This document provides an overview of using Azure DocumentDB as a HL7 document repository for healthcare integration. It discusses DocumentDB features like JSON documents, indexing, CRUD operations, and querying. Example use cases for a HL7 document repository using DocumentDB are presented, including personal health records, document sharing, decision support, and patient demographics. The document concludes by previewing the design of an Azure API connector app for DocumentDB and a Logic App for HL7 FHIR.

1. Sponsored & Brought to you by
Azure DocumentDB for
Healthcare Integration
Howard Edidin
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2. Azure DocumentDB for Healthcare Integration
Howard S. Edidin
Microsoft Partner Technical Specialist (BizTalk, Azure) for Healthcare
Gold Member

3. About the series
• Currently there is no direct support for HL7 in Azure
• Using DocumentDB as the foundation, we will overcome this issue
3

4. INTRODUCTION TO DOCUMENTDB
Azure DocumentDB for Healthcare Integration – Part 1
4

5. Azure DocumentDB for Healthcare
Integration
• Azure DocumentDB, features and capabilities
• Creating a DocumentDB database
• CRUD operations
• API’s
– REST
– SQL Query Language
– Server-side JavaScript
• Leveraging DocumentDB as a HL7 document repository
• Preview API and Logic Apps
5

6. AZURE DOCUMENTDB, FEATURES AND CAPABILITIES
Azure DocumentDB for Healthcare Integration – Part 1
6

7. DocumentDB
• DocumentDB is unique among NoSQL stores
– It was developed and delivered as a service
– It’s truly schema-free, queryable and JSON aware
– Offers transactional processing through language integrated JavaScript
– Predictable performance and tunable consistency
7

8. Resource Model
8

9. Access Model
• RESTful interaction over HTTP
• Standard HTTP verbs & semantics
• Can utilize BizTalk as a client
• Built-in support for TCP for smart clients
• Designed for Gateway as well as Direct Connectivity options
POST
Item
resource TenantFeed
URI
PUT
Item
resource
Item
URI
DELETE
Item
URI
GET
PATCH
TenantFeed Or Item
URI
Item URI
Create a new resource
/Execute a sprocs/trigger/query
Replace an existing resource
Delete an existing resource
Read/Query an existing
resource
*Selectively Edit an existing resource
Item
resource
POST http://myaccount.documents.azure.net/dbs
{ "name":"My Company Db"}
...
[201 Created]
{
"name": "My Company Db",
"id": "UoEi5w==",
"self": "dbs/UoEi5w==/",
"colls": "colls/",
"users": "users/"
}
9

10. JSON Documents
JavaScript Object Literals
JSON serializable
values (aka JSON
Infoset)
Why JSON?
Ubiquitous
Schema-free and yet queryable
Minimal impedance mismatch
Committed to JSON & JavaScript
Automatic indexing of documents without requiring schema or secondary indices
SQL query dialect rooted in JSON; extensible via JavaScript
Efficient execution of application logic with (JavaScript) language integrated database transactions
Minimal impedance mismatch between the programming languages and the database type systems
10

11. Data partitioned into collections
10GB
zz
RU/s
$z per
hour
10GB
yy
RU/s
$y per
hour
10GB
xx
RU/s
$x per hour
• Collections can be added and removed from
databases
• Each collection has reserved storage (10 GB)
and throughput
• Scale horizontally across multiple collections
• Collections can be configured with different
throughput levels
POST
Item
resource TenantFeed
URI
Create a new resource
/Execute a sprocs/trigger/query
11

12. Indexing
How it works
• Automatic indexing of documents
• JSON documents are represented as
trees
• Structural information and instance
values are normalized into a JSON-
Path
• Fixed upper bound on index size
(typically 5-10% in real production
data)
Example
{"headquarters": "Belgium"}  /"headquarters"/"Belgium"
{"exports": [{"city": “Moscow"}, {"city": Athens"}]}  /"exports"/0/"city"/"Moscow"
and /"exports"/1/"city"/"Athens".
12

13. CREATING A DOCUMENTDB DATABASE
Azure DocumentDB for Healthcare Integration – Part 1
13

14. DocumentDB app
• We are NOT designing a DocumentDB application
– We won’t need to Model data as JSON
– List common access patterns – top 5-10 queries, sprocs, and CRUD
– Review indexing policy and query
– Decide partitioning scheme
14

15. DEMO - CREATING A DOCUMENTDB DATABASE
Azure DocumentDB for Healthcare Integration – Part 1
15

16. DocumentDB Database
A DocumentDB database is a logical container of one or more
collections and users, as shown in the following diagram. You can
create any number of databases under a DocumentDB database
account subject to offer limits.
16

17. REST
• The DocumentDB REST API supports the following:
– Access control to resources.
– Query functionality for resources.
– Basic CRUD operations for resources.
17

18. Access control on resources
• Access to DocumentDB resources is governed by a master key token
or a resource token. To access a resource, the selected token is
included in the REST authorization header, as part of the
authorization string.
18

19. Query functionality for resources
• All DocumentDB resources except account resources, can be queried
using DocumentDB SQL language.
• To perform a SQL query on a resource, do the following:
– Execute a POST method against a resource path using JSON with the "query"
property set to the SQL query string, and the "parameters" property set to the
array of optional parameter values.
– Set the x-ms-documentdb-isquery header to true.
– Set the Content-Type header to application/query+json.
POST https://contosomarketing.documents.azure.com/dbs/XP0mAA==/colls/XP0mAJ3H-AA=/docs HTTP/1.1
x-ms-documentdb-isquery: True
x-ms-date: Mon, 18 Apr 2015 13:05:49 GMT
authorization:
type%3dmaster%26ver%3d1.0%26sig%3dkOU%2bBn2vkvIlHypfE8AA5fulpn8zKjLwdrxBqyg0YGQ%3d
x-ms-version: 2015-04-08
Accept: application/json
Content-Type: application/query+json
Host: contosomarketing.documents.azure.com
Content-Length: 50
{
query: "SELECT * FROM root WHERE (root.Author.id = 'Don')",
parameters: []
}
19

20. CRUD OPERATIONS
Azure DocumentDB for Healthcare Integration – Part 1
20

21. CRUD Operations
• The DocumentDB API supports basic CRUD operations on the
resources under a database account
– The document resource is represented by docs in the DocumentDB resource
model
• A document consists of user-defined content in JSON format
• Aside from the required id property, users can define any arbitrary elements, structures,
and hierarchies for the content. The id element is a unique string that is user-settable and
must not exceed 255 characters
• By default, documents are automatically indexed, thus making a document queryable as
soon as it is created
• Attachments can also be linked to a document
21

22. Create a document
• A new document can be created by executing an HTTPS POST
request against the docs URI resource path.
Request Syntax:
Method Request URI HTTP Version
POST https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-col}/docs HTTP/1.1
Note that the {databaseaccount} is the name of the DocumentDB account created under your
subscription. The {_rid-db} value is the resource ID of the database. The {_rid-col} value is the resource
ID of the collection that contains the document.
22

23. Get a document
• Performing a GET operation on a specific document resource
retrieves the user defined JSON elements and system properties of
the document.
Request Syntax:
Method Request URI HTTP
Version
GET https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-col}/docs/{_rid-doc} HTTP/1.1
Note that the {databaseaccount} is the name of the DocumentDB account created under your
subscription. The {_rid-db} value is the resource ID of the database. The {_rid-col} value is the resource
ID of the collection that contains the document.
23

24. Replace a document
• Performing a PUT operation on a specific document resource replaces the entire
document resource. All user settable properties, including the id, and the user
defined JSON elements must be submitted in the body to perform the
replacement. Any element omissions result in unintended data loss as this
operation is a full replace operation. The x-ms-indexing-directive header can be
set and submitted for the operation to include or exclude the document from being
indexed.
Request Syntax:
Method Request URI HTTP
Version
PUT https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-col}/docs/{_rid-doc} HTTP/1.1
24

25. Delete a document
• Performing a DELETE operation on a specific document resource deletes the
document resource from the collection.
Method Request URI HTTP
Version
DELETE https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-col}/docs/{_rid-doc} HTTP/1.1
Request Syntax:
25

26. OTHER OPERATIONS
Azure DocumentDB for Healthcare Integration – Part 1
26

27. Other operations
• Operations on DocumentDB Document Collections
– Create a collection
– List collections
– Get a collection
– Delete a collection
• Operations on DocumentDB Attachments
– Create an Attachment
– Replace an attachment
– List attachments
– Delete attachments
27

28. Other operations
• Operations on Stored Procedures
– Create a stored procedure
– Replace a stored procedure
– List stored procedures
– Delete a stored procedure
– Query stored procedures
– Execute a stored procedure
28

29. Other operations
• Operations on User Defined Functions
– Create a UDF
– Replace a UDF
– List UDFs
– Delete a UDF
– Query UDFs
• Operations on Triggers
– Create a trigger
– Replace a trigger
– List triggers
– Delete a trigger
– Query triggers
29

30. Other operations
• Operations on DocumentDB Databases
– Create a Database
– List Databases
– Get a Database
– Delete a Database
• Querying DocumentDB Resources
– All DocumentDB resources except account resources can be queried using
DocumentDB SQL language.
30

31. DocumentDB Resource URI Syntax
for REST
Resources Base URI
Database https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}
User https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/users/{_rid-user}
Permission https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/users/{_rid-user}/permissions/{_rid-perm}
Collection https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-coll}
Stored Procedure https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-coll}/sprocs/{_rid-sproc}
Trigger https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-coll}/triggers/{_rid-trigger}
UDF https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-coll}/udfs/{_rid-udf}
Document https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-coll}/docs/{_rid-doc}
Attachment https://{databaseaccount}.documents.azure.com/dbs/{_rid-db}/colls/{_rid-coll}/docs/{_rid-
doc/attachments/{_rid-attch}
31

32. DOCUMENTDB SQL QUERY LANGUAGE
Azure DocumentDB for Healthcare Integration – Part 1
32

33. SQL Query
• Azure DocumentDB supports querying of documents using a familiar
SQL (Structured Query Language) like grammar over hierarchical
JSON documents without requiring explicit schema or creation of
secondary indexes
33

34. SQL Query
techreadytv.com
Query Playground
34

35. LEVERAGING DOCUMENTDB AS A HL7
DOCUMENT REPOSITORY
Azure DocumentDB for Healthcare Integration – Part 1
35

36. HL7 Document Repository
Integrating HL7 newest standard
Azure on FHIR©
36

37. HL7 Document Repository
Using DocumentDB as a FHIR© document repository
• Possible Use Cases
– Personal Health Record (PHR)
• In the PHR scenario, an Electronic Medical Record system (EMR, though many other
names and acronyms are also used) provides a RESTful API that allows patients to access
their own medical record via a common web portal or mobile application.
– Document Sharing (XDS)
• One common way to integrate healthcare information from a variety of sources is to build a
repository of documents around a patient record. Building a repository of documents allows
for less stringent alignment around policy, procedures and record-keeping/informatics
standards.
37

38. HL7 Document Repository
– Decision Support
• One common use of healthcare information systems is to integrate some
form of decision support software into clinical systems.
– Common uses of clinical decision support are:
» Drug-drug interaction checking, and more generally, prescription safety checks
» Suggesting commonly missed diagnostic data interpretations (including delta
checking)
» Patient surveillance for early warning of deteriorating patient health (both acute and
ambulatory care)
» Identifying candidates for alternative treatment plans for improved efficacy
38

39. HL7 Document Repository
– Patient Demographics Query for Mobile (PDQm)
• The Patient Demographics Query for Mobile (PDQm) Profile defines a lightweight RESTful
interface to a patient demographics supplier leveraging technologies readily available to
mobile applications and lightweight browser based applications.
• The functionality is identical to the PDQ Profile
• The differences are transport and messaging format of messages and queries. The profile
leverages HTTP transport, and the JavaScript Object Notation (JSON), Simple-XML, and
Representational State Transfer (REST). The payload format is defined by the HL7 Fast
Health Interoperable Resources (FHIR) draft standard.
– Web based EHR/EMR applications which wish to provide dynamic updates of patient
demographic information such as a non-postback search, additional demographic detail, etc.
– A health portal securely exposing demographics data to browser based plugins
39

40. PREVIEWING API AND LOGIC APPS
Azure DocumentDB for Healthcare Integration – Part 1
40

41. Previewing API and Logic Apps
Azure DocumentDB for Healthcare Integration – Part 2
– Design and development of an Azure API Connector app for DocumentDB
– Designing a Logic App for HL7 FHIR©
41

42. Azure DocumentDB for Healthcare Integration
42
Howard S. Edidin MCTS, MCP, Author, Trainer, TechNet Wiki Ninja
Microsoft Partner Application Integration
|HL7|HIPAA
Microsoft Virtual Technical Specialist (BizTalk, Azure) for Healthcare
hedidin@edidingroup.net