full metadata subscription (fsub) profile proposal for 2012/13 presented to the it infrastructure...

Full metadata SubscriptionFull metadata Subscription(FSUB)(FSUB)

Profile Proposal for 2012/13Profile Proposal for 2012/13presented to thepresented to the

IT Infrastructure Technical CommitteeIT Infrastructure Technical Committee

Mauro ZanardiniMauro ZanardiniMc Lean, December, 4Mc Lean, December, 4thth 2012 2012


FSUB - Key Elements

This proposal focuses on the extension of DSUB profile This proposal focuses on the extension of DSUB profile

Key elements:Key elements:

• Notification of events occurred during a clinical workflowNotification of events occurred during a clinical workflow• Notification of content published whose type can’t be known Notification of content published whose type can’t be known

in advance by Notification Recipient (hospitalization etc…) in advance by Notification Recipient (hospitalization etc…) • Notification of content specifically targeted to one Recipient. Notification of content specifically targeted to one Recipient. • Address inconsistencies or lacks of DSUB profiles (e.g. Address inconsistencies or lacks of DSUB profiles (e.g.

constraint in using fullNotification)constraint in using fullNotification)


Why it is necessary to extend DSUB:Why it is necessary to extend DSUB:• DSUB is not implemented in a wide way, probably because DSUB is not implemented in a wide way, probably because

it is focused on a restricted set of use-cases.it is focused on a restricted set of use-cases.• DSUB has built a powerful notification infrastructure, that DSUB has built a powerful notification infrastructure, that

can be used to increase the process of digitalization can be used to increase the process of digitalization reaching a more efficient access to the clinical content. reaching a more efficient access to the clinical content.

• Many vendors has already implemented products based on Many vendors has already implemented products based on DSUB out of the standard. DSUB out of the standard.

• A workflow Management system without a notification A workflow Management system without a notification system is not applicable in real use case. system is not applicable in real use case.

FSUB - Necessity


Alignment with IHE purpose:

• The extension grants backward compatibility with DSUB’s The extension grants backward compatibility with DSUB’s products.products.

• The addition of new use-cases can only increase the of The addition of new use-cases can only increase the of vendors interested in the profilevendors interested in the profile

• The extension doesn’t involve additional complexity to the The extension doesn’t involve additional complexity to the profile.profile.

• Many other domains (PCC, RAD, PHARACY) have developed Many other domains (PCC, RAD, PHARACY) have developed Workflow Definition profiles with the idea that DSUB’s Workflow Definition profiles with the idea that DSUB’s notification system could be applied. ITI has to provide an notification system could be applied. ITI has to provide an instrument to fix this lack.instrument to fix this lack.


Use Case 1: clinical workflow

Many use-case (each workflow that can be managed using Many use-case (each workflow that can be managed using XDW), same functionalities needed:XDW), same functionalities needed:

•During a clinical workflow, actors involved would like to be During a clinical workflow, actors involved would like to be acknowledged for the specific workflow they belong to (notify in acknowledged for the specific workflow they belong to (notify in accordance to Workflow fixed reference). accordance to Workflow fixed reference). •A clinician would like to understand instantly which is the A clinician would like to understand instantly which is the workflow that has been updated (self-consistent notification).workflow that has been updated (self-consistent notification).•Notification system can be used to update the set of actors Notification system can be used to update the set of actors involved in the workflow (coupling between WS-HumanTask involved in the workflow (coupling between WS-HumanTask notification system and DSUB). notification system and DSUB).


Use Case 2: laboratory Report production, hospitalization, etc…

Other use-cases requires that a notification has to be sent Other use-cases requires that a notification has to be sent to a specific Recipient identified by the Source of clinical to a specific Recipient identified by the Source of clinical document:document:

•Laboratory Report:Laboratory Report: the requester ask for a result, but in many the requester ask for a result, but in many case what he can request is different from the test performed by case what he can request is different from the test performed by the laboratory (the source identifies the intendedRecipient of the the laboratory (the source identifies the intendedRecipient of the content)content). . •Report produced without the request of the GP: Report produced without the request of the GP: many many processes requires the uknowledgment of the GP, but he is not processes requires the uknowledgment of the GP, but he is not involved in the process as requester (hospitalization)involved in the process as requester (hospitalization)


Use Case 3: prolonged patient hospitalization

Many times all clinical information produced during an Many times all clinical information produced during an hospitalization are collected using a folder:hospitalization are collected using a folder:

•Clinician involved can’t define in advance the type of Clinician involved can’t define in advance the type of content produced: content produced: the subscribtion of documentEntry the subscribtion of documentEntry metadata are not usefulmetadata are not useful. . •Some clinician can only put inside a folder the reference to Some clinician can only put inside a folder the reference to other documents already published: other documents already published: this action has to be this action has to be notified as like as a new pubblication notified as like as a new pubblication


Proposed Standards & Systems

• ITI Afferent IHE ProfilesITI Afferent IHE Profiles: : – DSUB, XDW, DSUB, XDW,

• Afferent IHE Profiles:Afferent IHE Profiles: – Pharmacy: CMPD,Pharmacy: CMPD,– Patient Care Coordination: XBeR-WD, XTB-WD, XTHM-WD, etc.Patient Care Coordination: XBeR-WD, XTB-WD, XTHM-WD, etc.– Radiology: XSM-WDRadiology: XSM-WD

• Other standards itemsOther standards items: : – WS-BaseNotification, WS-TopicsWS-BaseNotification, WS-Topics

• Stability and robustnessStability and robustness: : – No new transaction are introduced No new transaction are introduced – No new actors are definedNo new actors are defined– Backwards compatibility Backwards compatibility


Simple Technical Approach

• Exension of the filter expressionExension of the filter expression: : now DSUB profile allows to now DSUB profile allows to create subscriptions only based on findDocuments querycreate subscriptions only based on findDocuments query

Changes affect: Changes affect:

Actors: Actors: Document Metadata Subscriber, Document Document Metadata Subscriber, Document Metadata Notification BrokerMetadata Notification Broker

Transactions:Transactions: Document Metadata Notify, Document Document Metadata Notify, Document Metadata SubscribeMetadata Subscribe

PurposePurpose: implementing subscriptions not based on query (content : implementing subscriptions not based on query (content defined in ITI-18 transaction) but based on metadata. The defined in ITI-18 transaction) but based on metadata. The subscription has to use the query sintax but the filter expression subscription has to use the query sintax but the filter expression can be created using any combination of metadata.can be created using any combination of metadata.


Simple Technical Approach

• Allows different notification payloadsAllows different notification payloads: the payload is : the payload is defined by the topicExpression tag. DSUB now define only defined by the topicExpression tag. DSUB now define only two values for this tag: ihe:MinimalDocumentEntry, two values for this tag: ihe:MinimalDocumentEntry, ihe:FullDocumentEntry.ihe:FullDocumentEntry.

Changes affect: Changes affect:

Actors: Actors: Document Metadata Notification Broker, Document Document Metadata Notification Broker, Document Metadata Notification RecipientMetadata Notification Recipient

Transactions: Transactions: Document Metadata NotifyDocument Metadata Notify

PurposePurpose: Allows the delivery of other objects then documents. : Allows the delivery of other objects then documents. Folders or submissions can contain information more useful in Folders or submissions can contain information more useful in some cases (folderId, sourceId, intendedRecipient…). some cases (folderId, sourceId, intendedRecipient…).


Effort Estimates

• The work effort (in term of documentation) for profiling the The work effort (in term of documentation) for profiling the FSUB is SMALL because there arenFSUB is SMALL because there aren’’t new transactions t new transactions and the new actor, and the template of DSUB can be used and the new actor, and the template of DSUB can be used for the extension. for the extension.

• Only two transactions are affected by the extension, Only two transactions are affected by the extension, • The main part of the work can be the definition of new use-The main part of the work can be the definition of new use-

cases and addressing inconsistencies of DSUB.cases and addressing inconsistencies of DSUB.• Proposed editors:Proposed editors:

– Mauro Zanardini, Arsenàl.IT, Mauro Zanardini, Arsenàl.IT, [email protected] – Organization: Arsenàl.IT, Organization: Arsenàl.IT, www.consorzioarsenal.it