1September, 2005 What IHE Delivers

XDS Document Source XDS Document Source and Consumer and Consumer Implementation Implementation

StrategiesStrategies

IHE Vendors Workshop 2006IHE Vendors Workshop 2006

IHE IT Infrastructure EducationIHE IT Infrastructure Education

George Cole (Allscripts)George Cole (Allscripts)

with thanks to Charles Parisot for many slideswith thanks to Charles Parisot for many slides

2

OverviewOverview

Review XDSReview XDS

Related ProfilesRelated Profiles

Implementation StrategiesImplementation Strategies

ResourcesResources

QuizQuiz

3

Cross-Enterprise Document SharingCross-Enterprise Document Sharing

A baseline profileA baseline profile

Focused on managing the sharing of Focused on managing the sharing of patient healthcare documentspatient healthcare documents

Provides for Distributed RepositoriesProvides for Distributed Repositories

Content NeutralContent Neutral

Referenced and reused by other profilesReferenced and reused by other profiles

4

XDS for DummiesXDS for Dummies

Document Source submits to RepositoryDocument Source submits to Repository

Document Consumer queries RegistryDocument Consumer queries Registry

Document Consumer retrieves from Document Consumer retrieves from RepositoryRepository

5

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

XDS Actors and TransactionsXDS Actors and Transactions

6

Clinical EncounterClinical Encounter ClinicalClinicalIT SystemIT System 1-Expression of a 1-Expression of a

need for additional need for additional informationinformation

Index of patients records(Document-level)

Temporary Aggregate Patient History

3-Documents3-DocumentsReturnedReturned

DocumentRepositories

4-Patient data 4-Patient data presented to presented to

PhysicianPhysician

3-Reference3-Referenceto Docs from to Docs from

InquiryInquiry2- Inquiry 2- Inquiry for Docs for Docs

XDS in ActionXDS in Action

7

Related ProfilesRelated Profiles

Patient Identifier Cross-referencing (PIX) Patient Identifier Cross-referencing (PIX) or Patient Demographics Query (PDQ)or Patient Demographics Query (PDQ)

Consistent Time (CT)Consistent Time (CT)

Audit Trail and Node Authentication Audit Trail and Node Authentication (ATNA)(ATNA)

Document Digital Signature (DSG)Document Digital Signature (DSG)

Notification of Document Availability Notification of Document Availability (NAV)(NAV)

8XDS Affinity Domain (NHIN sub-network)

Community Clinic

Lab Info. System

PACS

Teaching Hospital

PACS

ED Application

EHR System

Physician Office

EHR System

XDS Scenario + use of ATNA & CTXDS Scenario + use of ATNA & CT

PMS

Retrieve DocumentRetrieve Document

Register DocumentRegister DocumentQuery DocumentQuery Document

XDS Document Registry

ATNA Audit ATNA Audit record repositoryrecord repository CT Time serverCT 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

9XDS Affinity Domain (NHIN sub-network)

Community Clinic

Lab Info. System

PACS

Teaching Hospital

PACS

ED Application

EHR System

Physician Office

EHR System

XDS Scenario + use of PIX & PDQXDS Scenario + use of PIX & PDQ

A87631L-716

Affinity Domain Patient Identity Source

M8354673993

Retrieve DocumentRetrieve Document Provide & Register Docs

Register (using Pt ID)Register (using Pt ID)Query Document (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 ATNA Audit record repositoryrecord repository CT Time serverCT Time server

10

IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006

Consistent TimeCoordinate time across

networked systems

Audit Trail & Node Authentication

Centralized privacy audit trail and node to node authentication

to create a secured domain.

Patient Demographics Query

Cross-Enterprise Document Sharing

Registration, distribution and access across health enterprises of clinical

documents forming a patient electronic health record

Patient Identifier Cross-referencing

Map patient identifiers across independent identification

domains

Emergency Referrals

Format of the Document Content and associated coded vocabulary

PHR Extract

Format of the Document Content and associated coded vocabulary

ECG Report Document

Format of the Document Content and associated coded vocabulary

Lab Results Document Content

Format of the Document Content and associated coded vocabulary

Scanned Documents

Format of the Document Content

Consent Management

Patient consents

Cross-enterpriseDocument InterchangeMedia-CD/USB & e-mail push

Notification of Document Availability

Notification of a remote provider/ health enterprise

Imaging Information

Format of the Document Content and associated coded vocabulary

Medical Summary (Meds, Allergies, Pbs)

Format of the Document Contentand associated coded vocabulary

Document Digital Signature

Attesting “true-copy and origin

11

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

XDS Actors and TransactionsXDS Actors and Transactions

12

Document Availability ManagementDocument Availability Management

Availability Status Visible to a Document Source

ApprovedAvailable for Patient Care

Availability Status Change under the Control ofOriginal Document Source and Patient (if allowed in Affinity

Domain)

DeprecatedObsolete

SubmittedRegistration in progress

Availability Status Visible to a Document Consumer

13

Document Life Cycle ManagementDocument Life Cycle Management

A two-way relationship between Original and Addendum

Document

Addendum

Document 1(Approved)

Addendum

ReplacementDocument

Replacement

Document 1(Deprecated)

Document 2(transform)

Transform

Document 1(Approved)

A two-way relationship between Original and Replacement Document.

A two-way relationship between Original and Transform (alternative format with same scope).

Time

Addendum to a registered document

Replacing a registered document by a new document

Registering an alternate form of a registered document

Time

14

Provide and Register Document SetProvide and Register Document Set

Document Source to Document Document Source to Document RepositoryRepository

Metadata describing zero or more new Metadata describing zero or more new documentsdocuments

Submission Set defining linkage to new Submission Set defining linkage to new and references to existing documentsand references to existing documents

Zero or more Folder definitionsZero or more Folder definitions

15

• Created by a single Document Source.

• Issued by a single Provide & Register Document Set or Register Document Set transaction.

• Related to care event(s) of a uniquely identified patient.

• Records new documents.

• References prior documents.

• Associated with a “content code” (e.g. clinical meaning) by the Document Source.

• Accessible via the Query Registry transaction.

XDS Submission SetXDS Submission Set

16

Example:Example:Document Source prepares a submission request :Document Source prepares a submission request :

One One Submission SetSubmission Setassociated with two Documents and a Folderassociated with two Documents and a Folder

Document

Document

DocumentEntry

DocumentEntry

SubmissionSet1 Objects to be

Registered

Objects to be stored in the Repository

Folder A

17

• A means to group one or more documents for any reason.

• Groups documents related to a single patient.

• May include contributions from one or more Document Sources.

• Can have new or existing documents inserted at anytime by a Document Source.

• Will be permanently known by the registry.

• Accessible via the Query Registry transaction.

• Associated with a code (e.g. clinical meaning) by Document Sources.

XDS FolderXDS Folder

18

Details and ExamplesDetails and Examples

National Institute of Standards and Technology (NIST) Notes on XDS http://hcxw2k1.nist.gov/wiki/index.php/Notes_on_X

DS_Profile SOAP with Attachments How to Construct XDS Metadata

19

Implementation StrategiesImplementation Strategies

Project ManagementProject Management Corporate commitmentCorporate commitment Applications, Fees, Deadlines, … (this costs $$’s)Applications, Fees, Deadlines, … (this costs $$’s) Signage, Marketing, Spin Doctors…Signage, Marketing, Spin Doctors…

Software Development & TestingSoftware Development & Testing This is YOURS; is it yours alone ?This is YOURS; is it yours alone ? Success depends on many different skillsSuccess depends on many different skills Teams !Teams !

20

Strategy: Divide and ConquerStrategy: Divide and Conquer

Before MESA TestingBefore MESA Testing

MESA TestingMESA Testing

ConnectathonConnectathon

HIMSSHIMSS

Incorporation – IHE is not just for DemosIncorporation – IHE is not just for Demos

21

Phase ActivitiesPhase Activities

Before MESA TestingBefore MESA Testing Read, Read, Read the ProfilesRead, Read, Read the Profiles Write Test HarnessesWrite Test Harnesses Develop / Improve code baseDevelop / Improve code base

MESA TestingMESA Testing Do the tests, in orderDo the tests, in order

ConnectathonConnectathon Read the Test PlansRead the Test Plans Plan the weekPlan the week

HIMSSHIMSS

IncorporationIncorporation Write and publish IHE Integration StatementsWrite and publish IHE Integration Statements

22

Deliverables by PhaseDeliverables by Phase

Initial Development & Project Setup 09/05 – 11/01/05Initial Development & Project Setup 09/05 – 11/01/05Valid CDA/CRS; Valid multi-part mime XDS MessageValid CDA/CRS; Valid multi-part mime XDS Message

Pre-Connectathon Tests 11/01/05 – 12/01/05Pre-Connectathon Tests 11/01/05 – 12/01/05Completion of all Required Tests (and several Optionals)Completion of all Required Tests (and several Optionals)

““Product” Integration 12/01/05 – 01/11/06Product” Integration 12/01/05 – 01/11/06A version of TouchWorks that incorporates Phases 1,2A version of TouchWorks that incorporates Phases 1,2

Connectathon 01/16/06 – 01/20/06Connectathon 01/16/06 – 01/20/06Completion of IHE Profile Tests: XDS-MS, ATNA, CTCompletion of IHE Profile Tests: XDS-MS, ATNA, CT

Polish for HIMSS 01/23/06 – 02/08/06Polish for HIMSS 01/23/06 – 02/08/06Showcase ready laptopsShowcase ready laptops

HIMSS 02/11/06 – 02/16/06HIMSS 02/11/06 – 02/16/06Successful ShowSuccessful Show

Planning for 07 HIMSS 02/20/06 – 03/01/06Planning for 07 HIMSS 02/20/06 – 03/01/06Rough Needs Analysis for 07 RequirementsRough Needs Analysis for 07 Requirements

23

Progress (from the Scorecard)Progress (from the Scorecard)

Project Completion

0%

20%

40%

60%

80%

100%

9/12

/200

5

9/19

/200

5

9/26

/200

5

10/3

/200

5

10/1

0/200

5

10/1

7/200

5

10/2

4/200

5

10/3

1/200

5

11/7

/200

5

11/1

4/200

5

11/2

1/200

5

11/2

8/200

5

12/5

/200

5

12/1

2/200

5

12/1

9/200

5

12/2

6/200

5

1/2/

2006

1/9/

2006

1/16

/200

6

1/23

/200

6

1/30

/200

6

2/6/

2006

2/13

/200

6

2/20

/200

6

% C

om

ple

te

Actual Complete Estimated Complete

Project Milestones & Due Dates

Project Approval 9/13/05Application & Payment 9/15/05Budget Plan Submitted to Joe 9/16/05Profile Reviews 9/16/05Preliminary Designs 9/23/05Hardware Acquisition & Setup 9/30/05Mesa Tools Installed 9/30/05Participants Workshop 10/7/05Final UI Design 12/11/05Final Architecture Design 12/13/05Development Environments Working 10/18/05Pre-Connectathon Tests Complete 12/1/05Ship Hardware to Connectathon 1/11/05Connectathon Begins 1/16/05Connectathon Ends 1/20/05Ship Hardware to HIMSS 2/1/05Final Changes for HIMSS Showcase 2/10/05HIMSS Setup 2/11/05HIMSS Ends 2/16/05

24

Component ExamplesComponent Examples

Document SourceDocument Source Document ProductionDocument Production Document MetadataDocument Metadata Submission SetSubmission Set Web Post (http://… and https://…)Web Post (http://… and https://…)

Document ConsumerDocument Consumer AdHocQuery GeneratorAdHocQuery Generator Document ListDocument List Single Document RetrieveSingle Document Retrieve Document PresentationDocument Presentation Document ParserDocument Parser Document StorageDocument Storage Document FormatterDocument Formatter Web Retrieval (http://… and https://…)Web Retrieval (http://… and https://…)

25

Components – Don’t forgetComponents – Don’t forget

PIX or PDQPIX or PDQ

ATNA – it is not a simple add-on or plug-inATNA – it is not a simple add-on or plug-in

Certificate ManagementCertificate Management

Logging – test documentation and Logging – test documentation and verificationverification

Configurability – everything, yes, Configurability – everything, yes, Everything that can be Configurable Everything that can be Configurable should be Configurableshould be Configurable

26

XDS-MS Document SourceXDS-MS Document Source

Create CDA/CRS documentsCreate CDA/CRS documents

Validate to CDA schemaValidate to CDA schema

Use PCC-supplied SchematronUse PCC-supplied Schematron

Create Submission SetCreate Submission Set

Review and check using NIST ToolsReview and check using NIST Tools

Follow Tests in orderFollow Tests in order

27

XDS-MS ConsumerXDS-MS Consumer

Retrieve from file system and consumeRetrieve from file system and consume

Test Consumer options:Test Consumer options: DisplayDisplay ImportImport Import and parse structured itemsImport and parse structured items

Query RegistryQuery Registry

Retrieve DocumentRetrieve Document

28

XDS ResourcesXDS Resources

IHE IT Infrastructure Technical Framework, Volumes 1 and 2

National Institute of Standards and Technology (NIST) XDS Wikihttp://hcxw2k1.nist.gov/wiki/index.php/XDS_-_Cross-Enterprise_Document_Sharing

The people sitting next to you

29

Content ResourcesContent Resources

IHE Profiles

CDA/CRS Quick Start Guide

EHRVA Validatorhttp://www.xmeta.com:8080/ehrva/

CDA/CRS Schematron

IBM Deployment Guide

The people sitting next to you

30

QuizQuiz

What should you never do while getting What should you never do while getting ready for HIMSS ?ready for HIMSS ?

31

Never Give UpNever Give Up

Whatever it is you do forWhatever it is you do for

Stress ReliefStress Relief

32

I RideI Ride