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