Smile CDR v2024.05.PRE
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30.0.1System to System Data Exchange Module
Experimental

 
Please contact us if you would like to try out this experimental new feature.

This module is used to facilitate server to server operations.

The operations that this module supports are listed below.

30.0.1.1Payer to Payer

Patient data can be transferred from an old system to a new system in a payer-to-payer transfer. Smile can be configured to act as both the old system (which will be called source from here on out) or the new system (which will be called target from here on out).

Our quick start guide provides configuration instructions for a basic setup.

30.0.1.2Invoke Export

The $invoke-export endpoint allows a health provider to kick off the process of a server to server exchange of patient records between 2 HRex compliant servers for a member match operation.

This operation causes this server to act as a target health provider server and start a Member Match operation with a given source health provider server.

In order to use this Smile Digital Health server as a target server, the following must be configured:

  1. A storage module 1. Add System to System module:
    • Add a storage module dependency (same as in step 1)
    • Add a Reference System used by Target Patient, which should match exactly one identifier on whatever local patients are used for $invoke-export
    • Add a Responder Identifier System

30.0.1.2.1Implementation

Name Type Cardinality Description
export Parameter 1..1 The input parameters to be used in the $export operation to the source.
memberMatch Parameter 0..1 The input parameters to be used in the $member-match operation to the source. If not provided, a sourcePatientId must be specified.
localPatient reference 1..1 The reference to the patient on the source server.
endpoint reference 0..1 The endpoint of the source server.
organization reference 0..1
sourceIssuerUrl string 0..1 The issuer url of a local (to the target) OIDC server configuration for authentication on the source server. This OIDC server configuration should be saved to the System to System data exchange module.

30.0.1.2.2Example

http://example.com/Patient/$invoke-export

{
	"resourceType": "Parameters",
	"parameter":
	[
		{
			"name": "export",
			"resource":
			{
				"resourceType": "Parameters",
				"parameter":
				[
					{
						"name": "_outputFormat",
						"valueString": "application/fhir+ndjson"
					},
					{
						"name": "_type",
						"valueString": "Patient, Practitioner"
					},
					{
						"name": "_since",
						"valueInstant": "2019-10-25T11:01:45.660-04:00"
					},
					{
						"name": "_typeFilter",
						"valueString": "Patient?identifier=foo"
					},
					{
						"name": "patient",
						"valueReference": {
							"reference": "Patient/123"
						}
					}
				]
			}
		},
		{
			"name": "endpoint",
			"valueReference": {
				"reference": "Endpoint/1234"
			}
		},
		{
			"name": "organization",
			"valueReference": {
				"reference": "Organization/1234"
			}
		},
		{
			"name": "localPatient",
			"valueReference": {
				"reference": "Patient/1234"
			}
		},
		{
			"name": "member-match",
			"resource":
			{
				"resourceType": "Parameters",
				"parameter": [
					{
						"name": "MemberPatient",
						"resource": {
							"resourceType": "Patient",
							"id": "1",
							"identifier": [
								{
									"type": {
										"coding": [
											{
												"system": "http://hl7.davinci.org",
												"code": "MB"
											}
										]
									},
									"system": "http://oldhealthplan.example.com",
									"value": "55678",
									"assigner": {
										"reference": "Organization/2",
										"_reference": {
											"fhir_comments": [
												"MB is passed from coverage card by new health plan."
											]
										}
									}
								}
							],
							"name": [
								{
									"use": "official",
									"family": "Person",
									"given": [
										"Patricia",
										"Ann"
									]
								}
							],
							"gender": "female",
							"birthDate": "1974-12-25"
						}
					},
					{
						"name": "CoverageToMatch",
						"resource": {
							"resourceType": "Coverage",
							"id": "OLD_COVERAGE_ID",
							"text": {
								"status": "generated",
								"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
							},
							"contained": [
								{
									"resourceType": "Organization",
									"id": "Organization/2",
									"name": "Old Health Plan",
									"endpoint": [
										{
											"reference": "http://www.oldhealthplan.com"
										}
									]
								}
							],
							"identifier": [
								{
									"system": "http://oldhealthplan.example.com",
									"value": "OLD_IDENTIFIER"
								}
							],
							"status": "draft",
							"beneficiary": {
								"reference": "BENEFICIARY_PATIENT_ID"
							},
							"period": {
								"start": "2011-05-23",
								"end": "2012-05-23"
							},
							"payor": [
								{
									"reference": "Organization/2"
								}
							],
							"class": [
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "group"
											}
										]
									},
									"value": "CB135"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "plan"
											}
										]
									},
									"value": "B37FC"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "subplan"
											}
										]
									},
									"value": "P7"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "class"
											}
										]
									},
									"value": "SILVER"
								}
							]
						}
					},
					{
						"name": "CoverageToLink",
						"resource": {
							"resourceType": "Coverage",
							"id": "AA87654",
							"contained": [
								{
									"resourceType" : "Organization",
									"id" : "Organization/3",
									"name" : "New Health Plan",
									"endpoint" : [
										{
											"reference" : "http://www.newhealthplan.com"
										}
									]
								}
							],
							"identifier": [
								{
									"system": "http://newealthplan.example.com",
									"value": "234567"
								}
							],
							"status": "active",
							"beneficiary": {
								"reference": "Patient/1"
							},
							"period": {
								"start": "2020-04-01",
								"end": "2021-03-31"
							},
							"payor": [
								{
									"reference": "Organization/3"
								}
							],
							"class": [
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "group"
											}
										]
									},
									"value": "A55521",
									"name": "New Health Plan Group"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "subgroup"
											}
										]
									},
									"value": "456"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "plan"
											}
										]
									},
									"value": "99012"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "subplan"
											}
										]
									},
									"value": "A4"
								},
								{
									"type": {
										"coding": [
											{
												"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
												"code": "class"
											}
										]
									},
									"value": "GOLD"
								}
							]
						}
					},
					{
						"name" : "Consent",
						"resource" : {
							"resourceType" : "Consent",
							"status" : "active",
							"scope" : {
								"coding" : [
									{
										"system" : "http://terminology.hl7.org/CodeSystem/consentscope",
										"code" : "patient-privacy"
									}
								]
							},
							"category" : [
								{
									"coding" : [
										{
											"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
											"code" : "IDSCL"
										}
									]
								}
							],
							"patient" : {
								"reference" : "Patient/1"
							},
							"performer" : [
								{
									"reference" : "Patient/1"
								}
							],
							"policy" : [
								{
									"uri" : "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition-hrex-consent.html#regular"
								}
							],
							"provision" : {
								"type" : "permit",
								"period" : {
									"start" : "2022-01-01",
									"end" : "2022-01-31"
								},
								"actor" : [
									{
										"role" : {
											"coding" : [
												{
													"system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
													"code" : "performer"
												}
											]
										},
										"reference" : {
											"identifier" : {
												"system" : "http://hl7.org/fhir/sid/us-npi",
												"value" : "9876543210"
											},
											"display" : "Old Health Plan"
										}
									},
									{
										"role" : {
											"coding" : [
												{
													"system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
													"code" : "IRCP"
												}
											]
										},
										"reference" : {
											"identifier" : {
												"system" : "http://hl7.org/fhir/sid/us-npi",
												"value" : "0123456789"
											},
											"display" : "New Health Plan"
										}
									}
								],
								"action" : [
									{
										"coding" : [
											{
												"system" : "http://terminology.hl7.org/CodeSystem/consentaction",
												"code" : "disclose"
											}
										]
									}
								]
							}
						}
					}
				]
			}
		}
	]
}

This operation, if successful, will return with a status of 200 (OK) and a Content-Location pointing to a Task resource.

The Task resource can be queried to check the status of the operation.

Because $export jobs can take a while to process, it's not advisable to query more frequently than once a minute.


30.0.1.3Member Match

The $member-match operation allows one health provider (target) to retrieve the FHIR ID for a member from another health provider (source) using a member's demographic and coverage information. The id returned from the operation can then be used to perform subsequent queries and operations.

In order to use this Smile CDR server as a $member-match source server, configure the following:

  1. In the Storage module:
    • enable bulk export 2. Add System to System Data Exchange module:
    • add Storage module dependency (the same module configured in step 1.)
    • (optional) enable storage consent filtering

30.0.1.3.1Implementation

Smile CDR supports the HRex Implementation of the $member-match operation.

Use Name Type Cardinality Description
IN MemberPatient Patient 1..1 The target of the operation. It contains member patient demographics for the matching process.
IN Consent Consent 1..1 Consent held by the requester that grants permission to access the patient information on the receiving system for whom a patient is sought.
IN CoverageToMatch Coverage 1..1 Parameter that identifies the coverage to be matched by the receiving system. It contains the coverage details of health plan coverage provided by the member, typically from their health plan coverage card.
IN CoverageToLink Coverage 1..1 Parameter that identifies the coverage information of the member as they are known by the requesting system. This information allows the receiving system to link their member coverage information to that of the requesting system to ease subsequent exchanges, including evaluating authorization to share information in subsequent queries. This parameter is optional as this operation may be invoked by non-payer systems. However, If the system invoking the operation is a payer, they SHALL include their coverage information for the member when invoking the operation.
OUT MemberIdentifier Identifier 1..1 This is the Patient FHIR ID for the patient as known by the receiving system. If the $member-match operation is successful, it will be returned to the caller.

30.0.1.3.2Example

http://example.com/Patient/$member-match

{
	"resourceType": "Parameters",
	"parameter": [
		{
			"name": "MemberPatient",
			"resource": {
				"resourceType": "Patient",
				"id": "1",
				"identifier": [
					{
						"type": {
							"coding": [
								{
									"system": "http://hl7.davinci.org",
									"code": "MB"
								}
							]
						},
						"system": "http://oldhealthplan.example.com",
						"value": "55678",
						"assigner": {
							"reference": "Organization/2",
							"_reference": {
								"fhir_comments": [
									"MB is passed from coverage card by new health plan."
								]
							}
						}
					}
				],
				"name": [
					{
						"use": "official",
						"family": "Person",
						"given": [
							"Patricia",
							"Ann"
						]
					}
				],
				"gender": "female",
				"birthDate": "1974-12-25"
			}
		},
		{
			"name": "CoverageToMatch",
			"resource": {
				"resourceType": "Coverage",
				"id": "OLD_COVERAGE_ID",
				"text": {
					"status": "generated",
					"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
				},
				"contained": [
					{
						"resourceType": "Organization",
						"id": "Organization/2",
						"name": "Old Health Plan",
						"endpoint": [
							{
								"reference": "http://www.oldhealthplan.com"
							}
						]
					}
				],
				"identifier": [
					{
						"system": "http://oldhealthplan.example.com",
						"value": "DH10001235"
					}
				],
				"status": "draft",
				"beneficiary": {
					"reference": "BENEFICIARY_PATIENT_ID"
				},
				"period": {
					"start": "2011-05-23",
					"end": "2012-05-23"
				},
				"payor": [
					{
						"reference": "#Organization/2"
					}
				],
				"class": [
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "group"
								}
							]
						},
						"value": "CB135"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "plan"
								}
							]
						},
						"value": "B37FC"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "subplan"
								}
							]
						},
						"value": "P7"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "class"
								}
							]
						},
						"value": "SILVER"
					}
				]
			}
		},
		{
			"name": "CoverageToLink",
			"resource": {
				"resourceType": "Coverage",
				"id": "AA87654",
				"contained": [
					{
						"resourceType": "Organization",
						"id": "Organization/3",
						"name": "New Health Plan",
						"endpoint": [
							{
								"reference": "http://www.newhealthplan.com"
							}
						]
					}
				],
				"identifier": [
					{
						"system": "http://newealthplan.example.com",
						"value": "234567"
					}
				],
				"status": "active",
				"beneficiary": {
					"reference": "BENEFICIARY_PATIENT_ID"
				},
				"period": {
					"start": "2020-04-01",
					"end": "2021-03-31"
				},
				"payor": [
					{
						"reference": "#Organization/3"
					}
				],
				"class": [
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "group"
								}
							]
						},
						"value": "A55521",
						"name": "New Health Plan Group"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "subgroup"
								}
							]
						},
						"value": "456"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "plan"
								}
							]
						},
						"value": "99012"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "subplan"
								}
							]
						},
						"value": "A4"
					},
					{
						"type": {
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
									"code": "class"
								}
							]
						},
						"value": "GOLD"
					}
				]
			}
		},
		{
			"name": "Consent",
			"resource": {
				"resourceType": "Consent",
				"status": "active",
				"scope": {
					"coding": [
						{
							"system": "http://terminology.hl7.org/CodeSystem/consentscope",
							"code": "patient-privacy"
						}
					]
				},
				"category": [
					{
						"coding": [
							{
								"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
								"code": "IDSCL"
							}
						]
					}
				],
				"patient": {
					"reference": "BENEFICIARY_PATIENT_ID"
				},
				"performer": [
					{
						"reference": "BENEFICIARY_PATIENT_ID"
					}
				],
				"policy": [
					{
						"uri": "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition-hrex-consent.html#regular"
					}
				],
				"provision": {
					"type": "permit",
					"period": {
						"start": "2022-01-01"
					},
					"actor": [
						{
							"role": {
								"coding": [
									{
										"system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
										"code": "performer"
									}
								]
							},
							"reference": {
								"identifier": {
									"system": "http://hl7.org/fhir/sid/us-npi",
									"value": "9876543210"
								},
								"display": "Old Health Plan"
							}
						},
						{
							"role": {
								"coding": [
									{
										"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
										"code": "IRCP"
									}
								]
							},
							"reference": {
								"identifier": {
									"system": "http://hl7.org/fhir/sid/us-npi",
									"value": "0123456789"
								},
								"display": "New Health Plan"
							}
						}
					],
					"action": [
						{
							"coding": [
								{
									"system": "http://terminology.hl7.org/CodeSystem/consentaction",
									"code": "disclose"
								}
							]
						}
					]
				}
			}
		}
	]
}

This operation returns a Parameters resource that includes the Patient FHIR ID for the patient as known by the receiving system:

Note: the structure of the return value is subjected to change as the PDex specification continues to evolve.

{
	"resourceType": "Parameters",
	"parameter": [
		{
			"name": "MemberIdentifier",
			"valueId": "Patient/1326"
		}
	]
}

30.0.1.4Consent Service Interceptors

In order to support $member-match operations, all that is required is to add and configure this module (the System to System Data Exchange module) to the current Smile CDR server.

A default implementation of $member-match will allow the export of all resources associated with the member (Patient) used when invoking the operation to begin with.

Additional filtering of exported resources can be done by registering a storage module consent service and implementing either the willSeeResource method in a Java consent interceptor, or providing a consentWillSeeResource JavaScript function.

This method will be invoked for all bulk data export jobs ($export operations invoked on System, Type, or Instance). But if a System to System Data Exchange module is also present, the RequestDetails object will contain user data that will include a serialized Consent resource for $member-match invoked bulk export operations.

The Consent resource can be found at userData['consentResource'] and can be deserialized using a parser created from the Fhir context.

The following script is an example of a JavaScript Consent Script:

function consentWillSeeResource(theRequestDetails, theUserSession, theContext, theResource, theClientSession) {
    var resourceType = theResource.resourceType;
    var userData = theRequestDetails.getUserData();

    if (userData) {
        var consentResourceStr = userData['consentResource'];

        if (consentResourceStr) {
            var consentResource = Fhir.getContext()
                .newJsonParser()
                .parseResource(consentResourceStr);

            if (consentResource.status != "ACTIVE") {
                theContext.reject();
                return;
            }
        }
    }

	theContext.proceed();
}