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Project Information

Project Goals

The goal of this project is to identify the required clinical data with associated vocabulary bindings and value sets for patient summary, in the context of specific use cases, and to build an international document and associated templates based on HL7 CDA R2 (or a future CDA release) and potentially the FHIR standards, with value sets to support data elements within those templates. The initial use cases will be the patient summary, providing support for emergency care and unplanned care.

The International Patient Summary (IPS) is intended to be "a minimal and non-exhaustive patient summary, specialty-agnostic, condition-independent, but readily usable by clinicians for the cross-border unscheduled care of a patient."

These templates/profiles aim to:
  • Serve for both cross-jurisdictional (through adaptation/extension for multi-language and realm scenarios, including translation) and national (through localization) patient summaries.
  • Support emergency care and unplanned care in any country (home and foreign), regardless of language
  • Define value sets based on international vocabularies that are usable and understandable in any country 
The deliverable(s) will address the requirements of an international patient summary:
  • For the exchange of structured and coded information (section headings, entries)
  • For administrative data in order to support content commitment, audit/logging/provenance
The project will receive input from the EHR WG regarding the specification of functional requirements on patient summaries.

This includes a compilation of the required clinical data, based on results of multiple previous projects on patient summaries (including but not limited to epSOS, ONC, Trillium Bridge, eHealth Exchange), rules and recommendations for the use and maintenance of associated vocabulary bindings and value sets (in multilingual settings), and templates for the implementation of international patient summary documents. 

Therefore this project has its primary focus on provisions for semantic interoperability. 

Templates/profiles should take in consideration, where applicable, legal, organizational, security and infrastructure requirements based on experiences of pilot implementations (Trillium Bridge).

The white paper on Comparative Analysis Between HL7 C-CDA R1.1 CCD and epSoS PS v1.4 will inform the development of the harmonized template and associated value sets.

Project Background

In 2010 a MoU was signed between EU and US to strengthen global cooperation in eHealth/Health. As a result, the ONC S&I “Interoperability of EHR” work group was launched in US in 2013 (http://wiki.siframework.org/EU-US+eHealth+Cooperation+Initiative) and the Trillium Bridge Project (www.trilliumbridge.eu) in Europe to compare the CDA templates specified at that time in Europe (epSOS PS V1.4) and in US (MU – C-CDA CCD v1.1) for Patient Summaries (PSs) and to build a Trans-Atlantic exchange proof of concept. Both initiatives resulted identifying the need for a common template and vocabularies for the Patient Summary, in particular the following recommendation was offered and endorsed by all members of the Joint Initiative Council and by the HL7 International Council: “to advance an International Patient Summary (IPS) standard and enable people to access and share their health information for emergency or unplanned care anywhere and as needed. At minimum the IPS should include immunizations, allergies, medications, clinical problems, past operations and implants.”

Meanwhile:
  • A new version of the EU/US MOU Transatlantic eHealth/health IT Cooperation Roadmap entered consultation in November 2015 , ;
  • (US) a Shared Nationwide interoperability roadmap was published in November 2015 ;
  • The Joint Initiative Council (JIC) on SDO Global Health Informatics Standardization, initiated the standard sets project with patient summary as its pilot ;
  • A maintenance process for the European Patient Summary Guidelines  is in progress (expected release on Nov 2016);
  • The European eHealth Digital Service Infrastructure (project for the operational deployment of the EU cross-borders services) has been launched (2016-2018) 
  • ART-DECOR® and the HL7 DSTU (now STU) template exchange format are being more and more used by European countries, including for the European Patient Summary templates (aka epSOS PS template). ART DECOR is also connected to the IHE 

Additional project information

This project is marked as a repository
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Prefix: hl7ips-Default language: en-US Contains reusable content
Publication locationProject overview
https://hl7intl.art-decor.pub/Project index
Disclaimer
The content of this publication has been carefully prepared and reviewed. However, authors and contributors do not guarantee the accuracy, completeness or quality of the information provided, or that it is up-to-date. Liability claims against authors or contributors in respect of material or immaterial damage caused by the use or non-use of the information offered or by inaccurate or incomplete information are in principle ruled out provided that there is no provable culpable intent or gross negligence on author's or contributor's part.

Authors / Contributors

  • HL7 International - as author 2016-2026
List of Authors
  • Administrator
  • Dr. Kai Heitmann
  • Giorgio Cangioli
  • Alexander Henket
  • Catherine Chronaki
  • Rob Hausam
  • Dr. Stefan Sabutsch
  • Stephen Chu
  • François Macary
  • Christof Gessner
  • Andrea Fourquet
  • Lori Fourquet

Version Info

DateByDescription
2026‑02‑15 08:38:13Dr. Kai HeitmannOfficial Release: 2.0.1

Changes applied so far from issues submitted for the 2.0.0-ballot.

RESOLVED - NO CHANGE

CDA-21167

IPS Radiology Result Observation Component templateId issues updated

2024-09-12

CDA-20071

Alignment of the MMAT code cardinality between IPS and Pharma templates

2021-09-29

CDA-2079

STU-2079 – harmonization

2021-09-23

APPLIED

CDA-21184

Fix the "* to be checked ==>" links

2026-01-27

CDA-21165

Alerts Section & Patient Story Section templateId OIDs should follow convention

2026-01-07

CDA-20545

UV Generalized Medicine Class add required determinerCode

2024-06-12

CDA-20037

Change pharm:containerPackagedProduct determinerCode from INSTANCE to KIND

2021-09-23

CDA-20541

asContent.quantity extension: align template and XML schema

2024-06-12

CDA-2083

STU-2083 - generalizedMedicineClass

2021-09-23

CDA-2084

STU-2084 - substance administration

2021-09-23

CDA-2081

STU-2081 - containerpackagedProduct

2021-09-23

CDA-2078

STU-2078 - pharm:ingredient

2021-09-23

CDA-2077

STU-2077 - harmonize

2021-10-20

CDA-2058

STU-2058 - problem concern act

2021-09-23

CDA-2059

STU-2059 - problem concern act

2021-09-23

CDA-2057

STU-2057 - Pharm:ascontent.quantity

2021-09-23

CDA-1979

STU-1979 - Problem Status Observation

2021-10-20

CDA-1975

STU-1975 - languageCode element

2021-09-23

CDA-1974

STU-1974 - representedCustodianOrganization

2021-09-23

CDA-1895

STU-1895 - realmCode

2021-09-23

CDA-1894

STU-1894 - Manufacturedmaterial Example

2021-09-23

CDA-1892

STU-1892 - Finding day missing

2021-09-23

CDA-1888

STU-1888 - Cardinality change

2021-09-23

CDA-1891

STU-1891 - Ingredient Substance code and name optional

2021-09-23

CDA-1887

STU-1887 - Pregnancy status observation

2021-09-23

CDA-1886

STU-1886 - Value of code

2021-09-23

CDA-1889

STU-1889 - Procedure Date

2021-09-23

 

2024‑11‑07 13:25:24Dr. Kai HeitmannOfficial Release: 2.00

HL7 CDA® R2 Implementation Guide: International Patient Summary Edition 2 (Universal Realm), 1st STU Ballot, September 2024

2020‑07‑07 12:04:20Giorgio CangioliOfficial Release: v1.9.0
HL7 CDA® R2 Implementation Guide: International Patient Summary, Release 1
as used by
IHE International Patient Summary (IPS) Profile Revision 1.1 – Trial Implementation
2018‑09‑06 09:52:42Giorgio CangioliOfficial Release: v1.86
There have been changes to the following 2 issues since the last intermediate version or release.
  • Issue 142 "C-CDA Pregnancy Status alignment" with status "Open". Last event (2018-09-06T09:35:44):
    In the yesterday IPS call (2018-09-05) it was agreed to change the boolean value of the pregnacy status observation into a codeableConcept.

    The same shall be done in the next version of the CDA template.
  • Issue 145 "Fix the Pregnancy section code" with status "Closed". Last event (2018-09-06T09:51:09):
    Pregnancy History Section updated
2018‑08‑29 11:43:19Giorgio CangioliOfficial Release: v1.85
Release: v1.85
STU Release after the reconciliation of the D2 Ballot for the January 2018 ballot cycle:
HL7 CDA® R2 Implementation Guide: International Patient Summary, Release 1, STU

There have been changes to the following 2 issues since the last intermediate version or release.
  • Issue 143 "Procedure effectiveTime to 1..1 R" with status "Open". Last event (2018-07-12T10:53:27):
    Finding:

    the pr EN 17269 and the FHIR IPS procedure have a 1..1 Procedure date

    Suggestion:

    change the cardinality from 0..1 R to 1..1 R for alignment

    Further explanation:

    This should be added as STU comment as soon as the CDA IG will be published.

  • Issue 144 "Pregnancy Status effectiveTime to 1..1 R" with status "Open". Last event (2018-07-12T11:16:18):
    Finding:

    the prEn 17269 indicates the Date of Observation as required (not mandatory) data. 

    Suggestion:

     consider to change the cardinality from 0..1 R to 1..1 R

    Further explanation:

    -

2018‑07‑10 12:54:10Dr. Kai HeitmannOfficial Release: v1.84
Check-Release towards STU after reconcile of the D2 Ballot for the January 2018 ballot cycle:
HL7 CDA® R2 Implementation Guide: International Patient Summary, Release 1

There have been changes to the following 9 issues since the last intermediate version or release.
  • Issue 61 "LOINC Code for the CertaintyObservation code" with status "Geschlossen". Letzte Ereignis (2018-03-19T10:02:42):
    According a conversation between Rob and Regenstrief, we should use 66455-7 Condition status. We agreed at the Paris March 2018 meeting.
  • Issue 127 "Constrained template for the PlayingEntity" with status "Geschlossen". Letzte Ereignis (2018-02-08T16:54:31):
    Solved long ago.and published in the December ballot.
  • Issue 136 "Ingredient Substance code and name both optional " with status "Offen". Letzte Ereignis (2018-02-07T15:52:12):
    Finding:

    Ingredient Substance code and name both are optional, which is probably not enough. HL7 Pharmacy WG and IHE have defined code O and name R.

    Suggestion:

    Make either name R or create a co-constraint code or name must be present

  • Issue 137 "Update value set" with status "Geschlossen". Letzte Ereignis (2018-02-24T11:05:37):
    Updated!
  • Issue 138 "ActStatusActiveCompleted no more used" with status "Offen". Letzte Ereignis (2018-02-24T11:59:08):
    Finding:

    The current guide does not use anymore this value set (the x_ActStatusActiveComplete is used instead)

    Suggestion:

    remove from the list ?

    Further explanation:

    already removed from the list reported in the CDA IG (wiki)

    -

  • Issue 139 "Wrong datatype?" with status "Offen". Letzte Ereignis (2018-03-08T14:17:40):
    Unfortunately I had no time yet to update the data set with the latest CEN EN version....

    this is for sure a typo, but several other changes have to be applied..
  • Issue 140 "Add body site to Medical Device (as entryRelationship)" with status "Offen". Letzte Ereignis (2018-03-19T17:49:56):
    Finding:

    The body site of the implant cannot be specified

    Suggestion:

    Add a body site as entryRelationship to an implant procedure carrying the body site

  • Issue 141 "Move the code for binding for Absent or Unknown Devices" with status "Offen". Letzte Ereignis (2018-03-19T17:57:02):
    Finding:

    The code for Absent or Unknown Devices is placed now that the participation level code.

    Suggestion:

    Move the Absent or Unknown Devices code to the Supply.code (that have been dropped earlier but need to be re-introduced here)

    Further explanation:

    -

  • Issue 142 "C-CDA Pregnancy Status alignment" with status "Offen". Letzte Ereignis (2018-05-14T14:57:50):
    Finding:

    StrucDoc today accepted a use case for "Possible Pregnant" that does not yet seem covered in HL7 IPS. Looking at C-CDA (code ASSERTION, value 77386006 (SNOMED CT), it looks as if there's more room for alignment than just this one use case.

    Suggestion:

    Seek alignment with C-CDA in general for this template, but at least consider "Possible Pregnant" as use case.

    Further explanation:

    Contact for C-CDA: Sarah Gaunt

2017‑12‑17 19:27:23Dr. Kai HeitmannOfficial Release: v1.76
Release for the D2 Ballot for the January 2018 ballot cycle
HL7 CDA® R2 Implementation Guide: International Patient Summary, Release 1 (PI ID: 1087) (CDAR2_INTLPATSUMMARY_R1_D2_2018JAN)

There have been changes to the following 28 issues since the last intermediate version or release.
  • Issue 19 "Allergy Agent Value Set" with status "Closed". Last event (2017-09-01T16:08:49):
  • Issue 48 "IPS Comment Activity: schematron test assertion" with status "Closed". Last event (2017-11-22T18:27:07):
    Nothing to do
  • Issue 50 "VS binding missing for methodCode and targetSiteCode" with status "Closed". Last event (2017-10-30T18:44:14):
    Decision taken during the 2017-10-11 call

    targetSiteCode: to be removed form Lab and Pathology results. (Giorgio to update the excel file).

    methodCode: to be removed results observations / procedure

    approachSiteCode: to be removed procedure

    targetSiteCode: intensional SCT based value set; preferred value set; not part of the request for free.for-use set… (all descendants of 442083009 |Anatomical or acquired body structure (body structure))

  • Issue 51 "result observation: full SCT binding" with status "Closed". Last event (2017-11-15T10:10:52):
    All the bindings issue related to the targetSiteCode; methodCode; and so on have been fixed.
  • Issue 54 "Missing VSs for methodCode,approachSiteCode and targetSiteCode" with status "Closed". Last event (2017-10-30T18:44:36):
    Decision taken during the 2017-10-11 call

    targetSiteCode: to be removed form Lab and Pathology results. (Giorgio to update the excel file).

    methodCode: to be removed results observations / procedure

    approachSiteCode: to be removed procedure

    targetSiteCode: intensional SCT based value set; preferred value set; not part of the request for free.for-use set… (all descendants of 442083009 |Anatomical or acquired body structure (body structure))

  • Issue 55 "No value set for the procedure code" with status "Closed". Last event (2017-09-01T16:08:32):
    Intensional definition provided
  • Issue 57 "Medical Device supply.code: value set binding missing" with status "Closed". Last event (2017-11-15T10:09:02):
    Call 2017-11-09
    The supply code element has not been considered relevant for the purpose of the IPS. It has been omitted 
  • Issue 69 "Add ASSERTs for the defined constraints" with status "Open". Last event (2017-09-01T16:04:45):
    reported as ballot comment
  • Issue 82 "Change the rule for language from nn-CC ?" with status "Closed". Last event (2017-12-12T19:02:11):
    Updated assertion
    Added the agreed constraint.
  • Issue 84 "How remove the refrence to the human language value set ?" with status "Closed". Last event (2017-09-01T15:17:10):
    Removed. Not in the balloted PDF
  • Issue 87 "Author functionCode missing value set" with status "Closed". Last event (2017-11-03T15:51:41):
    2017-10-25
    Do not assign a value set binding 
  • Issue 89 "assignedAuthor with no assignedPerson or assignedAuthoringDevice" with status "Closed". Last event (2017-11-03T15:13:07):
    According to the resolution of the ballot comment #203 at least one device or person shall be present.

    remove the conf "If assignedAuthor has an associated representedOrganization with no assignedPerson or assignedAuthoringDevice, then the value for "ClinicalDocument/author/assignedAuthor/id/@nullFlavor" SHALL be "NA" "Not applicable""
  • Issue 90 "Author code value set and description" with status "Closed". Last event (2017-11-03T15:39:23):
    According to the disposition agreed during the ballot the author code is valued with the professional roles (Doctors;...). (is the value set that was used for the functionCode)
  • Issue 109 "Immunizations without immunoglobulins etc?" with status "Closed". Last event (2017-11-22T18:23:36):
    Call 2017-11-22
    Keep the current value set
  • Issue 110 "Missing Present x plus out of three plus" with status "Closed". Last event (2017-09-01T15:37:19):
  • Issue 111 "64572001 Condition -> Disease" with status "Closed". Last event (2017-11-22T18:04:31):
    displayName fixed.

    the 404684003 Clinical finding (finding) can be used for conditions

  • Issue 117 "Result Organizer with ObservationMedia?" with status "Closed". Last event (2017-08-21T10:15:45):
    The ObservationMedia is in the right place: Result Organizer. 
    Same as in XD-LAB profile where it is part of the Battery Organizer and not part of the Laboratory Observation.
    APSR 2.0 also supports ObservationMedia within an Organizer: the Problem Organizer.
    Example of an electrophoresis: The Result Organizer contains as many observations as there are proteins fractions (albumin, alpha 1, alpha 2, ...), and contains one observationMedia, which provides the whole graph.
    Remember that the Result section contains zero to many Result organizers. This allows to group together a set of observations and the related images (observationMedia).
  • Issue 121 "Value sets to be defined" with status "In Progress". Last event (2017-09-01T15:48:17):
    • Microorganisms defined
    • to be revised the Results Coded Values Pathology
    • to be defined the IPS Results Coded Values Radiology
    Added as ballot comment the part related to radiology.
  • Issue 122 "Visualization of union of VSs" with status "Closed". Last event (2017-09-01T15:45:41):
    When the rules are not too complex the intensional definition is shown in the main window
  • Issue 125 "Check vocabulary and template flexibility" with status "Closed". Last event (2017-09-01T15:36:34):
  • Issue 126 "Check choice items' representation" with status "In Progress". Last event (2017-09-01T15:38:45):
    Added as a ballot comment
  • Issue 127 "Constrained template for the PlayingEntity" with status "In Progress". Last event (2017-08-21T09:09:02):
    Change requested as a comment to the ballot.
  • Issue 130 "Examples to be revised (template IDs)" with status "Closed". Last event (2017-09-01T15:36:56):
  • Issue 131 "Consider a revision of the name of the section" with status "Closed". Last event (2017-11-02T16:24:26):
    Call 2017-11-02

    Align the name with the LOINC description
  • Issue 132 "Remove cpm from the PQR elements" with status "Open". Last event (2017-09-06T15:14:53):
    The same change needs to be applied to the specifcation....
  • Issue 133 "change the cardinality of relatedDocument ?" with status "Open". Last event (2017-10-27T17:29:03)

    According to the CDA constraint

    "A conformant CDA document can have a single relatedDocument with typeCode "APND"; a single relatedDocument with typeCode "RPLC"; a single relatedDocument with typeCode "XFRM"; a combination of two relatedDocuments with typeCodes "XFRM" and "RPLC"; or a combination of two relatedDocuments with typeCodes "XFRM" and "APND". No other combinations are allowed. "

    Should we change the cardinality to 0..2 ? 
  • Issue 134 "Section/text is 0..1 M" with status "Closed". Last event (2017-11-23T22:17:59):
    Thanks for pointing to this, fixed to 1..1 M as it should be for all IPS Sections
  • Issue 135 "Code missing" with status "Open". Last event (2017-11-27T19:41:39):

    d day is missing

    Add d