2:104.4.1.3 - conditional update, but not really

[lynnfel]

Section Number 2:104.4.1.3 https://profiles.ihe.net/ITI/PIXm/ITI-104.html#23104413-expected-actions

Issue conditional update, but not really. see below

Proposed Change
Preface: Someone can tell me I'm wrong about this...

In ITI-104, we say the following (italics are my comments):

2:3.104.4.1.3 Expected Actions
The Patient Identifier Cross-reference Manger SHALL provide a CapabilityStatement with the capabilities interaction and indicate that conditionalUpdate is available on the Patient. (OK... then, if I'm a a client reading/processing the capability statement, I can reasonably assume that this server provides conditional update, as defined in FHIR, on Patient Resources, ...but wait...)

A Patient Identifier Cross-reference Manager SHALL support the Conditional Update based on a patient identifier (I don't know what Conditional Update ** based on patient identifier** means) as outlined in http://hl7.org/fhir/http.html#cond-update. The Patient Identifier Cross-reference Manager MAY create a Patient resource on a Conditional update/create but is not required to do so This specifically (and intentionally) contradict the behavior specified in http://hl7.org/fhir/http.html#cond-update; there is no requirement on PIX Manager to manage Patient resources, only to cross-correlate provided identifiers.

I'm not sure what the value is of saying we are doing a conditional update, when we're not (it seems). In that case, we should just specify the expected behavior directly in ITI-104 since it seems to be so different than what a server does for a "real" conditional update as defined here http://hl7.org/fhir/http.html#cond-update

Also,
Should we specify that the [search parameters] in the PUT shall contain at least patient ID and assigning authority?

2:3.104.4.2.4 Response message
See http://hl7.org/fhir/http.html#cond-update for response. Similarly, the response semantics defers completely to FHIR; is that adequate for how we're using conditional update?

Priority:

• Medium: Significant issue or clarification. Requires discussion, but should not lead to long debate.

[oliveregger]

I'm not sure what the value is of saying we are doing a conditional update, when we're not (it seems).

We are doing a Conditional Update, this is also mentioned in the FHIR spec: This variant can be used to allow a stateless client (such as an interface engine) to submit updated results to a server,

. The Patient Identifier Cross-reference Manager MAY create a Patient resource on a Conditional update/create but is not
required to do so This specifically (and intentionally) contradict the behavior specified in http://hl7.org/fhir/http.html#cond
-update; there is no requirement on PIX Manager to manage Patient resources, only to cross-correlate provided identifiers.

This is correct, thats why we added the MAY (or may). I don't see the contradiction, I think we need further discussion on this.

Should we specify that the [search parameters] in the PUT shall contain at least patient ID and assigning authority?
yes, this is also related to #71

[oliveregger]

discussion about:

This update interaction creates a new current

this issue is the may create in the conditional update description. need further discussion.

[oliveregger]

for further discussion: can we add a text that we are using the API in circumstances where there is no real create?

[oliveregger]

Instead of:

The Patient Identifier Cross-reference Manager may create a Patient resource on a Conditional update/create but is not required to do so, there is no requirement on PIX Manager to manage Patient resources, only to cross-correlate provided identifiers.

I suggest to word it the following way:

The Patient Identifier Cross-reference Manager is not required to return a Patient resource, only to cross-correlate provided identifiers.

See also somehow related Zulip discussion on Response to Create Interaction:

None of that requires that the resource exist or be available, but it does imply that some record of the transaction needs to be retained (unless the location is a random UUID and you regard references to resources by UUID as likely a reference to a past resource and you don't care about integrity)

[oliveregger]

http://build.fhir.org/ig/IHE/ITI.PIXm/branches/cond_update/ITI-104.html#23104413-expected-actions

[oliveregger]

change cross-correlate to cross-reference

[oliveregger]

The Patient Identifier Cross-reference Manager is not required to return a Patient resource, only to cross-correlate provided identifiers.

change to:

The Patient Identifier Cross-reference Manager is not required to maintain a Patient resource, only to cross-reference provided identifiers.