201809 Patient Track

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Patient

Starting with the Connectathon 14 event in San Antonio this track now includes additional levels of testing that introduce more formalized execution and reporting of test results.

FHIR Connectathon 19 Patient Track Orientation Slides

Pre-Requisites

For all levels of testing the required pre-requisite is the fundamental requirement that all FHIR servers SHALL support the capabilities interaction.

Level 1 - Introduction - New Participants/Systems

This has been and will remain the primary purpose of this track and provides a 'friendly introduction' for those new to FHIR. Attendees participate in this track using a simple scenario that can be met with limited domain knowledge and by those who have not had a lot of exposure to FHIR. It is quite feasible to complete the client side of the track within a day with only knowledge of a development environment and little to no previous FHIR knowledge. If creating a server, advanced preparation will be required, but this scenario should somewhat limit the effort involved.

Pre-connectathon testing is encouraged, but not required, where the participants can utilize the existing Publicly_Available_FHIR_Servers_for_testing.

Testing and test reporting at the Connectathon event will be self-attested using the Results tab of the Connectathon Management Tool (FHIR Connectathon 19 link) and primarily involve peer-to-peer execution between known FHIR clients and/or servers.

Level 2 - Formal Testing - Participants with FHIR experience

(Level 1 +) This level introduces a more formalized testing approach for those participants that have been working the FHIR specification and wish to move beyond basic testing and may have systems that are in active development, deployed or soon to be deployed into a production environment. Automated testing is significantly leveraged for both automated testing (testing tool to FHIR server) and surveliance of peer-to-peer testing (external FHIR client to external FHIR server).

Pre-connectathon testing is highly encouraged in order to be better prepared for the actual Connectathon event and become familiar with the public testing platforms that will be used for the formal testing.

Testing and test reporting will be done using the public testing platforms which will provide test results via the new FHIR TestReport resource type as well as any specific reporting capabilities of those testing platforms. These reports will provide qualitative and quantitative analysis of the system under test and its conformance to the FHIR specification.

Submitting WG/Project/Implementer Group

FHIR Management Group (FMG)

Justification

This is the Patient Track testing that is included in all FHIR Connectathons.

This track provides new participants with a friendly introduction to FHIR, using a simple scenario that can be met with limited domain knowledge and by those who have not had a lot of exposure to FHIR.

Proposed Track Lead

See Connectathon_Track_Lead_Responsibilities

Coordinator: Ron Shapiro

Test Support: Richard Ettema

Expected participants

Level 1

• Many of the new participants which typically make up 30% or more of Connectathon attendees.
• Public testing platforms may be used to assist participants; e.g. AEGIS - Touchstone tool and test scripts (optional)

Level 2

• Those Connectathon attendees interested in using a more formalized testing approach.
• Public testing platforms are used and will host the required TestScripts; e.g. AEGIS - Touchstone tool and test scripts

Roles

FHIR Client

This actor initiates the processing requests that enable the creation, deletion, manipulation and retrieval of Patient resource instances. The required, supported interactions are the defined basic CRUD operations: create, read, update and delete. Additional required, supported interactions are the operations: vread, history and search.

(Example FHIR Client CapabilityStatement here)

FHIR Server

This actor receives, processes and responds to the requests for creation, deletion, manipulation and retrieval of Patient resource instances. The implementation of this actor would normally provide for a repository storage mechanism along with corresponding maintenance and retrieval capabilities of the Patient resource instances. The required, supported interactions are the defined basic CRUD operations: create, read, update and delete. Additional required, supported interactions are the operations: vread, history and search.

(Example FHIR Server CapabilityStatement here)

Scenarios

Level 1 - Introduction - New Participants/Systems

The following scenarios represent the basic scenarios that participants will work to implement during the Connectathon event. Execution of these scenarios is expected to be performed with the other participants of this track as well as the Publicly_Available_FHIR_Servers_for_testing.

1. Register a new patient

Action: FHIR client creates a new patient and save to FHIR server. The client can assign the Id.

Precondition: Patient does not exist in FHIR server prior to action

Success Criteria: Patient created correctly on FHIR server (use browser to inspect Patient)

Bonus point: The Patient resource has an extension

>>Note: the resource Id can either be created by the client or the server (depending on the capability of the server). However, if the server assigns the Id, then the client will need to be able to retrieve the Id from the server response or by a patient query.

2. Update a patient

Action: FHIR client updates the patient created in scenario #1 and updates to FHIR server. The patient is retrieved by Id.

Precondition: Patient has been created

Success Criteria: Patient updated on FHIR server (use browser to inspect Patient)

Bonus Point #1: Update a patient that has extensions, but leaving the extension untouched.

Bonus Point #2: Update a patient that has extensions, and update the extension also.

3. Retrieve Patient history

Action: FHIR client searches the FHIR server for the history of a Patient

Precondition: There is a patient that has at least one update

Success Criteria: Patient's history displayed in interface. (use browser to query FHIR server)

Bonus point: The UI allows the user to display previous versions of the Patient

4. Search for a patient on name

Action: FHIR client searches the FHIR server for patients with a given name

Precondition: Patients with that name have been created

Success Criteria: patients displayed in interface. (use browser query to confirm)

5. Delete a patient

Action: FHIR client deletes the patient with a given id

Precondition: a Patients with that Id has been created

Success Criteria: Subsequently querying for the patient - either searching by name or by Id - fails.

Formal Testing

Level 2 - Formal Testing - Participants with FHIR experience

The following scenarios represent the formal testing scenarios that participants have been working to implement both prior to and during the Connectathon event. Execution of these scenarios will focus on automated testing with the public testing platforms and is expected to be performed with the other participants of this track as well as the Publicly_Available_FHIR_Servers_for_testing. Each of the scenarios are implemented as FHIR TestScript resources that include extensive assertions to provide a more comprehensive validation/verification of the systems under test conformance to the FHIR specification.

NOTE 1: All testing scenarios are performed by choosing FHIR TestScript resources that use:

(a) XML or JSON

(b) client or server assigned resource IDs

NOTE 2: When testing a FHIR server, all of the test scenarios can be completed with a single TestScript--see 99. test scenario below.

NOTE 3: When testing a FHIR client, be sure to remember the following:

(a) Use the proxy URL of the FHIR server you are sending the request to, not the proxy URL of the FHIR client. The proxy URL assigned to the FHIR client is only used if the FHIR client is also a FHIR server and can accept requests.

(b) The warning about a missing conformance statement for the FHIR client can be ignored. If the FHIR client does publish a conformance statement, it is used by the test tool, but it is not required.

(c) When the test tool is "Waiting for Request", click on "Waiting for Request" and check the details of what it is waiting for under the "Submit the following request:" section--specifically, the Method, URL and Header values which should all match 100% what is sent.

1. Patient Registration/Creation

FHIR Server

Action: Use testing tool to create a new patient on the FHIR server

Precondition: TestScript will first delete the patient if it exists

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP status returned is 201 (Created), (b) returned format matches sent format, (c) patient can be retrieved and HTTP status 200 (OK) is returned, (d) retrieved patient format matches sent format and (e) conforms to base FHIR Patient profile.

FHIR Client

Action: FHIR client creates a new patient and saves it to FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient does not exist in FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is PUT, (b) URL contains full URL to Patient resource, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type contains the correct value, (e) requested resource type is Patient, and (f) the HTTP Response from the FHIR server is valid.

2. Patient Modification/Update

FHIR Server

Action: Use testing tool to update an existing patient on the FHIR server with a new birth date

Precondition: TestScript will first delete the patient if it exists and create a new patient resource to update

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP status returned is 200 (OK), (b) HTTP Header Content-Type is returned with correct value, (c) updated patient can be retrieved and HTTP status 200 (OK) is returned, (d) retrieved patient conforms to base FHIR Patient profile.

FHIR Client

Action: FHIR client updates a patient on the FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient exists on FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is PUT, (b) URL contains full URL to Patient resource, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type contains the correct value, (e) requested resource type is Patient, and (f) the HTTP Response from the FHIR server is valid.

3. Patient Read

FHIR Server

Action: Use testing tool to retrieve a patient from the FHIR server

Precondition: TestScript will first delete the patient if it exists and create a new patient resource to retrieve

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP status returned is 200 (OK), (b) HTTP Header Content-Type is returned with correct value, (c) retrieved patient conforms to base FHIR Patient profile

FHIR Client

Action: FHIR client retrieves a patient from the FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient exists on FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is GET, (b) URL contains full URL to Patient resource, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type is absent and (e) the HTTP Response from the FHIR server is valid.

4. Patient History

FHIR Server

Action: Use testing tool to retrieve patient history from the FHIR server

Precondition: TestScript will first delete the patient if it exists and create a new patient resource and update it with a 2nd revision to be retrieved

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP status returned is 200 (OK), (b) HTTP Header Content-Type is returned with correct value, (c) returned resource type is Bundle, (d) the returned Bundle conforms to the base FHIR Bundle profile, (e) the Bundle type is history, (f) the Bundle contains at least 2 entries and (g) the Bundle total value matches the number of entries.

FHIR Client

Action: FHIR client retrieves the patient history from the FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient exists on FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is GET, (b) URL contains full URL to Patient resource history, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type is absent and (e) the HTTP Response from the FHIR server is valid.

5. Patient Version Read

FHIR Server

Action: Use testing tool to retrieve specific patient versions from the FHIR server

Precondition: TestScript will first delete the patient if it exists and create a new patient resource and update it with a 2nd revision to be retrieved

Success Criteria: Testing tool passes all assertions and validations for both versions of the patient which include (a) HTTP status returned is 200 (OK), (b) HTTP Header Content-Type is returned with correct value, (c) returned resource conforms to base FHIR Patient profile.

FHIR Client

Action: FHIR client retrieves a specific patient version from the FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient exists on FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is GET, (b) URL contains full URL to specific Patient version, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type is absent and (e) the HTTP Response from the FHIR server is valid.

6. Patient Searching via Multiple Criteria

FHIR Server

Action: Use testing tool to search for patient on the FHIR server

Precondition: TestScript will first delete the patient if it exists and create a new patient resource to search for by identifier, given and family name

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP status returned is 200 (OK), (b) HTTP Header Content-Type is returned with correct value, (c) returned resource type is Bundle, (d) the returned Bundle conforms to the base FHIR Bundle profile, (e) the Bundle type is searchset, and (f) the Bundle total value matches the number of entries.

FHIR Client

Action: FHIR client searches for the patient on the FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient exists on FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is GET, (b) URL contains search parameters for identifier, family and given, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type is absent and (e) the HTTP Response from the FHIR server is valid.

7. Patient Deletion/Removal

FHIR Server

Action: Use testing tool to delete patient on the FHIR server

Precondition: TestScript will first delete the patient if it exists and create a new patient resource to be deleted

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP status returned is 204 (No Content), (b) after attempting to read patient an HTTP status 410 (Gone) is returned, and (c) after attempting to search patient an HTTP status 200 (OK) is returned, the HTTP Content-Type is returned with the correct value, returned resource type is Bundle, and the returned Bundle contains no entries.

FHIR Client

Action: FHIR client deletes a patient from the FHIR server. A testing tool is used as a proxy in order to validate that the transaction is processed correctly.

Precondition: Patient exists on FHIR server prior to action

Success Criteria: Testing tool passes all assertions and validations which include (a) HTTP method is DELETE, (b) URL contains full URL to Patient resource, (c) HTTP Header Accept contains the correct value, (d) HTTP Header Content-Type is absent and (e) the HTTP Response from the FHIR server is valid.

98. All Non-Versioning Patient Operations Defined Above

FHIR Server (use this TestScript to perform all non-versioning test scenarios listed above with a single TestScript execution)

Action: Use testing tool to perform all of the test scenarios listed above on the FHIR server which include (1) create a patient, (2) update the patients birth date, (3) retrieve the current patient, (4) search for the patient by identifier, given and family name and (5) delete the patient.

Precondition: TestScript will first delete the patient if it exists

Success Criteria: Testing tool passes all assertions and validations which include those for each of the test scenarios listed above

99. All Patient Operations Defined Above

FHIR Server (use this TestScript to perform all test scenarios listed above with a single TestScript execution)

Action: Use testing tool to perform all of the test scenarios listed above on the FHIR server which include (1) create a patient, (2) update the patients birth date, (3) retrieve the current patient, (4) retrieve the patient history, (5) retrieve each version of the patient, (6) search for the patient by identifier, given and family name and (7) delete the patient.

Precondition: TestScript will first delete the patient if it exists

Success Criteria: Testing tool passes all assertions and validations which include those for each of the test scenarios listed above

FHIR Client

NOTE: FHIR clients must execute the 7 test scenarios one at a time so, there is no TestScript artifact for this test scenario

Help Links

Here are some links to assist implementers:

• REST API in the Specification.
• Patient resource in the Specification.
• Open_Source_FHIR_implementations.
• Publicly Available FHIR Servers for testing.
• Step by step tutorial and sample projects.

TestScript(s)

The supporting TestScripts and corresponding fixtures have been committed to the FHIR documents Github repository at: https://github.com/FHIR/documents/tree/master/connectathons/CologneMay2018/Connectathon18/Patient-01-Intro, and https://github.com/FHIR/documents/tree/master/connectathons/CologneMay2018/Connectathon18/Patient-02-Formal

Results

The FHIR Connectathon 19 Patient Track outcomes are available here.

Breakout Session

The "FHIR Overview" breakout session presented Saturday morning at the FHIR 19 Connectathon can be downloaded as PowerPoint.

The "FHIR Testing and Touchstone" breakout session presented Saturday morning at the FHIR 18 Connectathon can be downloaded as PowerPoint.