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Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

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Page 1: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

Publication and DiscoveryXDS and DSUB

IHE IT Infrastructure Webinar Series

Page 2: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDSCross-Enterprise Document Sharing

Page 3: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

What is XDS ?

The Cross-Enterprise Document Sharing (XDS) IHE Integration Profile facilitates the registration, distribution and access across health enterprises of patient electronic health records

It provides a standards-based specification for managing the sharing of documents between any healthcare enterprise

Currently only one XDS profile, based on Web Services - XDS.b (original XDS.a is now deprecated)

Page 4: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS Affinity Domains

Group of healthcare enterprises that have agreed to work together using a common set of policies and standards-based infrastructures for sharing patient clinical documents, using XDS:• Regional community of care• Nationwide EHR• Specialized or disease-oriented (cardio, diabetes, oncology)• Government-sponsored or federation of enterprises• Insurance provider supported communities

XDS profile is designed to accommodate a wide range of policies on:• Patient identification and consent• Controlling access to information• Format, content, structure, and representation of clinical information

Page 5: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Some Common Scenarios

• Patient Care Summary (e.g. within a region)– Publishing of Care Summaries by providers– Access to patient’s Care Summary in an emergency

• eReferral between primary and secondary care providers• Sharing of radiology reports and images between facilities• Sharing of laboratory reports by clinical laboratories with

ordering physicians and other care providers• ePharmacy between community pharmacy and

ambulatory physicians

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IT Infrastructure Planning Committee

Main Systems and Responsibilities

• A document Repository is responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests.

• A document Registry is responsible for storing information or metadata about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored.

• Any IT system (e.g. point of care) may act as a Document Sources or Document Consumers submitting documents for registration, or querying/retrieving relevant documents.

Notes:• Analogous to a library (book repository) and catalog/index• The Registry does not have access to the documents – an important separation from

security and privacy perspective• Multiple Repositories can be linked to one Registry

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IT Infrastructure Planning Committee

ConsumerRegistry

Repository

1. Sources post document packages to the Repository

2. Repository registers the documents metadata and pointer with the Registry

3. Consumers search for documents with specific information

4. Consumers retrieve selected documents from Repository (-ies)

XDS Document (Metadata):

ClassPatient IdAuthorFacilityDate of Service…

Source of Documents

XDS Flow and Interactions

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IT Infrastructure Planning Committee

XDS TECHNICAL OVERVIEW

Cross-Enterprise Document Sharing ProfileActors and Transactions

Page 9: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS.b Formal Diagram

Patient Identity Source

Document Registry

Document Repository

Document Source

Document Consumer

Patient Identity Feed [ITI-8]Patient Identity Feed HL7v3 [ITI-44]

Provide&RegisterDocument Set-b [ITI-41]

Retrieve Document Set [ITI-43]

Registry Stored Query [ITI-18]

Register Document Set-b [ITI-42]

Integrated Document Source/Repository

Page 10: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS.b Actors

• Document Source – producer and publisher of documents, responsible for sending documents and their metadata to a Document Repository actor

• Document Repository is responsible for both the persistent storage of these documents as well as for their registration with the appropriate Document Registry

• Document Registry maintains metadata about each registered document and a link to the Document in the Repository where it is stored. Responds to queries from Document Consumer actors about documents meeting specific criteria.

• Document Consumer queries a Document Registry for documents meeting certain criteria, and retrieves selected documents from one or more Document Repository actors

• Patient Identity Source provides unique identifier for each patient and maintaining a collection of identity traits. This facilitates the validation of patient identifiers by the Registry Actor in its interactions with other actors

• Integrated Document Source/Repository combines the functionality of the Document Source and Document Repository actors into a single actor that does not expose the Provide and Register Document Set transaction

Page 11: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS.b Transactions (1)

• Provide and Register Document Set – For each document in the submitted set, the Document Source Actor provides both the documents as an opaque octet stream and the corresponding metadata to the Document Repository. The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction.

• Register Document Set allows a Document Repository Actor to register one or more documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry.

Page 12: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS.b Transactions (2)

• Patient Identity Feed conveys the patient identifier and corroborating demographic data, in order to populate the Document Registry with patient identifiers that have been registered for the XDS Affinity Domains. (At least one of the options [ITI-8] or [ITI-44] should be supported.)

• Registry Stored Query is issued by the Document Consumer Actor to a Document Registry. It will return registry metadata containing a list of document entries found to meet the specified criteria including the locations and identifier of each corresponding document in one or more Document Repositories.

• Retrieve Document Set – initiated by a Document Consumer. The Document Repository shall return the document set that was specified by the Document Consumer.

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IT Infrastructure Planning Committee

XDS Document Content Types

XDS profile is content agnostic – it can be used with a variety of document types, e.g.:• XDS-SD: Scanned document, plain text or PDF/A, in HL7

CDA R2 format• XDS-MS: Medical summary in HL7 CDA format• XDS-I: Radiology report in plain text of PDF format, or

reference to a collection of DICOM SOP Instances in a manifest document in the DICOM Key Object Selection format

Page 14: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS.b – Actors and Options

Actors Options Reference

Document Source

Document Replacement ITI TF-1: 10.2.1

Document Addendum ITI TF-1: 10.2.2

Document Transformation ITI TF-1: 10.2.3

Folder Management ITI TF-1: 10.2.4

Basic Patient Privacy Enforcement ITI TF-2b:3.41.4.1.3.1

Document Repository

Document Registry Patient Identity Source

Patient Identity Feed ITI TF-2a: 3.8

Patient Identity Feed HL7v3 ITI TF-2b: 3.44

Document ConsumerBasic Patient Privacy Enforcement ITI TF-2a: 3.18.4.1.3.5

ITI TF-2b: 3.43.4.1.3.1

Basic Patient Privacy Proof ITI TF-2a: 3.18.4.1.3.6

Page 15: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Security and Privacy Considerations

• All actors be grouped with a ATNA Secure Node Actor resulting in each node (systems supporting XDS actors) of the XDS Affinity Domain should have audit and security mechanisms in place

• Transactions used between different secure nodes (systems supporting XDS actors) shall use the ATNA Encryption Option

• Each XDS Transaction will result in audit event records sent to an ATNA audit Repository Actor

Page 16: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS Affinity Domain

PMS

Physician Office

EHR System

Teaching HospitalCommunity

Clinic

Lab Info. System

PACS

PACS

Retrieve Document

Provide & Register

Register Document

(using Patient ID)

Query Document

(using Patient ID)

Document RegistryDocument

Repository

Document Repository

ED Application

PIX or PDQ

Query

PIX or PDQ

Query

ATNA

CT

Audit record repository Time server

Patient Demographics Supplier

Record Audit Event

Maintain

Time

Maintain

Time

Maintain

Time

XDS Workflow Health Information Exchange Network

14355M8354673993

L-716

A87631M8354673993

A8763114355L-716

Patient Identity XRef Mgr

Record AuditEvent

Page 17: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Relevant Standards

Infrastructure: use of Web Services Standards:• WS-* Specifications• WS-I Profiles• ITI TF-2x: Appendix V

Document content• HL7 CDA• CEN ENV 13606• ASTM 4400 CCR• DICOM

Page 18: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Point-to-point Deployment Models

1 - Unknown partners, patient ID out-of-band, labelled document (with meta-data)

------------------------------------

2 - Known partners, patient ID out-of-band, labelled document (with meta-data)

------------------------------------

3 - Known partners, linked patient, labelled document (with meta-data)

IHE Cross-Enterprise Document Exchange - Media Option (XDM): CD or USB-Key

----------------------------------------------------------------

IHE Cross-Enterprise Document Exchange - Email Option (XDM-Email)

--------------------------------------------------------

IHE Cross-Enterprise Reliable Exchange (XDR) w Patient ID Reconciliation (PIX/PDQ)

Moving to the next level

Page 19: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Health Information Sharing Deployment Models

4 - Community HIEMany potential partners, linked

patient, labelled (with metadata) documents

Centralized services (registry/EMPI)

------------------------------

5 – Region/Nation/cross-nation Health Information Network Exchange

IHE Cross-Enterprise Document Sharing (XDS) (On-Demand Document Option and Document Subscription / Notification (DSUB))

IHE Patient ID Cross-reference (PIX) and Patient Demographics Query (PDQ)

--------------------------------------------- IHE Cross-Community

Exchange (XCA) IHE Cross-community

Patient Discovery (XCPD)

IHE addresses 5 transport use cases !

Page 20: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

XDS Metadata

Light Client

Health Information Exchange and IHE Profiles

Application Client

IHE XDM (e-mail)

IHE XDR (Web Service)

IHE XCA (cross-HIE)

IHE XDS (Intra-HIE)

Pt-to-PtPush

Share& Pull

Page 21: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Flexible Infrastructure

Health Information Exchange

Publish

PullStructuredobjects

Pull

Send to Switch Send to

Write ReadInterchange

Media

XDS

XDR

XDM

Replace with agreed new version of this slide

Page 22: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee 23

IHE XDS adopted in National & Regional Projects (sample)

Quebec, Toronto,Alberta, British ColumbiaCanada Infoway

THINC- New YorkNCHICA – N. Carolina

Italy Conto CorrenteVenetto - Friuli

Boston Medical

Center - MA

Philadelphia HIE

CHINA-MoHLab results sharing

CHINA-ShanghaiImaging Info Sharing

JAPAN-NagoyaImaging Info Sharing,

Nationwide PDI guideline

South Africa

VITL-Vermont

CareSpark – TN & VA

NETHERLANDSFriesland

Natn’l Mamography

LowerAustria

Austria

FranceDMPWales

Imaging

BelgiumFlemish-Leuven

SuisseSt GallenLausane

Providence Health

System - OR

KeyHIE Pennsylvani

a

SHARP CA

France Imaging

IDF

23

For more complete list see: tinyurl.com/wwXDS

Page 23: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Who Is Using XDS?

• Stable specification since 2009 (See IHE ITI Technical Framework)

• First implementation in clinical use in region of Genoa - Italy) since early 2006.

• Several since: Lower Austria region, State of Vermont, Nagoya city, South Africa region, Dutch regions, etc.

• Adopted by several national programs world-wide:

France, Canada, Switzerland, USA, Slovenia, China, etc.• Numerous product implementations world-wide:

Close to 100 EMR/Clinical Systems products shipping

More than 20 Infrastructure products shipping

Page 24: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Open Source Implementation Tools

Open source implementations are available for XDS, XCA, XCPD, PIX, PDQ, ATNA, CT, and more:

– NIST under Source Forge http://sourceforge.net/projects/iheos/ – HIE-OS under Source Forge http://sourceforge.net/projects/hieos/

– Microsoft under codeplex http://ihe.codeplex.com/ – FHA CONNECT http://www.connectopensource.org

– OHT – IHE Profiles Charter https://iheprofiles.projects.openhealthtools.org

– OHT – Open Exchange Forge https://openexchange.projects.openhealthtools.org

– OHT – Model Driven Health Tools-Charter https://mdht.projects.openhealthtools.org

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Page 25: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

DSUBDocument Metadata Subscription supplement

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IT Infrastructure Planning Committee

DSUB Overview

The Document Metadata Subscription (DSUB) supplement contains two related parts:• Publish/Subscribe Infrastructure: General framework for

defining web-services based publish/subscribe interactions• Document Metadata Subscription (DSUB) Integration

Profile: Use of subscriptions within an XDS Affinity Domain or across communities

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IT Infrastructure Planning Committee

Publish/Subscribe Infrastructure

• Presents a framework for building event-driven information exchange patterns using a publish/subscribe data exchange model (See ITI TF Volume 3 section 4.4

• Defines the transport of publish, subscribe and notify messages.

• Supports IHE profiles which define the use case specific content to be carried in the publish, subscribe and notify messages

Document Metadata Subscription (DSUB) first profile to use this framework.

Page 28: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Publish/Subscribe Infrastructure Actors and Transactions

Publisher

Publish 4.4.2.3

Notification Broker

Notification Recipient

SubscriberSubscribe 4.4.2.1

Notify 4.4.2.2

Page 29: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Possible Combined Actors

Publisher

Notification Broker

Notification Recipient

SubscriberSubscribe

Notify

Publish

Publisher

Notification Broker

Notification Recipient Subscriber

Subscribe

Notify

Notification Broker

Notification Recipient Subscriber

Subscribe

Notify

Publisher

Page 30: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Document Metadata Subscription (DSUB) Integration Profile

• Defines a subscription which allows for the matching of metadata during the publication of a new document for a given patient, and results in the delivery of a notification.

• Enabled within an XDS Affinity Domain or XCA environment

• Use Cases– Emergency Department: Notification of new document availability

during treatment– Primary Care Management: PCP receives notification when new

documents for patient are available

Page 31: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

DSUB Actors and Transactions

Document Metadata Publisher

Document Metadata Publish [ITI-54]

Document Metadata Notification Broker

Document Metadata Notification Recipient

Document Metadata Subscriber

Document Metadata Subscribe [ITI-52]

Document Metadata Notify [ITI-53]

XDS Registry

Page 32: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

Transactions

• Document Metadata Subscribe : start a subscription for a particular topic and filtering within that topic. Supports full and minimal notifications and where to send the notification.

• Document Metadata Notify : send a notification about the availability of a document or documents of interest, based on the subscribers' filters on selected topics

• Document Metadata Publish : notify that an event occurred for which there may be a subscription.

Page 33: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

DSUB Illustration of Use

Publisher Notification Broker

Notification Recipient

Subscriber

Subscribe

Publish

Publish

Notify

Notify

Unsubscribe

Publish

Page 34: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series

IT Infrastructure Planning Committee

DSUB Implementation

• DSUB topic tree– ihe:FullDocumentEntry : subscribes to Document Entry registration

events; the notification shall contain the full metadata describing each matching Document Entry

– ihe:MinimalDocumentEntry : subscribes to Document Entry registration events; the notification shall contain a minimal set of data (identifiers only) describing each matching Document Entry

• DSUB Standards– Web Services Standards

• WS-BaseNotification 1.3 OASIS Standard• WS-BrokeredNotification 1.3 OASIS Standard • WS-Topics 1.3 OASIS Standard• ITI TF-2x: Appendix V

– Filter expression• Registry Stored Query [ITI-18]

Page 35: Publication and Discovery XDS and DSUB IHE IT Infrastructure Webinar Series