This page is part of the International Patient Summary Implementation Guide (v1.1.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Generation and Data Inclusion

Generating & Accessing IPS Documents

The IPS document is composed by a set of resources organized as a Bundle. This implementation guide recommends two potential operations for how IPS documents may be generated:

• Using a $summary operation on the Patient resource. This operation returns an IPS document Bundle in response to a POST request. This operation is similar to how the $everything operation works on the Patient resource. Unlike $everything, $summary returns summary information, rather than all patient information, in a Bundle document through the use of a Composition resource. This operation would not necessarily create a persisted IPS instance on the server responding to the request.

• Using a $docref operation on a DocumentReference resource as defined in the International Patient Access guide. For this operation to generate an IPS Bundle, it may be necessary to specify the type as LOINC 60591-5 (patient summary). This operation may return a Bundle with Bundle.type of searchSet with a DocumentReference that references the IPS document Bundle. This operation would generally create a saved IPS DocumentReference and Bundle on the server.

Future implementation guides may provide alternative methods and further recommendations for IPS document Bundle generation. These may include methods different than those outlined above. In addition, the International Patient Access Implementation Guide Implementation Guide provides additional guidance accessing individual resources as well as documents from compatible FHIR servers.

Data Included in IPS Documents

The data included in IPS documents support the use case for ‘unplanned, cross border care’, but the IPS is not limited to it. Since health records may include data over a patient’s lifetime, not all information may be relevant at the time of summary generation. In the creation of a patient summary, a server or practitioner may apply logical rules to limit the data included in a summary. For example, a laboratory observation or one-time medication administration from 10 years ago may no longer be relevant in the context of current patient care.

This IPS IG does not provide any specific set of rules for when data may no longer be relevant for inclusion in a patient summary, although it defines that current allergies, medications and problems represent a minimum structural expectation for all IPS documents as required by the ISO 27269 standard. We recommend implementers take into consideration practices from the industry about data inclusion in clinical documents and other care summaries. Some relevant initiatives that may provide recommendations on data inclusion include:

• HL7 Relevant and Pertinent Implementation Guide
• Concise Consolidated CDA Recommendations (C-CDA guidance for USA)
• European Guidelines for Patient Summaries (eHealth Network)
• National adaptations of the IPS