High level explanation of how you would "attach" nondiscrete documents to a patient record?

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I am looking for a general overview of how you would attach a document to a patient record in healthshare.  For instance, an Advance Directive or Living Will.

 

Here are some starter questions:

  1. What format is required, if any?  Can it be a PDF or DOC?
  2. How can/should it be submitted?  HL7? XDS.b?  Embedded in a CCD?

Sorry for the open endedness.  Any info would be helpful while I research this.

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Answers

It might help if you were more specific. What do you mean by "attach"? How are you going to retrieve the documents? Where are the documents coming from?

From another EHR or from the Clinical Viewer.  As you know, we are an HIE.

Hi Scott,

One way you could do this is via an MDM^T02 HL7 message.  There is actually an example message containing a PDF document distributed with HealthShare: <install-directory>\Data\Scenario_4.hl7

The document data is encapsulated in a series of OBX segments:

OBX||ED|||^^PDF^Base64^JVBERi0xLjINCiXi48/TDQolICAgICAgICAgIA0KJTEwMDIzMFszMl0NCjEgMCBvYmogDTw8DQov

The critical pieces of this are:

OBX-2: Must be "ED" for "Encapsulated Data"

OBX-5.3: Must be the file type.  In this case it's "PDF".  If you want to view this document in the HealthShare Clinical Viewer, then you can find a list of supported doc types at websys.Document:ValidTypes in the Access Gateway namespace.

OBX-5.4: Must be "Base64" if the data is base64-encoded, otherwise it can be left blank.

OBX-5.5: The document data

 

Best,

Jorge

This is interesting and I will consider.  Do you know of any HL7 v3 options?

I suspect this can be done in v3, but I will have to defer to my colleagues who are experts on it.

In the UK the answer was HL7v3 ITK Non-Coded CDA Document, though I think FHIR may be an option.