This page is part of the International Patient Summary Implementation Guide (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

General Principles

With the formal agreement signed on April 2017, HL7 International and CEN/TC 251 expressed their intent to collaborate under a set of principles for the IPS.

Figure 1: The IPS principles

Based on this agreement, the standards specification for the IPS has to be (a) implementable (b) applicable for global use (c) extensible and open to future use cases and solutions. The standards specification and their implementation must be moreover sustainable. A detailed description of these principles is available in the IPS Wiki

Structuring Choices

The International Patient Summary is specified in this guide as a HL7 FHIR document (a bundle including an IPS composition), composed by a set of potentially reusable “minimal” data blocks (the IPS profiles). A HL7 CDA R2 representation is specified as well in a distinct Implementation Guide. The expressiveness of SNOMED CT and other primary terminologies enables this specification to represent the two general categories “condition/activity unknown” and “condition/activity known absent” in a style which is more independent of the underlying syntax (CDA R2 or FHIR), as explained in further detail here.

To be universally exchangeable and understood, a patient summary must rely as much as possible on structured data and multilingual international reference terminologies that are licensed at no cost for global use in the International Patient Summary. In the case of SNOMED CT, it is envisioned that SNOMED International could extend the idea of a globally accessible open and free specification for the International Patient Summary that references a core set of globally accessible and usable value sets licensed at no-cost with the aim to serve the public good. In this spirit, this version of the International Patient Summary defines SNOMED CT as a primary terminology (the meaning of “primary terminology” is explained here) and it is used in many of the value sets. To allow, however, a global and free implementation of the IPS this guide uses, where appropriate, the SNOMED CT IPS free subset. This subset is part of the SNOMED CT Global Patient Set). Other primary terminologies used in this specification are LOINC for observations (e.g., laboratory tests) and document sections, UCUM for units of measure, EDQM Standard Terms for dose forms and routes and ISO 3166 for countries [this ISO code system can be used for free in «lists» (e.g. value sets) or software]. Looking at the availability of other globally usable reference terminologies, in selected cases FHIR-defined terminologies are recommended.

Publishing or accessing the IPS

As described also in the IPS CDA implementation guide it is not in the scope of this version of this Implementation Guide to provide any indication about solutions and strategies for the creation, sharing, syntactical and semantic mapping, translation, and use of the IPS.

Future versions of this HL7 FHIR IPS Implementation Guide will address how to send/get IPS documents or resources by using FHIR APIs.