Merge pull request #44 from HL7/2024-narrative-updates

Rviewed with rhausam on joint call.
HL7 · Jul 30, 2024 · f1a7fdf · f1a7fdf
2 parents ebf4c49 + a34d8ab
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diff --git a/input/fsh/OperationDefinition-summary-uv-ips.fsh b/input/fsh/OperationDefinition-summary-uv-ips.fsh
@@ -13,11 +13,11 @@ Usage: #definition
 * publisher = "HL7 International / Patient Care"
 * contact.telecom.system = #url
 * contact.telecom.value = "http://www.hl7.org/Special/committees/patientcare"
-* description = "This operation returns an IPS document in response to a POST request.  The returned document MAY be generated on-demand and SHOULD represent the latest available information. This operation would not necessarily create a persisted IPS instance on the server responding to the request. When historic records or other documents are desired, this operation is not appropriate.  
+* description = "This operation returns an IPS document in response to a POST request.  The returned document MAY be generated on-demand and SHOULD represent the latest available information. This operation would not necessarily create a persisted IPS instance on the server responding to the request. When historic records or other documents are desired, this operation is not appropriate. For alternative operations and IPS generation guidance, please see [IPS Generation and Data Inclusion](./Generation-and-Data-Inclusion.html) 
 
-Generally when a patient's logical id is known, that id would be used to request the patient summary from a FHIR server (see [id] pattern below). When it is not known, servers MAY support using other identifiers (see 'identifier' parameter).
+Generally when a patient's logical id is known, that id would be used to request the patient summary from a FHIR server (see [id] pattern below). When it is not known, servers MAY support using other identifiers (see identifier parameter below).
 
-Servers MAY support profiles beyond the IPS. When supported, other profiles can be specified using the 'profile' parameter. When not supported, servers MAY use the universal Composition profile to identify what profile is returned by default.  
+Servers MAY support profiles beyond the IPS. When supported, other profiles can be specified using the profile parameter. When not supported, servers MAY use the universal IPS Composition profile to identify what profile is returned by default.  
 " 
 * jurisdiction = $m49.htm#001
 * affectsState = false

diff --git a/input/images/600px-IPS_principles.png b/input/images/600px-IPS_principles.png
diff --git a/input/images/IPS_composition.png b/input/images/IPS_composition.png
diff --git a/input/images/IPS_doc_library.png b/input/images/IPS_doc_library.png
diff --git a/input/images/IPS_principles.png b/input/images/IPS_principles.png
diff --git a/input/pagecontent/design.md → input/pagecontent/Design-Conventions.md b/input/pagecontent/design.md → input/pagecontent/Design-Conventions.md
diff --git a/input/pagecontent/principles.md → input/pagecontent/General-Principles.md b/input/pagecontent/principles.md → input/pagecontent/General-Principles.md
@@ -1,18 +1,18 @@
-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.
+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 International Patient Summary (IPS).
 
-{% include img.html img="600px-IPS_principles.png" caption="Figure 1: The IPS principles" width="40%" %}
+{% include img.html img="IPS_principles.png" caption="Figure 1: The IPS principles" width="40%" %}
 
 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. 
 
 
 ### Structuring Terminology 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).
+The IPS 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 from this guide enable the specification to represent information independent of the underlying syntax (CDA R2 or FHIR).
 
-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, SNOMED International has created an [open and free specification for the International Patient Summary](https://www.snomed.org/snomed-ct/Other-SNOMED-products/international-patient-summary-terminology) that references a core set of globally accessible and usable clinical concepts licensed at no-cost with the aim to serve the public good called the [IPS Free set](https://www.snomed.org/news-and-events/articles/hl7-snomed-international-patient-summary-(1)). This free set is maintained in collaboration with HL7 International and CEN and updated annually. SNOMED International has also produced a freely available resource called the IPS Terminology, a sub-ontology of SNOMED CT based on the IPS Free set, which will provide minimal ontological features for IPS implementations. In this spirit, this version of the International Patient Summary defines SNOMED CT as a primary terminology and it is used in many of the value sets. 
+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, SNOMED International has created the [IPS Terminology](https://www.snomed.org/snomed-ct/Other-SNOMED-products/international-patient-summary-terminology), which is an open and free sub-ontology of SNOMED CT that references a core set of clinical concepts licensed at no-cost with the aim to serve the public good. This sub-ontology is maintained in collaboration with HL7 International and other standards development organizations and updated annually. In this spirit, this version of the International Patient Summary defines SNOMED CT as a primary terminology and it is used in many of the value sets. 
 
 <blockquote class="stu-note">
-The IPS value sets that use SNOMED CT content are defined using intensional definitions, either in the form of FHIR inclusion and exclusion criteria or as Expression Constraint Language (ECL) queries.
+The IPS value sets that use SNOMED CT content are defined using FHIR inclusion and exclusion criteria. While not used computably in this implementation guide, equivalent Expression Constraint Language (ECL) queries are also shown within value set definitions for users to implement. 
 <br/>
 <br/>
 These value set definitions can be expanded against any available SNOMED CT content. For those in non-SNOMED International Member countries or those without a SNOMED CT Affiliate License,  the value set definitions should be expanded against the IPS Terminology, which includes a collection of SNOMED CT concepts that are freely accessible. For those in Member countries or with a SNOMED CT Affiliate license, the value set definitions should be expanded against the International Edition of SNOMED CT or a National Extension (or Edition), depending on the local requirements.
@@ -25,5 +25,5 @@ Other primary terminologies used in this specification are LOINC for observation
 
 ### Publishing or Accessing the IPS
 
-As described also in the [IPS CDA implementation guide](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=483) it is not in the scope of this version of this Implementation Guide to constrain solutions or strategies for the creation, sharing, syntactical and semantic mapping, translation, and use of the IPS. Recommendations on [operations for IPS generation](./ipsGeneration.html) are included in this guide, although future implementation guides may provide alternative methods and further recommendations different than those outlined. In addition, Integrating the Healthcare Enterprise (IHE) has also created guidance on the exchange of patient summaries which may be used in exchange of IPS documents as well. 
+As described also in the [IPS CDA implementation guide](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=483) it is not in the scope of this version of this Implementation Guide to constrain solutions or strategies for the creation, sharing, syntactical and semantic mapping, translation, and use of the IPS. Recommendations on [operations for IPS generation](./Generation-and-Data-Inclusion.html) are included in this guide, although future implementation guides may provide alternative methods and further recommendations different than those outlined. In addition, Integrating the Healthcare Enterprise (IHE) has also publsihed guidance on the [Sharing of IPS](https://profiles.ihe.net/ITI/sIPS/) which may be a helpful reference. 
 
diff --git a/input/pagecontent/ipsGeneration.md → ...econtent/Generation-and-Data-Inclusion.md b/input/pagecontent/ipsGeneration.md → ...econtent/Generation-and-Data-Inclusion.md
@@ -12,7 +12,7 @@ Future implementation guides may provide alternative methods and further recomme
 
 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](./ipsStructure.html) as required by the [ISO 27269 standard](https://www.iso.org/standard/79491.html). 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:
+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](./Structure-of-the-International-Patient-Summary.html) as required by the [ISO 27269 standard](https://www.iso.org/standard/79491.html). 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](https://www.hl7.org/implement/standards/product_brief.cfm?product_id=453)
 -	[Concise Consolidated CDA Recommendations (C-CDA guidance for USA)](http://www.commonwellalliance.org/wp-content/uploads/2018/07/Carequality_CommonWell_Improve_C-CDA_06-15-2018_V1.pdf) 

diff --git a/input/pagecontent/knownIssues.md → ...nt/Known-Issues-and-Future-Development.md b/input/pagecontent/knownIssues.md → ...nt/Known-Issues-and-Future-Development.md
@@ -7,3 +7,5 @@
 ### Future Development
 1. Investigate the relationships and the possible synergies with the proposed [International Patient Access Implementation Guide](https://hl7.org/fhir/uv/ipa/); exploring and better clarifying the role of the IPS document and of its reusable components (IPS profiles library).
 1. Explore the adoption of the Provenance resource with the IPS (bundle level, composition level or entry level) to document the IPS curation (see Known Issue ###1 above) (see also the ["International Patient Summary: Use Cases"](https://confluence.hl7.org/pages/viewpage.action?pageId=48237134###InternationalPatientSummary:UseCases-Examples) confluence page)
+1. Include additional guidance or references on approaches for selecting appropriate summary content and genearating narrative representations
+1. Gather feedback on the IPS [$summary operation](./OperationDefinition-summary.html) introduced in STU1.1 of the this guide. 
diff --git a/input/pagecontent/considerations.md → ...nt/Privacy-and-Security-Considerations.md b/input/pagecontent/considerations.md → ...nt/Privacy-and-Security-Considerations.md