TEST: OHIE-CR-08-FHIR

Patient Merges

This test ensures that the client registry properly handles merge requests sent by patient identity sources using the PMIR merge mechanism described in IHE Patient Mater Identity Registry.

References

• Integrating the Health Enterprise Patient Master Identity Registry

• HL7 FHIR RelatedPerson Resource

• HL7 FHIR Patient Resource

• Integrating the Health Enterprise Patient Identity Cross Reference for Mobile

Discussion

The PMIR profile makes the assumption that the client is controlling the process of merge by instructing the server to link/de-activate a victim. Since merging is an event which triggers several business rules in the Master Data Management layer, the SanteDB PMIR handler detects this condition (a client attempting to control linking of patients, which is an internal matter) and mimics the equivalent behaviors of ADT^A40 from HL7v2.

Furthermore, the SanteDB implementation of merging behaves as described in Chapter 3 - Patient Administration in HL7 Version 2 (see: 3.6.2.1.2). For example, if two patients from HOSPITAL_A are registered as illustrated below (patient 1 with two identifiers and patient 2 with one):

Then a merge requests where Patient 1 is replaced by Patient 2 would result in a merge such that:

Subsequent requests to query for a patient using GREEN_TRIANGLE would result in Patient 2 being resolved. This behavior differs from the prescribed behavior of PMIR whereby the victim (in this case Patient 2) is not returned, or continues to be resolved with an inactive flag.

Pre-Conditions

Prior to running this test ensure that the pre-conditions from TEST: OHIE-CR-04 and TEST: OHIE-CR-06 have been run.

Authenticate as TEST_HARNESS

The test harness authenticates against the SanteMPI IdP using a client_credentials grant for the test-harness-a account.

POST http://localhost:8080/auth/oauth2_token HTTP/1.1
Accept-Encoding: gzip,deflate
Content-Type: application/x-www-form-urlencoded;charset=UTF-8
Content-Length: 87
Host: localhost:8080
Connection: Keep-Alive
User-Agent: Apache-HttpClient/4.5.5 (Java/12.0.1)


grant_type=client_credentials&scope=*&client_secret=TEST_HARNESS&client_id=TEST_HARNESS

Register First Patient Identity in TEST

The test harness sends an authenticated request to create a new patient with a new identifier in TEST domain. Patient details:

• Identifier FHR-080 in http://ohie.org/test/test

• Identifier NID080 in http://ohie.org/test/nid

• Name: MERGY SMITH

• Gender: Male

• DOB: 1986-05-25

{
  "resourceType": "Bundle",
  "type": "message",
  "entry": [
    {
      "fullUrl": "MessageHeader/ohie-cr-08-10-fhir",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "1",
        "eventUri": "urn:ihe:iti:pmir:2019:patient-feed",
        "source": {
          "endpoint": "http://ohie.org/test/test_harness"
        },
        "focus": [
          {
            "reference": "Bundle/ohie-cr-08-10-fhir"
          }
        ],
        "destination": [
          {
            "endpoint": "http://ohie.org/test/endpoint/Bundle"
          }
        ]
      }
    },
    {
      "fullUrl": "http://test.ohie.org/fhir/Bundle/ohie-cr-08-10-fhir",
      "resource": {
        "resourceType": "Bundle",
	   "id": "ohie-cr-08-10-fhir",
        "type": "history",
        "entry": [
          {
         		"fullUrl": "http://test.ohie.org/fhir/Bundle/ohie-cr-08-10-fhir",
			"resource": {
			    "resourceType": "Patient",
			    "id": "ohie-cr-08-10-fhir",
			    "active": true,
			    "identifier": [
			      {
			        "use": "official",
			        "system": "http://ohie.org/test/test",
			        "value": "FHR-080"
			      },
			      {
			        "use":"usual",
			        "system": "http://ohie.org/test/nid",
			        "value":"NID080"
			      }
			    ],
			    "name": [
			      {
			        "use": "official",
			        "family": "SMITH",
			        "given": [
			          "MERGY"
			        ]
			      }
			    ],
			    "gender": "male",
			    "birthDate": "1986-05-25",
			  },
			  "request":{
			  	"method":"PUT",
			  	"url":"Patient/ohie-cr-08-10-fhir"
			  },
			  "response":{
			  	"status":"200"
			  }
			  
          }
        ]
      }
    }
  ]
}

Expected Behaviour

Requirement	Option	Description
MUST	PMIR Only	Return MessageHeader with response.code = ok
MUST		Return HTTP code of 201 Created
SHOULD	PMIR Only	Include an OperationOutcome entry in the response
SHOULD		Include a Patient entry in response containing created patient
SHOULD		Include a link to the master identity with code refer

Execute PIXm Query To Validate The First Patient in TEST

The test harness sends an IHE PIXm query for a patient with identifier FHR-080 to the receiver.

GET http://localhost:8080/fhir/Patient/$ihe-pix?sourceIdentifier=http%3A%2F%2Fohie.org%2Ftest%2Ftest%7CFHR-080 HTTP/1.1
Accept-Encoding: gzip,deflate
Authorization: BEARER XXXXXX
Accept: application/fhir+json
Host: localhost:8080
Connection: Keep-Alive
User-Agent: Apache-HttpClient/4.5.5 (Java/12.0.1)

Expected Behaviour

Requirement	Option	Description
MUST		Return HTTP code of 200 OK
MUST		Include a Parameters resource in the response
MUST		Have two parameters carrying the identifier in TEST and NID with parameter name of targetIdentifier and values FHR-080 and NID080
MUST		Include a parameter with name targetId which has a resource link to the created resource from the previous step.

Register Second Patient Identity in TEST

The test harness sends an authenticated request to create a new patient with a new identifier in TEST domain. Patient details:

• Identifier FHR-081 in http://ohie.org/test/test

• Name: MERGY SMYTHE

• Gender: Male

• DOB: 1986-05-25

{
  "resourceType": "Bundle",
  "type": "message",
  "entry": [
    {
      "fullUrl": "MessageHeader/ohie-cr-08-10-fhir",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "1",
        "eventUri": "urn:ihe:iti:pmir:2019:patient-feed",
        "source": {
          "endpoint": "http://ohie.org/test/test_harness"
        },
        "focus": [
          {
            "reference": "Bundle/ohie-cr-08-10-fhir"
          }
        ],
        "destination": [
          {
            "endpoint": "http://ohie.org/test/endpoint/Bundle"
          }
        ]
      }
    },
    {
      "fullUrl": "http://test.ohie.org/fhir/Bundle/ohie-cr-08-10-fhir",
      "resource": {
        "resourceType": "Bundle",
	   "id": "ohie-cr-08-10-fhir",
        "type": "history",
        "entry": [
          {
          	"fullUrl": "http://test.ohie.org/fhir/Patient/ohie-cr-08-20-fhir",
          	"resource": {
		    "resourceType": "Patient",
		    "id": "ohie-cr-08-20-fhir",
		    "active": true,
		    "identifier": [
		      {
		        "use": "official",
		        "system": "http://ohie.org/test/test",
		        "value": "FHR-081"
		      }
		    ],
		    "name": [
		      {
		        "use": "official",
		        "family": "SMYTHE",
		        "given": [
		          "MERGY"
		        ]
		      }
		    ],
		    "gender": "male",
		    "birthDate": "1986-05-25",
		  },
			  "request":{
			  	"method":"PUT",
			  	"url":"Patient/ohie-cr-08-20-fhir"
			  },
			  "response":{
			  	"status":"200"
			  }
          }
        ]
      }
    }
  ]
}

Expected Behaviour

Requirement	Option	Description
MUST	PMIR Only	Return MessageHeader with response.code = ok
MUST		Return HTTP code of 201 Created
SHOULD	PMIR Only	Include an OperationOutcome entry in the response
SHOULD		Include a Patient entry in response containing created patient
SHOULD		Include a link to the master identity with code refer

Execute PIXm Query To Validate The Second Patient in TEST

The test harness sends an IHE PIXm query for a patient with identifier FHIR-081 to the receiver.

GET http://localhost:8080/fhir/Patient/$ihe-pix?sourceIdentifier=http%3A%2F%2Fohie.org%2Ftest%2Ftest%7CFHR-081 HTTP/1.1
Accept-Encoding: gzip,deflate
Authorization: BEARER XXXXXXX
Accept: application/fhir+json
Host: localhost:8080
Connection: Keep-Alive
User-Agent: Apache-HttpClient/4.5.5 (Java/12.0.1)

Expected Behaviour

Requirement	Option	Description
MUST		Return HTTP code of 200 OK
MUST		Include a Parameters resource in the response
MUST		Have one parameter carrying the identifier in TEST with parameter name of targetIdentifier and value FHR-081.
MUST		Include a parameter with name targetId which has a resource link to the created resource from the previous step.

Merge FHR-081 (Patient 2) into FHR-080 (Patient 1)

In this step the test harness sends a PIMR request to instruct the Client Registry that FHR-081 has been replaced by FHR-080.

{
  "resourceType": "Bundle",
  "type": "message",
  "entry": [
    {
      "fullUrl": "MessageHeader/ohie-cr-08-30-fhir",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "1",
        "eventUri": "urn:ihe:iti:pmir:2019:patient-feed",
        "source": {
          "endpoint": "http://ohie.org/test/harness"
        },
        "focus": [
          {
            "reference": "Bundle/ohie-cr-08-30-fhir"
          }
        ],
        "destination": [
          {
            "endpoint": "http://ohie.org/test/endpoint/Bundle"
          }
        ]
      }
    },
    {
      "fullUrl": "http://ohie.org/test/Bundle/ohie-cr-08-30-fhir",
      "resource": {
        "resourceType": "Bundle",
        "id":"ohie-cr-08-30-fhir",
        "type": "history",
        "entry": [
          {
            "fullUrl": "http://ohie.org/test/Patient/ohie-cr-08-30-fhir",
            "resource": {
              "resourceType": "Patient",
              "id": "ohie-cr-08-20-fhir",
              "active": false,
              "identifier": [
                {
                  "use": "official",
                  "system": "http://ohie.org/test/test",
                  "value": "FHR-081"
                }
              ],
              "link": [
                {
                  "other": {
                    "type": "Patient",
                    "identifier": {
                      "value": "FHR-080",
                      "system": "http://ohie.org/test/test"
                    }
                  },
                  "type": "replaced-by"
                }
              ]
            },
            "request": {
              "method": "PUT",
              "url": "Patient/ohie-cr-08-30-fhir"
            },
            "response": {
              "status":"200"
            }
          }
        ]
      }
    }
  ]
}

You will notice that the link element in the above message uses the business identifier reference rather than an absolute reference by URL. This is considered best practice when merging on SanteDB server as it abstracts the logical identifier (which changes as the resource moves between servers). See: http://hl7.org/fhir/resource.html#identifiers

Requirement	Option	Description
MUST		Return HTTP code of 200 OK
MUST		Return MessageHeader with response.code = ok

Alternate Merge Request

Alternately, the test harness may fetch/obtain the logical ID of the resource and may indicate the merge using the logical identifier of the resource. For example, if the SanteDB MPI registered a patient with logical identifier 5d0e583f-1fda-4a25-8fbe-f4fb3e876f3c, the sender may issue a link request such as:

"link": [
  {
    "other": {
        "reference": "Patient/5d0e583f-1fda-4a25-8fbe-f4fb3e876f3c"
    },
    "type": "replaced-by"
  }
]

Expected Behavior

Requirement	Option	Description
MUST		Return MessageHeader with response.code = ok
MUST		Return HTTP code of 200 OK
SHOULD		Include an OperationOutcome entry in the response

Query for Merged Record

This test ensures that the client registry returns the new record (with identifier FHR-080) when the old record (FHR-081) is queried. This resolution ensures that the merge occurred successfully and any attempts to reference an old record results in the new being returned.

This test uses the business identifiers to ensure the cross referencing is updated, and is the recommended manner for handling record merges. Alternates (such as returning the old record with active of false would place a burden on the client to intelligently handle merges by following, potentially, dozens of "replaced-by" links)

GET http://localhost:8080/fhir/Patient?identifier=http%3A%2F%2Fohie.org%2Ftest%2Ftest%7CFHR-081 HTTP/1.1
Accept-Encoding: gzip,deflate
Authorization: BEARER XXXXXXXX
Accept: application/fhir+json
Host: localhost:8080
Connection: Keep-Alive
User-Agent: Apache-HttpClient/4.5.5 (Java/12.0.1)

Expected Behavior

Requirement	Option	Description
MUST		Return a bundle with an entry carrying a Patient resource with the FHR-080 identifier (i.e. the resource returned should be the survivor of the merge operation)
MUST		Return HTTP code of 200 OK
MAY		Return an additional Patient entry resource with active set to false and carrying the now inactive resource.
SHOULD		Carry a link with type replaces indicating that the record returned replaced a previous record.

Fetch Merged Record

This test ensures compliance with the IHE PMIR profile by explicitly querying for a resource by logical identifier (rather than business identifier). IHE PMIR provides several options for handling a READ or SEARCH operation for merged records. All of these options are expressed as alternates in the expected behaviors table.

This test requires that the logical resource identifier assigned by the iCDR / MPI instance is known by the SUT.

GET http://localhost:8080/fhir/Patient/bd9ab237-ee43-4f69-b363-5e016deb690d HTTP/1.1
Accept-Encoding: gzip,deflate
Authorization: BEARER XXXXXXX
Accept: application/fhir+json
Host: localhost:8080
Connection: Keep-Alive
User-Agent: Apache-HttpClient/4.5.5 (Java/12.0.1)

Expected Behavior

Requirement	Option	Description
MUST		Return an HTTP 200 OK with the replaced/merged record carrying active value of false
MUST	ALTERNATE	Return HTTP code of 404 NOT FOUND

Search Merged Record

This test ensures compliance with the IHE PMIR profile by explicitly searching for a resource by logical identifier (rather than business identifier). IHE PMIR provides several options for handling a SEARCH operation for merged records. All of these options are expressed as alternates in the expected behaviors table.

This test requires that the logical resource identifier assigned by the iCDR / MPI instance is known by the SUT.

GET http://sut:8080/fhir/Patient?_id=5d0e583f-1fda-4a25-8fbe-f4fb3e876f3c HTTP/1.1
Auhthorization: Bearer XXXXXX
Accept: application/fhir+json

Expected Behavior

Requirement	Option	Description
MUST		Return an HTTP 200 OK and a Bundle with the 0 results.
MUST	ALTERNATE	Return an HTTP 200 OK and a Bundle with the merged record with active set to false
MUST	ALTERNATE	Return an HTTP 200 OK and a Bundle with 2 results. One representing the survivor record (with active of true) and one representing the merged record (with active of false)

Execute PIXm Query To Validate Merged Record

This test ensures that the updates applied via the PMIR merge are reflected in the PIXm cross-referencing query request. The test harness issues a cross-referencing request to obtain the national health identifier for FHRA-081 (a patient, when registered, did not have a NID however by virtue FHRA-081 was merged into FHR-080 which carries a NID, FHRA-081 should carry a NID).

GET http://localhost:8080/fhir/Patient/$ihe-pix?sourceIdentifier=http%3A%2F%2Fohie.org%2Ftest%2Ftest%7CFHR-081&targetSystem=http%3A%2F%2Fohie.org%2Ftest%2Fnid HTTP/1.1
Accept-Encoding: gzip,deflate
Authorization: BEARER XXXXXXX
Accept: application/fhir+json
Host: localhost:8080
Connection: Keep-Alive
User-Agent: Apache-HttpClient/4.5.5 (Java/12.0.1)

Expected Behavior

Requirement	Option	Description
MUST		Return an HTTP 200 OK and a Parameters as the payload.
MUST		Return one targetIdentifier parameter carrying the NID of NID080
MUST		Return one targetId parameter with a pointer to the surviving record (i.e. not to the merged record)