Transcript
IHE IT Infrastructure
Domain Update
Karen Witting – IBM IT Infrastructure Technical Committee co-chair
IT Infrastructure Domain (ITI)
• Supports profiles which supply necessary infrastructure for sharing healthcare information.
• IT Infrastructure domain began in 2003 and now has 27 profiles that it supports.
• Key ITI profiles demonstrated today:– Information Exchange: XDS.b, XDM, 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
Categories of Healthcare Communication Services
Security/Privacy
DocumentSharing
Patient and Provider Identity Management
Dynamic InformationAccess
WorkflowManagement
Source persisted and attested health
records
Specific info snapshot
provided on demand
2 or more entitiessynchronize
a task
e.g. access last 6 mo. historical labs &
encounter summaries
e.g. order lab test, track status and receive results
e.g. get current list of allergies or med list
from source
HospitalsHIEs and RHIOs
ITI Profiles• Information Exchange
– Cross-Enterprise Document Sharing - b (XDS.b) ☼– Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼– Cross Community Access (XCA) ☼– Document Metadata Subscription (DSUB) ☼– Multi-Patient Queries ☼– Cross-Enterprise Document Media Exchange (XDM) ☼– Cross-Enterprise Document Reliable Interchange (XDR)– Notification of Document Availability (NAV)– Retrieve Form for Data Capture (RFD) ☼– Retrieve Information for Display (RID)– Patient Synchronized Applications (PSA)
• Terminology– Sharing Value Sets
▀ colored text designates 2009 new profiles☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010
ITI Profiles (continued)• Identify Management
– Patient Identifier Cross-Referencing (PIX)☼– Patient Demographics Query (PDQ) ☼– Patient Identifier Cross-Referencing HL7 V3 (PIX V3)☼– Patient Demographics Query HL7 V3 (PDQ V3) ☼– Patient Administration Management (PAM)– Pediatric Demographics Option– Cross-Community Patient Discovery (XCPD) ☼
• Security/Privacy– Cross-Enterprise User Assertion (XUA) ☼– Basic Patient Privacy Consents (BPPC) ☼– Enterprise User Authentication (EUA)– Consistent Time (CT) ☼– Audit Trail and Node Authentication (ATNA) ☼– Personnel White Pages (PWP)– Document Digital Signature (DSG)
▀ colored text designates 2009 new profiles☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010
Document Content & Modes of Exchange
Document Exchange Integration Profiles
DocumentSharing
XDS
MediaInterchange
XDM
ReliableInterchange
XDR
Document Content ProfilesConsentBPPC
EmergencyEDR
PreSurgery
PPH PScanned DocXDS-SD
Laboratory
XD*-LabPHR
ExchangeXPHR
Discharge &Referrals
XDS-MSImaging
XDS-I
Cross-CommunityAccess
XCA
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 Document
Register DocumentQuery Document
XDS Document Registry
ATNA Audit record repository CT Time server
Record AuditEvent
MaintainTime
MaintainTimeRecord Audit
Event
Maintain TimeProvide & Register Docs
Record AuditEvent
XDS Document Repository
XDSDocument
Repository
Secured 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 Mgr Patient 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
DocumentRegistry
PracticePracticePractice
ClinicClinic
HospitalsHospitalsHospitals
Repository
PracticeGateway
Repository
Patient IDservices
ILLINOIS
HIMSS 10 Cross-CommunityDemonstrating Sharing across regional boundaries
IHE transactions
DocumentRegistry
PracticePracticePractice
ClinicClinicClinicClinic
HospitalsHospitalsHospitalsHospital
Repository
PracticePractice HospitalHospital Gateway
Repository
Patient IDservices
NEW YORK
DocumentRegistry
PracticePracticePractice
Clinic
HospitalsHospitalsHospitals
Repository
Gateway
Patient IDservices
NORTH CAROLINA
DocumentRegistry
PracticePracticePractice
ClinicClinicClinicClinic
HospitalsHospitalsHospitalsHospital
Repository
PracticePractice HospitalHospital
Repository
Patient IDservices
CALIFORNIAGateway
XCPD Actors and Transactions
Initiating Community
Responding Community
Initiating Gateway
Responding
Gateway Patient Location
Query [ITI-56]
Cross Gateway
Patient Discovery [ITI-55]
XCPD Illustration of Use (Informative) Steps 1 -10
7. Consult local MPI
Community A: I&R Gateway
Community B:Consumer
4. Consult local MPI and save association
10. XCA Cross Gateway Query
5. Patient Location Query
1. Patient Feed 2.Cross Gateway Patient Discovery
Community A: Registration
Community C: I&R Gateway
Community B:I&R Gateway
7.Cross Gateway Patient Discovery
6. XDS Registry Stored Query
8.Cross Gateway Patient Discovery
9. Consult local MPI and save association
10. XCA Cross Gateway Query
10. XDS Registry Stored Query response Community A:
Consumer
3.Cross Gateway Patient Discovery
2. Consult local MPI
XCPD Illustration of Use (Informative) Steps 11-13
7. Consult local MPI
10. XCA Cross Gateway Query
7.Cross Gateway Patient Discovery
6. XDS Registry Stored Query
8.Cross Gateway Patient Discovery
9. Consult local MPI and save association
10. XCA Cross Gateway Query
10. XDS Registry Stored Query response Community A:
Consumer
11. XDS Registry Stored Query
12. Patient Location Query
13. XCA Cross Gateway Query
13. XCA Cross Gateway Query
13. XDS Registry Stored Query response
DSUB Overview
• The Document Metadata Subscription (DSUB) supplement contains two related parts
1) Publish/Subscribe Infrastructure: General framework for defining web-services based publish/subscribe interactions
2) Document Metadata Subscription (DSUB) Integration Profile: Use of subscriptions within an XDS Affinity Domain or across communities
Publish/Subscribe Infrastructure Actors and Transactions
← Subscribe 4 .4.2.1
↓ Publish 4.4.2 .3
Publish er
Notification Recipien t
Subscr iber
↓No tify 4.4.2 .2
Notificatio n Broker
DSUB Actors and Transactions
↓ D ocument Metadata Notify [ITI-53]
↓ Document Metadata Subscribe [ITI-52]
↓ Document Metadata Publish [ITI-54]
Document Metadata Notification Broker
Document Metadata No tification Recipient
Document Metadata Subscriber
Document Metadata Publisher
DSUB Illustration of Use Document Metadata Notification Broker
Unsubscribe
Document Metadata Subscriber
Document Metadata Notification Recipient
Notify
Document Metadata Publisher
Publish
Publish
Publish
Subscribe
Notify
Multi-Patient Query Actors and Transactions
Document Consumer Document Registry
Multi-Patient Stored Query [ITI-51]
Multi-Patient Queries - New Stored Queries
• FindDocumentsForMultiple Patients– Equivalent to FindDocuments but $XDSDocumentEntryPatientId
parameter:• is optional (zero values) • may have multiple values specified
– At least one of the following parameters is required:• ClassCode, EventCodeList, HealthcareFacilityTypeCode
– More of a medical event based query than a patient based query
• FindFoldersForMultiplePatients– Equivalent to FindFolders but $XDSFolderPatientId parameter:
• is optional (zero values) • may have multiple values specified
– At least one of the following parameters is required:• folderCodeList
– More of a medical event based query than a patient based query
IHE IT Infrastructure Schedule for 2010
• Development Schedule:• Planning Committee decision ……… December 2009• Issue Public Comment version …….. May 2010• Public Comment Due ……………….. June 2010• Issue Trial Implementation version … August 2010• IHE Connectathon …………………… January 2011• HIMSS Demo ………………………… February 2011
IHE IT Infrastructure Plan for 2010• New Supplements For 2010
• Enhanced Sharing Value Set (Enhanced SVS)Add supports for registering and updating value sets
• Healthcare Provider Directory (HPD)Supports healthcare provider search and feed
• System Directory for Document Sharing (SDDS)Supports directory of services used in document sharing environments
• XDS Metadata Update Service Supports update of metadata registered in a XDS Document Registry
• Dynamic/Deferred Document Sharing (D3S)Supports registration, query and retrieve of document content that is created at time of retrieval.
• XUA Extension for Access Control Extend XUA SAML assertion with authorization attributes
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