ihe it infrastructure domain update karen witting – ibm it infrastructure technical committee...
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IHE IT Infrastructure Domain Update
Karen Witting – IBM IT Infrastructure Technical Committee co-chair
IHE - Connecting standards to care
• Care providers work with vendors to coordinate the implementation of standards to meet their needs– Care providers identify the key interoperability
problems they face– Drive industry to develop and make available
standards-based solutions– Implementers follow common guidelines in
purchasing and integrating systems that deliver these solutions
IT Infrastructure Domain (ITI)
• Supports profiles which supply necessary infrastructure for sharing healthcare information.
• IT Infrastructure domain began in 2003 and now has 21 profiles that it supports.
• Key ITI profiles demonstrated today:– Information Exchange: XDS (XDS.a & XDS.b), XDM,
XDR, XDS-SD, RFD– Security: ATNA, CT, XUA, BPPC– Identity Management: PIX, PDQ (HL7 V2 & V3)
An Infrastructure Interoperability Component Is…
• An infrastructure Interoperability component…– Represents a common IT function or service that is
used as a building block for a variety of use cases– May be imbedded in an application, but is often
deployed as a shared resource within a RHIO or Health Information Exchange
– Is a necessary ingredient, but is rarely visible to the end user
Document Content and Modes of Document Exchange
Document Exchange Integration ProfilesDocument Exchange Integration Profiles
DocumentDocument SharingSharing
XDS.aXDS.aXDS.bXDS.b
MediaMediaInterchangeInterchange
XDMXDM
ReliableReliableInterchangeInterchange
XDRXDR
Doc Content ProfilesDoc Content ProfilesConsentConsent
BPPCBPPCEmergencyEmergency
EDREDRPrePre
SurgerySurgery
PPH PPPH P
Scanned DocScanned Doc
XDS-SDXDS-SD
LaboratoryLaboratory
XD*-LabXD*-LabPHR PHR
ExchangeExchange
XPHRXPHR
Discharge &Discharge &ReferralsReferrals
XDS-MSXDS-MS
ImagingImaging
XDS-IXDS-I
XDS StoredQuery & Patient Identity Merge
Cross-CommunityCross-CommunityAccessAccess
XCAXCA
New/updated in 2007
• Information Exchange– Cross-Enterprise Document Sharing - b (XDS.b) ☼– Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼– XDS Stored Query Transaction (addition to XDS) ☼– XDS Patient Identity Merge (addition to XDS)– Cross Community Access (XCA) ☼
– Retrieve Form for Data Capture (RFD) ☼– Cross-Enterprise Document Media Exchange (XDM) ☼– Cross-Enterprise Document Reliable Interchange (XDR)– HL7 V3 based PIX and PDQ transactions ☼
• Security/Privacy– Cross-Enterprise User Assertion (XUA) ☼– Basic Patient Privacy Consents (BPPC) ☼
▀ colored text designates 2006 profiles which were updated this year☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2007
2003-2005
• Information Exchange– Retrieve Information for Display (RID)– Patient Identifier Cross-Referencing (PIX)☼– Patient Synchronized Applications (PSA) – Cross-Enterprise Document Sharing (XDS.a) ☼– Patient Demographics Query (PDQ) ☼– Notification of Document Availability (NAV)– Patient Administration Management (PAM)
• Security/Privacy– Enterprise User Authentication (EUA)– Consistent Time (CT) ☼– Audit Trail and Node Authentication (ATNA) ☼– Personnel White Pages (PWP)– Document Digital Signature (DSG)
▀ colored text designates profiles still in Trial Implementation☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2007
Categories of Healthcare Communication Services
Security
DocumentSharing
Patient and Provider ID Mgt
DynamicInformation
Access
WorkflowManagement
Source persisted and attested health
records
Specific info snapshot
provided on demand
2 or more entitiessynchronize
a task
e.g. access to last 6 months historical
labs and encounter summaries
e.g. order a lab test, track status and receive results
e.g. get a current list of allergies or med list from a source
HospitalsHIEs and RHIOs
Health Information Exchanges Interoperability: Cross-enterprise Document Sharing
• Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution
• Patients have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment
• Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations
• Addresses the need for a longitudinal healthcare data and its intend is for support of archival data. It does not address workflow or dynamic data access.
• Workflows addressed in a second step in a much simpler manner.Point-to-Point messages best suited for workflows mgt
Cross-Enterprise Document Sharing (XDS) Standards Used
HealthcareContent Standards
HL7 CDA, CEN EHRcomHL7, ASTM CCR
DICOM …
Internet StandardsHTML, HTTP,
ISO, PDF, JPEG …
Electronic BusinessStandards
ebXML Registry, SOAP, Web Services …
• Implemented world-wide by more than 30 vendors/open source. Final text published December 2006.
• Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, etc.)
• IHE XDS: 42,300 “Google” references (Feb’ 07)
Why is IHE-XDS a breakthrough ?
• It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML.
• Sharing of digital documents as “attested by the source”, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Message feeding a central web server hinders use of EHRs).
• Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured.
• Meets both the needs of point-to-point push communication and on-demand pull in a variety of centralized or distributed architectures.
Offer a consistent, standards-based and functional Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systemsrecord sharing for EHRs, PHRs & other IT Systems
XDS.a and XDS.b
• XDS.a– Original XDS profile, pre 2007– Based on ebXML Reg/Rep 2.1– SOAP with attachments based Provide and Register– Retrieve is HTTP GET
• XDS.b– Based on a use of the Web Services and ebXML Reg/Reg
standards that is consistent with the current developments and best practices in the industry
– Based on ebXML Reg/Rep 3.0– MTOM based Provide and Register– MTOM based retrieve– HL7 V3 Patient Identity Feed
• Actors are the same in both XDS.a and XDS.b• Metadata is the same in both XDS.a and XDS.b
XDS.a Transactions Diagram
Document Consumer
Retrieve Document
Registry Stored Query
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide&Register Document Set
Register Document Set
Query Registry
XDS.b Transactions Diagram
Document Consumer
Retrieve Document Set
Registry Stored Query
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide&Register Document Set - b
Register Document Set - b
Patient Identity Feed HL7v3
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of ATNA & CT
PMS
Retrieve DocumentRetrieve Document
Register DocumentRegister DocumentQuery DocumentQuery Document
XDS Document Registry
ATNA Audit record repository CT Time server
Record AuditRecord AuditEventEvent
MaintainMaintainTimeTime
MaintainMaintainTimeTimeRecord AuditRecord Audit
EventEvent
Maintain TimeMaintain TimeProvide & Register Docs
Record AuditRecord AuditEventEvent
XDS Document Repository
XDSDocumen
t Reposito
rySecured MessagingSecured Messaging
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of PIX & PDQ
A87631
PACS
L-716
Affinity Domain Patient Identity Source
M8354673993
Retrieve Document Provide & Register Docs
Register (using Pt ID)Query Document (using Pt Id)
Patient Identity Feed
Document Registry
14355M8354673993
L-716
A87631
Patient Identity Feed
PIX Query
PIX Query
Patient Identity Feed
Patient Identity XRef MgrPatient Identity FeedPDQ Query to Acquire Affinity Domain Patient ID
M8354673993
A87631L-716
M8354673993
XDS Document Repository
XDSDocument
Repository
ATNA Audit record repository CT Time server
Cross Community Access (XCA)
• Sharing of documents across communities• Re-use of XDS.b transactions.• Document Consumer consistency
– Requirements of Document Consumer are the same as for local document query and retrieval
• Out of scope:– How to identify which communities to interact with– How to identify the patient id to use when interacting
XCA Transaction Diagramminimum required
XCA Transaction Diagram
XCA Transaction Diagram
XCA Transaction Diagram
Cross Community AccessActors and Transactions
• Initiating Gateway– On behalf of internal actors, initiates all transactions leaving the community– Receives Registry Stored Query and Retrieve Document Set from Document Consumer– Propagates transaction to local Document Registry and Repository, if appropriate– Propagates transaction to other communities by contacting their Responding Gateway
and sending: Cross Gateway Query and Cross Gateway Retrieve• Responding Gateway
– Single contact point for all transactions coming in to the community.– Propagates incoming transactions to local actors
• New Transactions:– Cross Gateway Query: from Initiating Gateway to Receiving Gateway, mimics Registry
Stored Query– Cross Gateway Retrieve: from Initiating Gateway to Receiving Gateway, mimics
Retrieve Document Set• Document Consumer
– Supports Registry Stored query and Retrieve Document Set– New requirement: propagation of the homeCommunityId requirement
• Applies to XDS.a, XDS.b and XCA profiles
XDS RegistryInitiatingGateway
DocumentConsumer
XCA Process Flow
XDS Registry
XDS Repository
RSQ
XDS Registry
RSQ
XGQ
XDS Repository
XDS Repository
Community A
Community B
Community C
RespondingGateway
RespondingGateway
XGQ
RSQ
RSQRDS
RSQ – Registry Stored QueryXGQ – Cross Gateway QueryRDS – Retrieve Document SetXGR – Cross Gateway Query
RDS
XGR
RDS
IHE IT Infrastructure – Schedule for 2007
• Development Schedule:Development Schedule:• Planning Committee decision:Planning Committee decision: December 2007December 2007• Issue Public Comment version: Issue Public Comment version: June 2008June 2008• Public Comment Due:Public Comment Due: July 2008July 2008• Issue Trial Implementation version: Issue Trial Implementation version: August 2008August 2008• IHE Connectathon: IHE Connectathon: January 2009January 2009• HIMSS Demo: HIMSS Demo: February 2009February 2009
IHE IT Infrastructure – Plan for 2008
• New Supplements For 2008 • Sharing of Value Sets• Referral Request• Emergency Contact Registry Query• Asynchronous XDS.b• Extended PDQ
• Significant updates to previous years profiles• XDS-SD conformance to PCC TF
• New White Papers for 2008• Publish/Subscribe Infrastructure for XDS
IHE IT Infrastructure Roadmap
2008-2009+ Profile Candidates• Continue Prior Profile Work
Web Services and SOA for Healthcare Cross- Community Location Cross-Enterprise User Authentication (Phase 2)
• Advance White Papers to Profiles Aggregate Data Monitoring Configuration Management
And then….
IHE IT Infrastructure Roadmap
2008-2009+ Profile Candidates• Add New Work
Cross-Enterprise Ordering Cross-Enterprise Workflow Scheduling XDS Affinity Domain Configuration XDS Templates Composite Documents Role-based Access Control Anonymization and Pseudonymization Mobile Security Master File Maintenance Service Discovery SNMP MIBs