IHE Domain Update

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


PIX Query

PIX Query


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


ClinicClinicClinicClinic

HospitalsHospitalsHospitalsHospital

Repository

PracticePractice HospitalHospital Gateway

Repository

Patient IDservices

NEW YORK

DocumentRegistry


Clinic

HospitalsHospitalsHospitals

Repository

Gateway

Patient IDservices

NORTH CAROLINA

DocumentRegistry


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




10. XDS Registry Stored Query response Community A:

Consumer



XCPD Illustration of Use (Informative) Steps 11-13








10. XDS Registry Stored Query response Community A:

Consumer


12. Patient Location 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