4.3 Content Specification

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The tables below represent all Workflow Document elements. The tables show for each element
the Optionality and the standard from which the definition and the structure of the element
derive.
Optionality:
R = element Required for XDW Profile

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R2 = element Required if known for XDW Profile
O = element Optional for XDW Profile
X = element shall not be used

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Inside the tables the column description is used to constrain the use of the attribute whenreferring to element defined in the underlining standard. When the description in blank noconstrains is required. When the element is defined by XDW this is the complete description.
There are three functional roles for interacting with these elements.

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The "create" role specifies what elements shall be created. The Content Creator ispermitted to include any optional element, and may include other elements.

•

The "view" role specifies what elements shall be presented by Content Consumer orContent Updater that support viewing of the document. It may present for viewing anyother element that it understands or has a means of presenting. There are elements thatare required for viewing, while being optional for both creation and viewing.

•

The "update" role specifies what elements shall be maintained with correct values when
updating a document. An "update" operation shall preserve the value of all elements thatare present, even if their meaning is unknown. This means that an updater might not
update the contents of optional elements when updating a workflow document.

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If one of the following tables does not specify separate values for the three roles, then thespecified value applies to all three roles.
Tables uses the following namespace conventions:3560•

cda="urn:hl7-org:v3";•

ht="http://docs.oasis-open.org/ns/bpel4people/ws-humantask/types/200803"•

xs="http://www.w3.org/2001/XMLSchema"•

xdw="urn:ihe:iti:xdw:2011"___________________________________________________________________________
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IHE IT Infrastructure Technical Framework, Volume 3 (ITI TF-3): Cross-Transaction andContent Specifications______________________________________________________________________________<XDW.WorkflowDocument>•
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Table 5.4.3-1: Elements of the Workflow Document
XDW.WorkflowDocument
element

Standard

id

HL7 CDA

title

HL7 CDA

Data
Type
cda:II
cda:ST

HL7 CDA

cda:TS

confidentialityCode

HL7 CDA

languageCode

HL7 CDA

cda:CEeffectiveTime

patient

HL7 CDA

cda:CS

xdw:tXD
Wpatient

OptionalityRDocument ID

O

Displayable title

R

Time of most recent
updateR
O

R

Patient information
derived from R-MIM.
Restricted to nonclinical necessarycontent.
See Table 5.4.3-2

R

Author information
derived from R-MIM.
Restricted to nonclinical necessarycontent.
See Table 5.4.3-3

RConveys theworkflow identifier.
It shall contain thesame value as theCXi.1 component oftheDocumentEntry.referenceIdList metadata
attribute.

xdw:tXD
WAuthorauthor

HL7 CDA

workflowInstanceId

IHE

OID

workflowDocumentSequenceN
umber

IHE

xs:intR

xs:tokenworkflowStatus

workflowStatusHistory

IHE

IHE

xdw:workflowSt
atusHistory_typeDescription

R

OPEN ifmodifications are
permitted to the
document contents.
CLOSED if
modifications are notexpected.

R

List of changes of theworkflowStatus
See Table 5.4.3-4___________________________________________________________________________
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XDW.WorkflowDocument
element
workflowDefinitionReference

IHE

TaskList

IHE

•

Data
Type

Standard

xs:anyU
RI
xdw:TaskList_type

OptionalityDescription

R

References (urn:
OID:) to the
documents that define
this kind of workflow.

R

List of all tasks andtheir history
See Table 5.4.3-6<patient>
Table 5.4.3-2: Patient Element
Patient elementid

HL7 CDAname

HL7 CDAadministrativeGenderCode

HL7 CDAbirthTime

HL7 CDA

martialStatusCode

Data
Type

Standard

HL7 CDA

Optionalitycda:IIR

cda:CEO

cda:CEO

cda:PNO

cda:TSO

Description

3570•<author>Table 5.4.3-3: Author Element
Author element

assignedAuthor

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•

Data
Type

Standard

HL7 CDA

cda:POC
D_MT000
040.Ass
ignedAu
thor

OptionalityR

Definition
EitherassignedAuthoringDe
vice orassignedPerson
should be specified<workflowStatusHistory>___________________________________________________________________________
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Table 5.4.3-4: workflowStatusHistory Element
TaskListelement

Data
TypeStandard

documentEvent

IHE

Optionalityxdw:tXD
WdocumentEvent_type

R

Description
A detailed event that
represents a change of
the workflowStatus
The first
documentEventelement is added
when the workflow
document is created.
A documentEventelement is then added
whenever theworkflowStatus of theworkflow documentchanges.
See Table 5.4.3-5•3580<documentEvent>
Table 5.4.3-5: documentEvent Element
documentEventelement

eventTime

eventType

Data
Type

Standard

OASIS_WSHumanTask

OASIS_WSHumanTask

xs:dateTime

ht:tTaskEventType

OptionalityDescription

R

Time when thespecific
documentEventelement is added to
the workflow
document.

R

The type of event that
happens that solicits
the modification of
the workflowStatus. It
should be valorizedwith one of thesetypes: create, stop,suspend, resume, fail,complete.
These types aredefined in the
HumanTask
specification (C. WSHumanTask Data
Types Schema, <!-Defines the humantask event types -->).

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documentEventelement

Data
TypeStandard

OptionalityDescription

taskEventIdentifier

IHE

xs:anyURIR

Element that permits
to track the reference
to the taskEvent thatsolicits themodification of theworkflowStatus. It
stores the same valueof the elementtaskEvent/identifierof the taskEvent ofreference.

authorIHE

xs:string

RActual owner of theworkflow after the
event

R

The previous value ofworkflowStatus.
Either “OPEN” or“CLOSED”. In caseof a Workflow
Document justcreated this element
shall be valorizedwith “”R

Equal to the current
value of theworkflowStatuselement. Either“OPEN” or“CLOSED”.

previousStatusactualStatus•

xs:token

IHE

xs:token

IHE<TaskList>

3585

Table 5.4.3-6: TaskList Element
TaskListelement
XDWTask

•

Data
Type

Standard
IHE

xdw:tXD
WTask

OptionalityR

Description
List of tasks
See Table 5.4.3-7<XDWTask>___________________________________________________________________________
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Table 5.4.3-7: XDWTask Element
XDWTaskelement

Data
TypeStandard

taskData

taskEventHistory

OASIS_WSHumanTask

ht:tTaskInstanceDataIHE

xdw:tXD
WeventH
istoryOptionalityDescription

R

Description of thecurrent task (status,
inputs, outputs, etc.)
See Table 5.4.3-8

R

History of thechanges to the current
task (dates, changes,
etc.)
See Table 5.4.3-11

3590•<taskData>

The XDW Profile adds the following restrictions to the OASIS definition for taskDetails:•

The taskData/input shall contain a taskData/input/part for every clinical document orworkflow that is to be used as input to the task. This element is of typetMessagePartsData. An element <part> shall have a child element<AttachmentInfo> of type tAttachmentInfo. Table 5.4.3-9 describes how to assign
values to each AttachmentInfo child elements.

•

The taskData/output shall contain a taskData/output/part for every clinical document orworkflow that is created as a result of the task that is to be shared. This element is of typetMessagePartsData. An element <part> shall have a child element<AttachmentInfo> of type tAttachmentInfo. Table 5.4.3-9 describes how to assign
values to each AttachmentInfo child element.

•

Any clinical documents that are registered in an XDS Document Registry shall beidentified in the taskData/input/part, taskData/output/part, or
taskData/attachmentInfos/info as described in Table 5.4.3-9.

3595

3600

3605

The element <part> shall have an attribute @name. The value of this attribute identifies therole played by the referenced object within the task. A Workflow Definition profile shall define alist of acceptable values for this attribute. If no Workflow Definition profile is supported and if
no values are defined by local policies, this value shall be set to “XDSRegisteredDocument”.
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Table 5.4.3-8: taskData Element
taskData
element
taskDetails

Standard

Data TypeOASIS_WS
HumanTask

ht:tTaskD
etails

Optionality
CreateView

UpdateR

R

R

Description
See Table 5.4.3-10___________________________________________________________________________
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taskData
element
description

input

3620

Data TypeOASIS_WS
HumanTask

xs:string

OASIS_WS
HumanTask

ht:tMessa
gePartsData

ht:tMessa
gePartsDa
ta

outputOASIS_WS
HumanTask

fault

OASIS_WS
HumanTask

ht:tFault
Data

comments

OASIS_WS
HumanTask

xs:string•

3615

Standard

Optionality

Description

CreateView

UpdateR

R

R

Textual description

R

This element lists
documents/workflowsreferenced by the task as
inputs, using a child<part> element for
each
document/workflow.

R

R

R

R

R

This element lists
documents/workflowsreferenced by the task as
outputs, using a child<part> element for
each
document/workflow.

O

R

O

Description of fault

O

R

O

Simple text comments
about the task

<AttachmentInfo>

Each document referenced in input or output elements is structured using a tAttachmentInfo data
type. The XDW Profile extends this data type, adding a new optional child element(homeCommunityId) that can be used to convey the home community Id of the referenced
document. The structure of the <AttachmentInfo> element is described in Table 5.4.3-9.
An <AttachmentInfo> element can be used to refer to another workflow. An<AttachmentInfo> element that stores a reference to a child or parent workflow shallcontain an accessType with the value
urn:ihe:iti:xdw:2013:workflowInstanceId.

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Table 5.4.3-9: AttachmentInfo Element
AttachedInfoele
mentStandard

Data
Type

Optionality
CreateView

Description
UpdateIf the accessType isurn:ihe:iti:xdw:2011:X
DSregistered; theidentifier shall containthe value ofDocumentEntry.uniqueIdidentifier

OASIS_WSHumanTask

xs:any
URI

R

R

R

name

OASIS_WSHumanTask

xs:str
ing

R

R

R

accessType

OASIS_WSHumanTask

xs:string

If the accessType isurn:ihe:iti:xdw:2013:w
orkflowInstanceId,; theidentifier shall containthe value of theDocumentEntry.referenc
eIdList in the referenced
workflow.
See Note 1.
Stores the same value ofthe part/@name attribute
If the attachment is adocument, the value ofaccessType shall beurn:ihe:iti:
xdw:2011:XDSregister
ed.

R

R

R

If the part element
references anotherworkflow, the value ofaccessType shall beurn:ihe:iti:xdw:2013:w
orkflowInstanceId.
See Note 1.

contentType

OASIS_WSHumanTask

xs:str
ing

R

R

R

Conveys the MIME typeof the referenced
document. If theattachment refers to achild/parent workflow
then this element shallbe empty.

contentCategory

OASIS_WSHumanTask

xs:any
URI

R

R

R

Fixed value
http://www.iana.org/assi
gnments/media-types

attachedTime

OASIS_WSHumanTask

xs:dat
eTime

R

R

R

The date/time when the
document is attached as
reference___________________________________________________________________________
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AttachedInfoele
mentStandard

Data
Type

Optionality

attachedBy

OASIS_WSHumanTask

ht:tUserhomeCommunityId

IHE

OID

Description

CreateView

UpdateR

R

R

The owner that attached
the reference to the task

O

O

O

The home community Idof the referenced
document

Note 1: The XDW Profile allows for reference to objects other than XDS documents or XDW Workflows. In this case the<identifier> element identifies the uid of the referenced object. The <accessType> of this referenced objects shallbe “URL”. No further constraints are defined for other elements.

3625

•

<taskDetails>
Table 5.4.3-10: taskDetails Element
Optionality
taskDetails
element

Standard

Data
Type

CreateView

Updateid

OASIS_WS
HumanTask

xs:any
URI

R

R

R

taskType

OASIS_WS
HumanTask

xs:str
ing

R

R

R

name

OASIS_WS
HumanTask

xs:QName

R

R

R

The name of the task

statusOASIS_WS
HumanTask

ht:tSt
atus

R

R

R

Recommend limiting
values to the statuses
described above.

priority

OASIS_WS
HumanTask

ht:tPriorityO

R

O

taskInitiator

OASIS_WS
HumanTask

ht:tuser

O

O

O

taskStakeholders

OASIS_WS
HumanTask

ht:tOrganizationalEntityOOODescription

Internal ID for the task___________________________________________________________________________
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Optionality
taskDetails
element

Standard

potentialOwners

OASIS_WS
HumanTask

businessAdministrators

OASIS_WS
HumanTask

actualOwner

OASIS_WS
HumanTask

Data
Type

Createht:tOrganizationalEntityht:tOrganizationalEntityht:tUser

View

UpdateOASIS_WS
HumanTask

createdTime

OASIS_WS
HumanTask

createdBy

Owners in Human Task
terminology arepeople/organizations/etc. that perform the
task.

O

O

O

O

O

O

R

R

R

The actual performer of
the task.
Notification Recipient
may be used to contain
information about
persons to be notified.
Use of this element does
not imply that Human
Task "notification" will
be used. This element
may be used to trigger
notification mechanisms
outside of XDW (e.g.,
IHE DSUB Profile).
This combined use is
not part of this profile
specification

ht:tOrganizationalEntitynotificationRecipients

Description

O

R

O

xs:dat
eTime

R

R

O

OASIS_WS
HumanTask

ht:tUser

R

RO

lastModifiedTime

OASIS_WS
HumanTask

xs:dateTime

R(Note 1)R

R

lastModifyBy

OASIS_WS
HumanTask

ht:tUser

O

R

R

activationTime

OASIS_WS
HumanTask

xs:dat
eTime

O

R

O

expirationTime

OASIS_WS
HumanTask

xs:dat
eTime

O

R

O

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Optionality
taskDetails
element

Standard

Data
Type

CreateView

UpdateisSkipable

OASIS_WS
HumanTask

xs:boo
lean

O

R

O

hasPotentialOwners

OASIS_WS
HumanTask

xs:boo
lean

O

O

O

startedByTimeExists

OASIS_WS
HumanTask

xs:boo
lean

X

X

X

completedByTimeExi
sts

OASIS_WS
HumanTask

xs:boo
lean

X

X

X

OASIS_WS
HumanTask

ht:tPresentationNa
me

O

O

O

O

O

O

xs:boo
lean

R

R

R

presentationName

presentationSubject

OASIS_WS
HumanTask

ht:tPresentationSubject

renderingMethodExists

OASIS_WS
HumanTask

hasOutput

OASIS_WS
HumanTask

xs:boo
lean

X

X

X

hasFault

OASIS_WS
HumanTask

xs:boo
lean

X

X

X

hasAttachments

OASIS_WS
HumanTask

xs:boo
lean

X

X

X

hasComments

OASIS_WS
HumanTask

xs:boo
lean

X

X

X

escalated

OASIS_WS
HumanTask

xs:boo
lean

O

R

O

searchBy

OASIS_WS
HumanTask

xs:str
ing

X

X

X

outcomeOASIS_WS
HumanTask

xs:str
ing

X

X

X

Description

Value shall be “false”___________________________________________________________________________
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Optionality
taskDetails
element

Standard

Data
Type

CreateView

UpdateparentTaskId

OASIS_WS
HumanTask

xs:any
URI

X

X

X

XDW prohibits use of
subTasks

hasSubTasksOASIS_WS
HumanTask

xs:boo
lean

X

X

X

XDW prohibits use of
subTasks.

3630

Description

Note 1: lastModifiedTime shall be the same as createdTime•<taskEventHistory>
Table 5.4.3-11: taskEventHistory ElementtaskEventHistory
element

taskEvent3635•

Standard

Data
Type

Optionality

OASIS_WSHumanTask

ht:task
Event_type

R

Description
See Table 5.4.3-12<taskEvent>
Table 5.4.3-12: taskEvent ElementtaskEventelement

Standard

Data
Type

Optionality

id

OASIS_WSHumanTask

xs:integer

ReventTimeOASIS_WSHumanTask

identifier

OASIS_WSHumanTask

principal

OASIS_WSHumanTask

xs:dateTimexs:anyU
RI
xs:string

Description

R
R
O___________________________________________________________________________
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taskEventelement

Data
TypeStandard
OASIS_WSHumanTask

ht:tTaskEventType

startOwner

OASIS_WSHumanTask

endOwner

OASIS_WSHumanTask

xs:string

statusOASIS_WSHumanTask

hasData

OASIS_WSHumanTask

Optionality

Description

R

The type of event that
happens that solicits themodification of the statusof the task (adding a newtaskEvent). It should bevalorized with one of thesetypes: create, stop,suspend, resume, fail,complete.
These types are defined in
the HumanTask
specification (C. WSHumanTask Data Types
Schema, <!-- Defines thehuman task event types ->).

eventTypeeventData
faultName

xs:string
ht:tStatus
xs:Boolean

OASIS_WSHumanTask

xs:anyT
ype

OASIS_WSHumanTask

xs:stri
ng

O
O
R
O

R2

This structure includes thedata elements that werechanged by this event.

O

5.4.4 Complete Example
3640

In the example in Figure 5.4.4-1 represents the XML of the XDW Workflow Document for theuse case described in ITI TF-1: 30.4.2.1. This example represents the complete Workflow
Document at the end of the process (see column C of ITI TF-1: Figure 30.4.2.2-1).
In this case there are two tasks:

3645

•

the first task has been created in status “COMPLETED” and so it has only one taskEventin the taskEventHistory;•

the second task ends the process in status “COMPLETED” and it has two taskEvent.

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3680

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3690

3695

3700

<?xml version="1.0" encoding="UTF-8"?><xdw:XDW.WorkflowDocument xmlns:hl7="urn:hl7-org:v3"
xmlns:ws-ht="http://docs.oasis-open.org/ns/bpel4people/wshumantask/types/200803"
xmlns:xdw="urn:ihe:iti:xdw:2011"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xsi:schemaLocation="urn:ihe:iti:xdw:2011 XDW-2014-12-23.xsd"><xdw:id root="1.2.3.4.5"/><xdw:effectiveTime value="20110401031520"/><xdw:confidentialityCode code="1.24.3.3.3"/><xdw:patient><xdw:id root="1.3.6.1.4.1.21367.13.20.1000" extension="33333"
assigningAuthorityName="IHERED"/></xdw:patient><xdw:author><xdw:assignedAuthor><hl7:id root="1.2.3.4.5" extension="11111"/><hl7:assignedPerson><hl7:name><hl7:family>Blum</hl7:family><hl7:prefix>Dr.</hl7:prefix></hl7:name></hl7:assignedPerson></xdw:assignedAuthor></xdw:author><xdw:workflowInstanceId>1.2.3.4</xdw:workflowInstanceId><xdw:workflowDocumentSequenceNumber>3</xdw:workflowDocumentSequenceNumber><xdw:workflowStatus>CLOSED</xdw:workflowStatus><xdw:workflowStatusHistory><xdw:documentEvent><xdw:eventTime>2011-03-28T10:00:12.0Z</xdw:eventTime><xdw:eventType>create</xdw:eventType><xdw:taskEventIdentifier>urn:oid:1.2.3.4.5</xdw:taskEventIdentifier><xdw:author>Mr. Rossi</xdw:author><xdw:previousStatus/><xdw:actualStatus>OPEN</xdw:actualStatus></xdw:documentEvent><xdw:documentEvent><xdw:eventTime>2011-04-01T03:15:20.0Z</xdw:eventTime><xdw:eventType>complete</xdw:eventType><xdw:taskEventIdentifier>urn:oid:1.2.3.4.7</xdw:taskEventIdentifier><xdw:author>Dr. Brum</xdw:author><xdw:previousStatus>OPEN</xdw:previousStatus><xdw:actualStatus>CLOSED</xdw:actualStatus></xdw:documentEvent></xdw:workflowStatusHistory><xdw:workflowDefinitionReference>urn:oid:1.2.3.4.5.6.7.8.9</xdw:workflowDefinitionReference><xdw:TaskList>___________________________________________________________________________
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<xdw:XDWTask><xdw:taskData><ws-ht:taskDetails><ws-ht:id>1</ws-ht:id><ws-ht:taskType>Requested</ws-ht:taskType><ws-ht:name>ReferralRequested</ws-ht:name><ws-ht:status>COMPLETED</ws-ht:status><ws-ht:actualOwner>Mr. Rossi</ws-ht:actualOwner><ws-ht:createdTime>2011-03-28T10:00:12.0Z</wsht:createdTime><ws-ht:createdBy>Mr. Rossi</ws-ht:createdBy><ws-ht:lastModifiedTime>2011-03-28T10:00:12.0Z</wsht:lastModifiedTime><ws-ht:renderingMethodExists>false</wsht:renderingMethodExists></ws-ht:taskDetails><ws-ht:description>Request for a specialist visit</wsht:description><ws-ht:input/><ws-ht:output/></xdw:taskData><xdw:taskEventHistory><xdw:taskEvent><xdw:id>101</xdw:id><xdw:eventTime>2011-03-28T10:00:12.0Z</xdw:eventTime><xdw:identifier>urn:oid:1.2.3.4.5</xdw:identifier><xdw:eventType>create</xdw:eventType><xdw:status>COMPLETED</xdw:status></xdw:taskEvent></xdw:taskEventHistory></xdw:XDWTask><xdw:XDWTask><xdw:taskData><ws-ht:taskDetails><ws-ht:id>2</ws-ht:id><ws-ht:taskType>Referral Referred</ws-ht:taskType><ws-ht:name>Referred</ws-ht:name><ws-ht:status>COMPLETED</ws-ht:status><ws-ht:actualOwner>Dr. Brum</ws-ht:actualOwner><ws-ht:createdTime>2011-03-29T09:20:01.0Z</wsht:createdTime><ws-ht:createdBy>Dr. Brum</ws-ht:createdBy><ws-ht:lastModifiedTime>2011-04-01T03:15:20.0Z</wsht:lastModifiedTime><ws-ht:renderingMethodExists>false</wsht:renderingMethodExists></ws-ht:taskDetails><ws-ht:description>Specialist visit</ws-ht:description><ws-ht:input><!-- one part element for each document in input --><ws-ht:part name="eReferralDoc1"><ws-ht:attachmentInfo><ws-ht:identifier>1.2.3.4.56.7.78</ws-___________________________________________________________________________
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ht:identifier><ws-ht:name>eReferralDoc1</ws-ht:name><ws-ht:accessType>urn:ihe:iti:
xdw:2011:XDSregistered</ws-ht:accessType><ws-ht:contentType>application/pdf</wsht:contentType><wsht:contentCategory>http://www.iana.org/assignments/media-types</wsht:contentCategory><ws-ht:attachedTime>2011-0401T03:15:20.0Z</ws-ht:attachedTime><ws-ht:attachedBy>Dr. Brum</ws-ht:attachedBy><xdw:homeCommunityId>urn:oid:1.2.3.4.5</xdw:homeCommunityId></ws-ht:attachmentInfo><!--eReferralDoc1--></ws-ht:part></ws-ht:input><ws-ht:output><!-- one documentReference element for each document in
input -->
<ws-ht:part name="ChildWorkflow"><ws-ht:attachmentInfo><ws-ht:identifier>1.2.3.4.12312.34</wsht:identifier><ws-ht:name>ChildWorkflow</ws-ht:name><wsht:accessType>urn:ihe:iti:xdw:2013:workflowInstanceId</ws-ht:accessType><ws-ht:contentType>application/xml</wsht:contentType><wsht:contentCategory>http://www.iana.org/assignments/media-types</wsht:contentCategory><ws-ht:attachedTime>2011-04-01T03:15:20.0Z</wsht:attachedTime><ws-ht:attachedBy>Dr. Brum</ws-ht:attachedBy></ws-ht:attachmentInfo></ws-ht:part></ws-ht:output></xdw:taskData><xdw:taskEventHistory><xdw:taskEvent><xdw:id>201</xdw:id><xdw:eventTime>2011-03-29T09:20:01.0Z</xdw:eventTime><xdw:identifier>urn:oid:1.2.3.4.6</xdw:identifier><xdw:eventType>create</xdw:eventType><xdw:status>IN_PROGRESS</xdw:status></xdw:taskEvent><xdw:taskEvent><xdw:id>202</xdw:id><xdw:eventTime>2011-04-01T03:15:20.0Z</xdw:eventTime><xdw:identifier>urn:oid:1.2.3.4.7</xdw:identifier><xdw:eventType>complete</xdw:eventType>___________________________________________________________________________
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3810<xdw:status>COMPLETED</xdw:status></xdw:taskEvent></xdw:taskEventHistory></xdw:XDWTask></xdw:TaskList></xdw:XDW.WorkflowDocument>

Figure 5.4.4-1: Sample XDW Workflow Document3815

5.4.5 Workflow Document Management
5.4.5.1 Workflow Document Lifecycle Management
The Cross-Enterprise Document Workflow Profile takes advantage of the lifecycle managementof XDS when used in an XDS environment.

3820

3825

A Workflow Document shall be created and be assigned a workflow identifier. The initial
document shall include at least one task on the TaskList, and have a workflowStatus of OPEN.
The Workflow Document is updated when:•

The information about a task is modified. This may be due to a change in some other task
related information like updating the output information.

•

A new task is added to the <TaskList>.

•

The workflow status is changed to CLOSED.

Each update shall be done using the XDS Document Replace when in an XDS environment. The
series of steps to be taken is:•

Update the XDW document to reflect the desired changes. This is often replacement of
the <TaskData>. It may also be a change by adding a new task to the <TaskList> ora new <taskEvent> to a Task.

•

Use the XDS Replace operation to replace the old document with this modified
document. This replacement document shall carry the same workflow identifier as theoriginal Workflow Document.

•

It is possible that a document replace will be rejected by the XDS Document Registry if
another actor has also done a replace in the time since the Workflow Document instancewas obtained. In this case (attempting to replace a document already replaced), the XDWDocument Creator or Updater shall obtain the most recent version of the Workflow
Document which was updated by another XDW actor, consider the evolution of theworkflow, and performed a new content update. This kind of race condition should bevery rare because updating is much faster than the rate at which people perform tasks. If
certain workflows definitions require reducing the likelihood of such race conditions, one
should consider placing in the Workflow Description one or more tasks "In Progress" andrequiring that other actor wait while such tasks are in-progress.

3830

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3840

When using XDR or XDM, the receiving actor shall perform an equivalent local update process.
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When an XDW actor decides that a workflow status code shall be placed in a CLOSED status, afinal update to set the workflow status code to CLOSED shall be performed. The specific rules
for determining when and which XDW actors are allowed or should set the workflow status code
to CLOSED are not specified by the XDW Profile. They may be determined within the
Workflow Definition. XDW Content Consumer and Content Updater Actors shall support themeans to query for Workflow Documents that are in a workflow status OPEN.
This profile does not further constrain the rules for document lifecycle management, but a
specific Workflow Definition may add requirements requiring that certain kinds of tasks becreated initially, restricting the kinds of tasks that can be added, and requiring that updates be
performed for specific task changes.

3855

5.4.5.2 Associations Types
A clinical document can be referenced by many Workflow Documents in different steps and for
different reasons. When the content of a Workflow Document is known, the related clinicaldocuments are always reached through the references (DocumentEntry.uniqueId andhomeCommunityId) tracked inside the different task in the “input" and “output” elements.

3860

The use of a workflow identifier is necessary to have a fixed id to identify the whole workflow.
Since the Workflow Document will be replaced many times (it is replaced at each step), itsDocumentEntry.uniqueId metadata attribute is not useful for maintaining a fixed reference. The
document uniqueId of each of the successive XDW documents can be used to identify aparticular state of the workflow.

3865

XDW uses a workflow identifier stored in the DocumentEntry.referenceIdList metadata attributeof each workflow document to group all versions of the workflow document.

3870

•

The Content Creator shall create a workflow identifier, as an OID, when a new workflow
is created.

•

The Content Creator shall create a single value in DocumentEntry.referenceIdList
containing the workflow identifier. Only the CXi.1 and CXi.5 component shall bepresent.
An example workflow identifier in DocumentEntry.referenceIdList is:
2.16.840.1^^^^urn:ihe:iti:xdw:2013:workflowInstanceId

3875

•

The Content Updater shall use the same value for the workflow identifier when it createsa new version of the Workflow Document.

Since every version of the Workflow Document replaces the previous, there is always one andonly one approved document with a given workflow identifier.

3880

If a workflow generates another workflow there shall be two different workflow identifiers, one
for each workflow. The relationship between the different workflows is always guaranteed to beinside the Workflow Documents using the DocumentEntry.referenceIdList as output of the taskof the parent Workflow Document and as the input of the first task in the child Workflow
Document.
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5.4.5.3 Create workflow
When the first step of a new workflow is completed, the XDW Content Creator shall:
3885•

create the first version of the Workflow Document.

Then the XDW Content Creator shall use Provide and Register Document Set-b [ITI-41] (in thecase of XDS):•
3890

submit the Workflow Document to the XDS Document Repository, using a newworkflow identifier in the document’s DocumentEntry.referencedIdList metadata
attribute, using Provide and Register Document Set-b [ITI-41].

5.4.5.4 Update Workflow Document
For each subsequent step in the Workflow an XDW Content Updater shall:•obtain the most recent version of the Workflow Document, the only version approved
with the specific workflow identifier in the DocumentEntry.referenceIdList (e.g., using agrouped XDS Document Consumer)•

update the content in the Workflow Document (by adding a new task or updating an
existing task with a new <taskEvent>);•

re-register (update) the Workflow Document by performing a document replace (e.g., in a
XDS environment using a grouped XDS Document Source).

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3900

This new version of the workflow document has the same workflow identifier as the previous
version.
In a Document Sharing infrastructure (e.g., an XDS environment) two different Content
Updaters could be in the situation of race condition when both update, in the same time, the same
Workflow Document.

3905

In this case two actors (Content Updater A and Content Updater B) retrieve the same Workflow
Document (e.g., Workflow Document with document uniqueId 1) and change it.
Content Updater A publishes a new version updated with a new document uniqueId (e.g.,document uniqueId 2) and the previous version (with document uniqueId 1) is deprecated..

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When Updater Creator B tries to replace the same Workflow Document (document uniqueId 1)
with his updated version this transaction generates an error because the document uniqueId 1 isdeprecated and replaced with document uniqueId 2.
Content Updater B shall retrieve the current version of the Workflow Document (document
uniqueId 2) and update it with a new version of the document with document uniqueId 3.
5.4.5.5 Association of a clinical document to a task and <taskEvent>3915

Any clinical documents included as input or output documents within the taskData element thatare registered in an XDS Document Registry shall be referenced using uniqueId andhomeCommunityId of the Clinical Document referenced.
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5.4.5.6 Get the Workflow Document and a clinical document associated to theworkflow
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The most recent version of the Workflow Document may be retrieved at any point during theworkflow.
The version of the Workflow Document with an approved status contains the most current
information on the workflow and its tasks. So an XDW Content Consumer needs to analyze only
the approved version to get all current information.

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Any Workflow Document contains details of each task that has been performed. A task or<taskEvent> includes the references (DocumentEntry.uniqueId and homeCommunityId) tozero or more input and/or output clinical documents. These documents may be obtained bymeans of XDS, or should be included along with the Workflow Document if XDR or XDM is
used.

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5.4.5.7 Use of the eventCodeList to manage the status of a Workflow Document
An overall workflow status is required to be set by each author of a new step. This value is either
OPEN or CLOSED.
This workflow status is required to be present in every workflow step, and shall take either thevalue OPEN or CLOSED.

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By setting this workflow status to OPEN, a step author indicates that, for the workflow definition
and the step author further steps are expected to be performed.
By setting this workflow status to CLOSED, a step author indicates that, for the workflow
definition and the step author no further steps are expected to be performed.
This workflow status shall be present for all XDW documents in its eventCodeList metadata.

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This use of workflow status enables the use of query to locate OPEN or CLOSED workflows
with certain other properties.
The EventCodeList contains the workflow status with two possible code values: either OPEN or
CLOSED.
5.4.5.8 Parameters for Required Queries

3945

The section below documents some examples of the possible queries in an XDS environment(defined in the Registry Stored Query [ITI-18] transaction) to obtain the different documents
related to the workflow from some parameters available:•

Find all open Workflow Documents for a patient
A Registry Stored Query “FindDocuments” maybe used with patientId, XDW document
formatCode and eventCodeList with the value “urn:ihe:iti:xdw:2011:eventCode:open”
for the Workflow Document.

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Find all particular type of open Workflow Documents for a patient___________________________________________________________________________
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formatCode, eventCodeList with the value “urn:ihe:iti:xdw:2011:eventCode:open” forthe Workflow Document and a specific XDW document typeCode.

3955•

Get one or more documents referenced in a Workflow Document
A Registry Stored Query “FindDocuments” which retrieves the Workflow Document(like in the first example) and a Registry Stored Query “GetDocuments” with document
uniqueId and homeCommunityId to retrieve one or more documents referenced inside theWorkflow Document.

3960•

Find the latest version of a Workflow Document for a given workflow identifier
A Registry Stored Query “FindDocumentsByReferenceId” may be used with patientId
and the workflow identifier.

5.4.6 XDS Metadata3965

5.4.6.1 Document Metadata
The following metadata elements shall be used to describe the Workflow Document in an XDS
Affinity Domain. The XDW Profile does not introduce new metadata and all the metadata
elements used are the common Document Sharing specified in Section 4.2.3.2.
Table 5.4.6.1-1: XDW Constraints for Document Metadata Attributes
DocumentEntry Attribute

XDW Constraints

authorRepresents the humans and/or machines that authored the
document.
In the Workflow Document the Author is the human and/or
machine which most recently updated the Workflow Document.
This means that when a Workflow Document is updated by adifferent person or machine, the author changes.

authorInstitution (sub-attribute of
author)No special requirements for Workflow Document

authorPerson (sub-attribute of author)

No special requirements for Workflow Document

authorRole (sub-attribute of author)

No special requirements for Workflow Document

authorSpecialty (sub-attribute of
author)No special requirements for Workflow Document

availabilityStatus

No special requirements for Workflow DocumentclassCodeThis code is specified by the XDS Affinity Domain. The XDS
Affinity Domain should specify a code for non-clinical Workflow
Management documents.

comments

No special requirements for Workflow Document

confidentialityCode

No special requirements for Workflow Document

creationTime

No special requirements for Workflow Document

entryUUID

No special requirements for Workflow Document___________________________________________________________________________
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DocumentEntry Attribute
eventCodeList

XDW Constraints
For a Workflow Document, one code of this list shall be used todefine the overall status of the workflow. This code shall have oneof the following two values:••

code: urn:ihe:iti:xdw:2011:eventCode:open
codingScheme: 1.3.6.1.4.1.19376.1.2.3

code: urn:ihe:iti:xdw:2011:eventCode:closed
codingScheme: 1.3.6.1.4.1.19376.1.2.3(See Section 5.4.5.7.)
formatCode

hash

Each XDW Workflow Document shall have the following value forthe formatCode attribute:
code: urn:ihe:iti:xdw:2011:workflowDoc
codingScheme: 1.3.6.1.4.1.19376.1.2.3
No special requirements for Workflow Document

healthcareFacility
TypeCode

No special requirements for Workflow Document

homeCommunityId

No special requirements for Workflow Document

languageCode

No special requirements for Workflow Document

legalAuthenticator

No special requirements for Workflow Document

mimeType

No special requirements for Workflow Document

patientId

No special requirements for Workflow Document

practiceSettingCodeNo special requirements for Workflow Document

referenceIdList

Contains the workflow identifier.
Only a single value shall be sent in this list.
Only the CXi.1 and CXi.5 components shall be used:
CXi.1 shall contain same value as
XDW.WorkflowDocument.workflowInstanceId
CXi.5 shall contain
urn:ihe:iti:xdw:2013:workflowInstanceId.

repositoryUniqueId

No special requirements for Workflow Document

serviceStartTime

Shall be the starting time the service being documented took place
For the Workflow Document the serviceStartTime is the time atwhich work began on the earliest task for this workflow.
If present, shall have a single value.

serviceStopTime

No special requirements for Workflow Document

size

No special requirements for Workflow Document

sourcePatientId

No special requirements for Workflow Document

sourcePatientInfo

No special requirements for Workflow Document

title

No special requirements for Workflow Document

typeCode

For Workflow Documents defined by an IHE profile, the profile
specifies the value of typeCode used. For other Workflow
Documents defined in the XDS Affinity Domain, the XDS Affinity
Domain specifies the value for typeCode.

uniqueId

No special requirements for Workflow Document___________________________________________________________________________
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DocumentEntry Attribute
URI

XDW Constraints
No special requirements for Workflow Document

3970
5.4.6.2 XDS SubmissionSet Metadata
No additional constraints. See Section 4.2.3.3.
5.4.6.3 XDS Folder Metadata
No additional constraints
3975

5.5

Document Digital Signature (DSG) Document Content

Document Digital Signature content shall conform to XAdES schema for signatures, withextensions and restrictions defined in the following. IHE is not changing any optionality,
prohibiting use of options, or mandating options. Issues such as long term archival managementof certificates are out of scope of this profile.
3980

5.5.1 References
5.5.1.1 Normative References[XAdES]: XML Advanced Electronic Signatures XAdES http://www.w3.org/TR/XAdES/ -aka. ETSI TS 101 903

3985

3990

[W3C XMLDSIG] XML-Signature Syntax and Processing. W3C Recommendation. Donald
Eastlake, Joseph Reagle, David Solo. February 2002. http://www.w3.org/TR/2002/RECxmldsig-core-20020212/[ASTM-E1762-05]ASTM E1762-95(2013) – Standard Guide for the Authentication of HealthCare Information http://www.astm.org/cgibin/SoftCart.exe/STORE/filtrexx40.cgi?U+mystore+odvl4256+L+ASTM:E1762+/usr6/htdocs/astm.org/DATABASE.CART/REDLINE_PAGES/E1762.htm
5.5.1.2 Informative References

3995

4000

[ETSI TS 201 733] ETSI TS 201 733 Sections C.3.1 and C.3.2; Electronic Signatures andInfrastructures and (ESI)Electronic Signature Formats
http://webapp.etsi.org/WorkProgram/Report_WorkItem.asp?WKI_ID=8179&curItemNr=1&tota
lNrItems=1&optDisplay=10&qSORT=REFNB&qETSI_NUMBER=201+733&qINCLUDE_SU
B_TB=True&qINCLUDE_MOVED_ON=&qSTOP_FLG=N&butExpertSearch=Search&includ
eNonActiveTB=FALSE&qREPORT_TYPE=SUMMARY[ASTM-E1985] E1985-98 -- Standard guide for user authentication and authorization
http://www.astm.org/cgibin/SoftCart.exe/DATABASE.CART/REDLINE_PAGES/E1985.htm?E+mystore___________________________________________________________________________
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IHE IT Infrastructure Technical Framework, Volume 3 (ITI TF-3): Cross-Transaction andContent Specifications______________________________________________________________________________[ASTM-E2212] ASTM E2212 – Standard Practice for Healthcare Certificate Policy
http://www.astm.org/cgi-bin/SoftCart.exe/STORE/filtrexx40.cgi?U+mystore+odvl4256+L+ASTM:E2212+/usr6/htdocs/astm.org/DATABASE.CART/REDLINE_PAGES/E2212.htm
4005

4010

[ASTM-E2084] ASTM E2084 – Standard Specification for the Authentication of Healthcare
Information using Digital Signatures http://www.astm.org/cgibin/SoftCart.exe/STORE/filtrexx40.cgi?U+mystore+odvl4256+L+ASTM:E2084+/usr6/htdocs/astm.org/DATABASE.CART/REDLINE_PAGES/E2084.htm[ISO17090 (1,2,3)] ISO/TS 17090 – Health Informatics Digital Signatures for Healthcare
http://www.iso.org/iso/en/CatalogueDetailPage.CatalogueDetail?CSNUMBER=35489&ICS1=3
5&ICS2=240&ICS3=80[ISO 21091]ISO/TS 21091- Health Informatics – Directory Services for Security,
Communications, and Identification of Professionals and Patients
http://www.iso.org/iso/en/CatalogueDetailPage.CatalogueDetail?CSNUMBER=35647&scopelist=PROGRAMME

4015[IETF RFC3280] IETF/RFC3280 regarding X.509v3 PKIX Private Key Infrastructure
RFC3280 http://www.faqs.org/rfcs/rfc3280.html
5.5.2 Signature Specification
The following constraints define the Digital Signature block. This block is common to thedetached signature and Enveloping signature.

4020

4025

4030

4035

•

Shall conform to XAdES-X-L – for support of Long Term signatures. The XAdES-X-L
specification adds the timestamp of the signing and inclusion of the certificate andstatement of revocation.

•

Shall use the hash algorithm sha256.

•

Shall use the canonicalization algorithm “Canonical XML 1.1 with Comments”(http://www.w3.org/2006/12/xml-c14n11#WithComments).

•

The policy may be identified as urn:ihe:iti:dsg:detached:2014 when the signature
document is a Detached Signature and urn:ihe:iti:dsg:enveloping:2014 when thesignature document is an Enveloping Signature to indicate that the signature documentcomplies with the DSG Profile.

•

Shall include a “CommitmentTypeIndication” element for the Purpose(s) of Signature(aka purposeOfSignature). The Purpose can be the action being attested to, or the roleassociated with the signature. The value shall come from ASTM E1762-95(2013) andreproduced in Table 5.5.2-1. Where a coding scheme is needed the value“1.2.840.10065.1.12” shall be used.

Note that Content Creators and Content Consumers should be capable of being configured toother conformance policies to support local policy. For example some environments may choosea different XAdES profile, hashing algorithm, policy identifier, or signature purpose vocabulary.
Content Creators would thus create Digital Signature blocks that are not conformant to this___________________________________________________________________________
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profile. Content Consumers can validate these Digital Signature blocks, and be capable ofconfigured behavior according to the local policy.
Table 5.5.2-1: Digital Signature Purposes from ASTM E1762-95(2013)
Code

Term

Definition

1.2.840.10065.1.12.1.1

Author’s
Signature

The signature of the primary or sole author of a health information
document. There can be only one primary author of a healthinformation document.

1.2.840.10065.1.12.1.2

Co-Author’s
Signature

The signature of a health information document co-author. There canbe multiple co-authors of a health information document.

1.2.840.10065.1.12.1.3

Co-participant’s
Signature

The signature of an individual who is a participant in the healthinformation document but is not an author or co-author. (e.g., asurgeon who is required by institutional, regulatory, or legal rules tosign an operative report, but who was not involved in the authorship ofthat report.)

1.2.840.10065.1.12.1.4

Transcriptionist/R
ecorder Signature

The signature of an individual who has transcribed a dictated
document or recorded written text into a digital machine -readable
format.

1.2.840.10065.1.12.1.5

Verification
Signature

A signature verifying the information contained in a document. (e.g., aphysician is required to countersign a verbal order that has previously
been recorded in the medical record by a registered nurse who has
carried out the verbal order.)1.2.840.10065.1.12.1.6

Validation
Signature

A signature validating a health information document for inclusion in
the patient record. (e.g., a medical student or resident is credentialed toperform history or physical examinations and to write progress notes.
The attending physician signs the history and physical examination tovalidate the entry for inclusion in the patient’s medical record.)

1.2.840.10065.1.12.1.7

Consent Signature

The signature of an individual consenting to what is described in ahealth information document.

1.2.840.10065.1.12.1.8

Signature Witness
Signature

The signature of a witness to any other signature.

1.2.840.10065.1.12.1.9

Event Witness
Signature

The signature of a witness to an event. (Example the witness has
observed a procedure and is attesting to this fact.)

1.2.840.10065.1.12.1.10

Identity Witness
Signature

The signature of an individual who has witnessed another individual
who is known to them signing a document. (e.g., the identity witness is
a notary public.)

1.2.840.10065.1.12.1.11

Consent Witness
Signature

The signature of an individual who has witnessed the health careprovider counselling a patient.

1.2.840.10065.1.12.1.12

Interpreter
Signature

The signature of an individual who has translated health careinformation during an event or the obtaining of consent to a treatment.

1.2.840.10065.1.12.1.13

Review Signature

The signature of a person, device, or algorithm that has reviewed orfiltered data for inclusion into the patient record. (e.g., (1) a medical
records clerk who scans a document for inclusion in the medical
record, enters header information, or catalogues and classifies the data,or a combination thereof; (2) a gateway that receives data from anothercomputer system and interprets that data or changes its format, or both,
before entering it into the patient record.)___________________________________________________________________________
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Code

Term

Definition

1.2.840.10065.1.12.1.14

Source Signature

The signature of an automated data source. (e.g., (1) the signature for
an image that is generated by a device for inclusion in the patient
record; (2) the signature for an ECG derived by an ECG system forinclusion in the patient record; (3) the data from a biomedical
monitoring device or system that is for inclusion in the patient record.)

1.2.840.10065.1.12.1.15

Addendum
Signature

The signature on a new amended document of an individual who hascorrected, edited, or amended an original health information document.
An addendum signature can either be a signature type or a signature
sub-type (see ASTM E1762-Section 8.1). Any document with anaddendum signature shall have a companion document that is theoriginal document with its original, unaltered content, and original
signatures. The original document shall be referenced via an attributein the new document, which contains, for example, the digest of theold document. Whether the original, unaltered, document is always
displayed with the addended document is a local matter, but theoriginal, unaltered, document must remain as part of the patient recordand be retrievable on demand.

1.2.840.10065.1.12.1.16

Modification
Signature

The signature on an original document of an individual who has
generated a new amended document. This (original) document shallreference the new document via an additional signature purpose. Thisis the inverse of an addendum signature and provides a pointer fromthe original to the amended document.

1.2.840.10065.1.12.1.17

Administrative(Error/Edit)
Signature

The signature of an individual who is certifying that the document isinvalidated by an error(s), or is placed in the wrong chart. An
administrative (error/edit) signature must include an addendum to the
document and therefore shall have an addendum signature sub-type(see ASTM E1762-Section 8.1). This signature is reserved for thehighest health information system administrative classification, since it
is a statement that the entire document is invalidated by the error andthat the document should no longer be used for patient care, although
for legal reasons the document must remain part of the permanentpatient record.

1.2.840.10065.1.12.1.18

Timestamp
Signature

The signature by an entity or device trusted to provide accurate
timestamps. This timestamp might be provided, for example, in thesignature time attribute.

5.5.3 Detached Signature
4045

4050

The Detached Signature utilizes the XML Signature - Reference element (ds:reference) to
identify and provide a hash for each document that is signed. This set of Reference elements is
considered the manifest. The URI type shall be used and hold the document uniqueID. Using theData Type “OID URN” form to encode the DocumentEntry.uniqueId. See Table 4.2.3.1.7-2. For
example, the OID “1.3.6.1.4.1.21367.2005.3.7” would be encoded as“urn:oid:1.3.6.1.4.1.21367.2005.3.7”.
5.5.3.1 SubmissionSet Signature
The SubmissionSet Signature is a variant of the Detached Signature used to digitally sign acomplete SubmissionSet. The signature can later be validated to assure that the SubmissionSet iscomplete and the same as when it was created.
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a. the SubmissionSet uniqueID with a hash value of “0”b. the document uniqueID for each of the documents contained in the SubmissionSet notincluding the SubmissionSet Signature document

4060

The SubmissionSet Signature creation is informatively described here with the Content Creatorgrouped with an XDS Document Source and is equally applicable with grouping the Content
Creator with the other Document Sharing infrastructure (e.g., XDR, and XDM). The document
publication transaction is not specific to the SubmissionSet Signature process or content, and isincluded here only to show overall workflow.
Informative process for creating a SubmissionSet Signature:
1. A set (n) of Documents of interest are gathered, or generated to be published4065

2. A SubmissionSet is created for the Documents, for example in preparation for using theProvide and Register Document Set-b [ITI-41] transaction or equivalent
3. A Digital Signature document is created which includes Reference elements of:a. The SubmissionSet.uniqueId is included in the manifest, with a zero hash value (thevalue “0”).

4070

b. All of the (n) documents to be included in the SubmissionSet, other than the signature
document, are listed in the manifest with their hash.
c. The signature document is processed according to Section 5.5.2, and thus signed.

4075

4080

4. The signature document would be added to the SubmissionSet according to Section 5.5.6.
The SubmissionSet may, but is not required, include all the “SIGNS” association definedin Section 5.5.6.4 with associations to all the other documents in the SubmissionSet. The“SIGNS” association is redundant in this case as the SubmissionSet already groups these
documents.
5. The SubmissionSet with the (n) documents and the Digital Signature document is
submitted using the Provide and Register Document Set-b [ITI-41] transaction, or
equivalent from the other Document Sharing infrastructures.
5.5.4 Enveloping Signature
The Enveloping Signature utilizes the XML Signature – “Include” capability where the fullcontent of the signed document is encoded inside the signature document in the Object element(ds:object).

4085

The signed document shall be base64 encoded, unless some other policy overrides.
The object element Encoding shall be specified (http://www.w3.org/2000/09/xmldsig#base64).
5.5.5 Signature Verification
There are three levels of signature verification:___________________________________________________________________________
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1. verifying that the Digital Signature block itself has integrity through verifying thesignature across the XML-Signature,
2. confirming that the signer was authentic, not revoked, and appropriate to the signature
purpose,
3. confirming that the signed Documents of interest are unmodified using the hashalgorithm.

4095

The Content Consumer shall verify the Digital Signature block has integrity.
The Content Consumer shall be able to be configured with local policy on PKI trust models, andmanagement that supports the confirmation that the signer was authentic, not revoked, andappropriate to the signature purpose. The Content Consumer shall use this configuration when
confirming the validity of the signature.

4100

4105

4110

The Content Consumer shall be able to confirm the validity of the documents that are signed.
•

Workflow or local policy may direct that all or a subset of the signed documents bevalidated. There are use cases where only one document within a signed set of documents
is all that is called for by the workflow.

•

The document may not be accessible to the user, for example authorization denied, so
confirmation of valid signed content may be impossible.

•

If there is a SubmissionSet unique ID included in the manifest, then the Content
Consumer shall be able to verify that the submission set reference in the manifest is theone containing the documents which are listed in the manifest and the documents listed in
the manifest are the complete list of documents in the submission set on the XDS
Registry.

The decision on what degree of verification is needed is determined by the application and use
case.
The Content Consumer shall be able to validate content that uses SHA256 as well as SHA1.
5.5.6 Document Sharing Metadata
4115

This section applies when the Content Creator or Content Consumer is utilizing a Document
Sharing Profile for transport. This section defines the source for all required Document Sharing
attributes and as many optional attributes as makes sense for implementers’ applications.
5.5.6.1 Document Sharing – DocumentEntry Metadata
The Signature Document shall have a compliant DocumentEntry with the following constraints:

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5.5.6.1.1 XDSDocumentEntry.formatCode
The XDSDocumentEntry.formatCode shall be urn:ihe:iti:dsg:detached:2014 when thesignature document is a Detached Signature and urn:ihe:iti:dsg:enveloping:2014 when the___________________________________________________________________________
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signature document is an Enveloping Signature. The formatCode codeSystem shall be
1.3.6.1.4.1.19376.1.2.3.
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5.5.6.1.2 XDSDocumentEntry.classCode
Shall be urn:oid:1.3.6.1.4.1.19376.1.2.1.1.1
Coding scheme= URN
code value = urn:oid:1.3.6.1.4.1.19376.1.2.1.1.1
Code value display name = “Digital Signature”

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5.5.6.1.3 XDSDocumentEntry.typeCode
Where policy does not define a workflow specific typeCode, the following code should be used:
Coding schema = “ASTM”
Code value = “E1762”
Code value display name = ”Full Document”

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5.5.6.1.4 XDSDocumentEntry.author
The author should represent the signer.
5.5.6.1.5 XDSDocumentEntry.eventCodeList
The eventCodeList shall contain the signature Purpose(s) from the Digital Signature block“CommitmentTypeIndication” element, using Table 5.5.2-1.

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5.5.6.1.6 XDSDocumentEntry.mimeType
Shall be “text/xml”
5.5.6.1.7 XDSDocumentEntry.title
Should be the same as the display name for the signature purpose
5.5.6.1.8 XDSDocumentEntry.language

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The language of the signature content shall be ‘art’ as in “artificial”.
5.5.6.2 Document Sharing – SubmissionSet MetadataThis document content profile makes no changes to the structure of Submission Sets.
5.5.6.3 Document Sharing - Folder MetadataThis document content profile makes no changes to the structure of Folders.

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5.5.6.4 Document Associations
When Detached Signature Option is used, the Content Creator shall use the “SIGNS”
associationType Document Relationship to associate the signature (sourceObject) to the
documents that it signs (targetObjects). See Section 4.2.2.

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When SubmissionSet Signature Option is used, the Content Creator may use the “SIGNS”
associationType Document Relationship to associate the signature (sourceObject) to the
documents that it signs (targetObjects). See Section 4.2.2.
5.5.7 Security Considerations
See XAdES specification for risk assessment and mitigation plan on Digital Signatures.
5.5.7.1 Content Creator

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When Content Creator is grouped with an ATNA Secure Node or Secure Application, shallcreate an Audit Message indicating the Signature Creation event.
Field Name
Event

AuditMessage/
EventIdentification

Opt

Value Constraints

EventID

M

EV(113031, DCM, “Signed Manifest”)

EventActionCodeM“C” (Create)

EventDateTimeM

not specialized

EventOutcomeIndicatorM

not specialized

EventTypeCode

M

EV(“urn:ihe:iti:dsg”, “IHE Transactions”, “Document Digital
Signature”)

Audit Source (Content Consumer) (1)
ActiveParticipant (User/System that requested Signature Creation) (0..n)
ActiveParticipant (Patient indicated in the Signature Document) (0..n)ParticipantObjectIdentification (Digital Signature Document) (1)5.5.7.2 Content Consumer
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When Content Consumer is grouped with an ATNA Secure Node or Secure Application, shallcreate an Audit Message indicating the Signature Verification event.
Field Name
Event

AuditMessage/
EventIdentification

Opt

Value Constraints

EventID

M

EV(110007, DCM, “Report Verification”)

EventActionCodeM“R” (Read)

EventDateTimeM

not specialized

EventOutcomeIndicatorM

not specialized

EventTypeCode

M

EV(“urn:ihe:iti:dsg”, “IHE Transactions”, “Document Digital
Signature”)

Audit Source (Content Consumer) (1)
ActiveParticipant (User/System that requested Signature Validation) (0..n)___________________________________________________________________________
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ActiveParticipant (Patient indicated in the Signature Document) (0..n)ParticipantObjectIdentification (Digital Signature Document) (1)___________________________________________________________________________
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