cross-enterprise document sharing cross-enterprise document sharing bill majurski national institute...

Cross-Enterprise Document SharingCross-Enterprise Document Sharing

Bill MajurskiNational Institute of Standards and Technology

IT Infrastructure Co-Chair

June 28-29, 2005 Interoperability Strategy Workshop2

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsWorking Together to Deliver

Interoperable Health Information SystemsIn the Enterprise

and Across Care Settings


2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA)

2005Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS)Audit Trail and Note Authentication (ATNA)Personnel White Pages (PWP)

2006Cross-Enterprise User Authentication (XUA)Document Digital Signature (DSG) – Notification of Document Availability (NAV)Patient Administration/Management (PAM)

IT Infrastructure ProfilesIT Infrastructure Profiles

Cross-Enterprise Document Sharing (XDS) – Registration, distribution

and access across health enterprises of clinical documents forming a patient EHR


Cross-Enterprise Document Sharing (XDS)Cross-Enterprise Document Sharing (XDS)Abstract / ScopeAbstract / Scope

• Provide support for document-based patient EHR

• Support for document storage within existing products

• Provide support for indexing of patient documents

• Support query and retrieval of patient documents

• Scalable architecture


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Value PropositionValue Proposition

Points of view• EHR-CR : Care-delivery Record

– Patient information – Managed by a Care Delivery Organization

• EHR-LR : Longitudinal Record – Documents shared by EHR-CR(s)– Tracked by Registry

• Clinical Affinity Domain : – Group of healthcare enterprises (EHR-CR)– Common set of policies– Share a single registry



Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc.

Effective means to contribute and access: clinical documents across health enterprises.

Scalable sharing of documents: between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems.

Easy access: Care providers are offered means to query and retrieve clinical documents of interest.



Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR.

Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII).

Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.)


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Transaction DiagramTransaction Diagram

Document Consumer

Retrieve Document

Query Documents

Patient Identity Source

Patient Identity Feed

Document Source

Document Registry

Document Repository

Provide&Register Document Set

Register Document Set


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) ActorsActors

Document SourceSource of documents and metadata about documents

Document Repository Stores documents, requests indexing in Document Registry, supports

retrieval

Document Registry Indexes documents, supports search

Patient Identity Source Feeds identity of known patients to Document Registry

Document Consumer Initiates search and retrieval for consumer of documents


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Value Proposition (cont)Value Proposition (cont)

Document Content Neutral: Document content is processed only by source and consumer IT systems.

Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Standards UsedStandards Used

HealthcareContent Standards

HL7 CDA, CEN EHRcomHL7, ASTM CCR

DICOM …

Internet StandardsHTML, HTTP,

ISO, PDF, JPEG …

Electronic BusinessStandards

ebXML, SOAP …



Two “categories” of standards used

XDS Infrastructure

XDS Content



XDS Infrastructure Standards• OASIS/ebXML

– Registry Information Model v2.0

• Basis of XDS Registry Information Model

– Registry Services Specifications v2.0

• Registry Services

– Messaging Services Specifications v2.0

• Offline protocols

• ISO/IEC 9075 Database Language SQL

– Registry Query Language

• SOAP with Attachments

– Protocol for communication with XDS Registries and Repositories

• SHA-1 [FIPS 180-1]

– Document Hashes



XDS Infrastructure Standards (cont)• HL7 Version 2.3.1

– Messages for Patient Identity Management

• HL7 Version 2.5– Datatypes for XDS Registry Attribute values

• HL7 CDA Release 1– XDS Document concept definition

– Source of XDS Document Entry Attributes

• DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom– Sources of XDS Document Entry Attributes



• HTTP– Protocol for Retrieve

Document

– Online SOAP bindings

• SMTP– Offline ebMS bindings

• IETF– Language Identifiers

• MIME– Document Type codes

• UTF-8– Encoding of Registry

Attributes

XDS Infrastructure Standards (cont)



XDS Content Standards• Outside scope of XDS; layer on top of XDS • Documented as Document Content Profiles

– Document use cases and translation of document content into registry metadata

– Publishable separately– Guide for writing DCPs available– Intended mostly for IHE domain committees

• Of concern only to Document Source and Document Consumer actors

• Examples include: HL7 CDA, DICOM, ASTM CCR


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Proposed OptionsProposed Options

Options center around Document Source actorBasic operations• Submit single document• Replace existing documentOptional features• Off-line mode• Multi-document submission• Document life-cycle management

– Submit addendum or transformation of document• Folder management

– Create folder, add to folder


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Related ProfilesRelated Profiles

Patient Identity• Patient Identity Feed

– Notification • from ADT system• to Document Registry• of patient admission/registration

– Submission to Registry requires validated patient ID• Patient Demographics Query (PDQ)

– Identify patient based on query of demographic information– Needed by Document Source: assign correct patient ID– Needed by Document Consumer: query against correct patient ID


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Transaction DiagramTransaction Diagram

Document Consumer

Retrieve Document

Query Documents



Document Source

Document Registry

Document Repository




Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Patient ID ManagementPatient ID Management

Document Consumer

Retrieve Document

Query Documents



Document Source

Document Registry

Document Repository



Affinity Domain

PIX Manager

Patient Demographics Supplier

PIX Query

Patient Demographics Query

Multi- Domain



Time/Audit/Authentication• Constant Time (CT)• Audit Trail and Node Authentication (ATNA)• Cross-Enterprise User Authentication (XUA)



New related profiles• Notification of Availability (NAV)

– Send notification that documents are available

• Digital Signature (DSG)– Signing of documents in repository/registry


Cross-Enterprise Document Sharing (XDS) Cross-Enterprise Document Sharing (XDS) Document StatusDocument Status

• XDS profile document being updated for this season• Final collection of changes are being balloted now• Final text of the profile and a catalog of changes from last

year will be posted on the Web and announced in two weeks.


More information….More information….

• IHE Web sites: www.ihe.net• Technical Frameworks, Supplements

– Fill in relevant supplements and frameworks

• Non-Technical Brochures :• Calls for Participation

• IHE Fact Sheet and FAQ

• IHE Integration Profiles: Guidelines for Buyers

• IHE Connect-a-thon Results

• Vendor Products Integration Statements

http://www.ihe.net/

cross-enterprise document sharing cross-enterprise document sharing bill majurski national institute...

Documents

cross enterprise document

document storage

document centric

xds actors document

patient ehr slide

scalable sharing of

clinical information

indexing of patient