September, 2011What IHE Delivers Cross-enterprise Workflow Management (XDW profile) IT Infrastructure Planning Committee Luca Zalunardo, Arianna Cocchiglia.

September, 2011 What IHE Delivers

Cross-enterprise Workflow Management

(XDW profile)

IT Infrastructure Planning Committee

Luca Zalunardo, Arianna Cocchiglia - Arsenal.IT

XDW Introduction

The Cross-Enterprise Document Workflow (XDW) profile enables participants in a multi-organizational environment to manage and track the tasks related to patient-centric workflows as they coordinate their activities:

No central controllerNo central schedulerDecisions are made by the “edges” (providers,

doctors, nurses, etc)XDW coordinates these activities

Necessity:

Digitizing clinical processes (paperless) and enhancing care coordination is a focus across organization and boundaries such as many regional and national projects

All expect to manage workflows beyond a single organization:

For example: eReferral workflows

Flexible solution for dynamic and adjustable workflow

Clinical, economic, social and organizational impact

XDW Problem Statements

Framework:

XDW is a framework operating in an XDS context which supports the management of clinical processes

XDW is a framework which is specialized by using Workflow Definition profiles to define specific clinical processes

XDW increases workflow interoperability and enables the development of interoperable workflow management applications where workflow-specific customization is minimized

XDW facilitates the integration of multi-organizational workflows which use a variety of existing workflow management systems within participating organizations (peer-to-peer)

XDW Framework

XDW Key Design Elements Key XDW design elements:

Provides a common, workflow-independent approach to interoperability

Enables the support of a wide range a specific workflow “content”

Designed to support the complexity of health services delivery with flexibility to adapt

Provides the means to associate documents to a broad range of workflows

Easy to deploy: no addt’l centralized infrastructure . Scales to regions & nations.

Builds upon the secured sharing of health documents provided by other IHE profiles (e.g. XDS, ATNA, BPPC, etc.)

XDW Framework Diagram

XDW Simple Case

Workflow Document in XDW:

Specified by XDW is generic across specific workflow content

Manages workflow specific status with relationship to input/output documents

Tracking the current/past steps of the workflow and engaged health care entities

Workflow driven/enforced by the XDW actors, infrastructure provides transparency

Structure of the step in the XDW Workflow Document

Workflow Document Structure:Workflow Document Structure:

Overall workflow contextOverall workflow context

Task level InformationTask level Information

TaskTask describes an activity that is planned or describes an activity that is planned or has been accomplished. Attributes of the has been accomplished. Attributes of the task:task: TypeType OwnerOwner Current Status (created, in-progress, completed, Current Status (created, in-progress, completed,

etc.)etc.) References to documents used for input or References to documents used for input or

produced as outputproduced as output The The Task Event History Task Event History tracks the past tracks the past Task Task

EventsEvents, up to the present state, up to the present state

Structure of the Workflow Document

It is possible divided the structure of It is possible divided the structure of the WD in 4 parts:the WD in 4 parts:

Part 1Part 1: elements derived from HL7 CDA : elements derived from HL7 CDA standardstandard

Part 2Part 2: two elements, patient and author, : two elements, patient and author, defined in the XDWSchema with the defined in the XDWSchema with the structure derived from HL7 R-MIM structure derived from HL7 R-MIM standardstandard

Part 3Part 3: elements defined by IHE XDW : elements defined by IHE XDW ProfileProfile

Part 4Part 4: the element <TaskList> in which : the element <TaskList> in which is defined by elements derived from the is defined by elements derived from the OASIS WS-HumanTask standard. OASIS WS-HumanTask standard.

XDS XDS InfrastructureInfrastructure

11. Sources post . Sources post workflow document workflow document and referenced and referenced document to the document to the XDS InfrastructureXDS Infrastructure

22. Consumers search . Consumers search about patient’s about patient’s workflowsworkflows

33. Consumers retrieve . Consumers retrieve selected documents selected documents from the XDS from the XDS InfrastructureInfrastructure

Content Content CreatorCreatorContent Content CreatorCreator

Content Content ConsumerConsumer

Content Content ConsumerConsumer

Content Content UpdaterUpdaterContent Content UpdaterUpdater

44. Sources update . Sources update the workflow the workflow document and post document and post possible new possible new referenced referenced documentsdocuments

55. Consumers search . Consumers search about patient’s about patient’s workflowsworkflows

66. Consumers retrieve . Consumers retrieve selected documents selected documents from the XDS from the XDS InfrastructureInfrastructure

Content Content ConsumerConsumerContent Content

ConsumerConsumer

XDW Flow and Interactionsin an XDS scenario

XDW Process Flowworkflow definition

2-2-Admission of Admission of the patientthe patient

3- Start of 3- Start of the the

ConsultationConsultation

4 – End of the 4 – End of the consultation and consultation and creation of the creation of the clinical reportclinical report

5 – Possible 5 – Possible notification to the notification to the

GPGP

1-Visit and 1-Visit and production of production of

eReferraleReferral

The workflow within The workflow within the organization is the organization is encapsulated into a encapsulated into a single XDW stepsingle XDW step

XDW Process Flowfirst task of the process

1-Visit and 1-Visit and production production of eReferralof eReferral

Workflow DocumentWorkflow Document

task: REQUESTEDtask: REQUESTEDStatus: COMPLETEDStatus: COMPLETEDAuthor: Mr.RossiAuthor: Mr.RossiTime: date/time/utcTime: date/time/utc

Inputs:Inputs:-> Lab Report-> Lab Report

Outputs:Outputs:-> eReferralDoc1-> eReferralDoc1

taskEventHistorytaskEventHistory

TaskEvent: 1TaskEvent: 1Status: Status: COMPLETEDCOMPLETEDInputs:Inputs:-> Lab Report-> Lab Report

Outputs:Outputs:-> eReferralDoc1-> eReferralDoc1

Task A: RequestedTask A: RequestedSS

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XDW Process Flowsecond task of the process, first status

Task B: ReferredTask B: ReferredSS

ttaattuuss 11:: IInn PPrrooggrreessss

2-2-Admission Admission

of of the patientthe patient

Workflow DocumentWorkflow Document

REQUESTEDREQUESTED

task: REFERREDtask: REFERREDStatus: Status: INPROGRESSINPROGRESSAuthor: Mr.BrumAuthor: Mr.BrumTime: date/time/utcTime: date/time/utc

Inputs:Inputs:-> eReferralDoc1-> eReferralDoc1

Outputs:Outputs:-> ->

taskEventHistorytaskEventHistory

TaskEvent: 1TaskEvent: 1Status: Status: INPROGRESSINPROGRESS

Inputs:Inputs:-> eReferralDoc1-> eReferralDoc1

Outputs:Outputs:-> ->

The workflow The workflow within the within the organization is organization is encapsulated into encapsulated into a single XDW stepa single XDW step

XDW Process Flowsecond task of the process, second status

5 – Possible 5 – Possible notification to notification to

the GPthe GP

3- Start of 3- Start of the the

ConsultatioConsultationn

4 – End of the 4 – End of the consultation and consultation and creation of the creation of the clinical reportclinical report

The workflow The workflow within the within the organization is organization is encapsulated into encapsulated into a single XDW stepa single XDW step

Task B: ReferredTask B: ReferredSS

ttaattuuss 22:: CCoommpplleetteedd

Workflow DocumentWorkflow Document

REQUESTEDREQUESTED

task: REFERREDtask: REFERREDStatus: Status: COMPLETEDCOMPLETEDAuthor: Mr.BrumAuthor: Mr.BrumTime: date/time/utcTime: date/time/utc

Inputs:Inputs:-> eReferralDoc1-> eReferralDoc1

Outputs:Outputs:-> ClinicalRepDoc2-> ClinicalRepDoc2

taskEventHistorytaskEventHistory

TaskEvent: 1TaskEvent: 1

TaskEvent: 2TaskEvent: 2Status: Status: COMPLETEDCOMPLETED

Inputs:Inputs:-> eReferralDoc1-> eReferralDoc1

Outputs:Outputs:-> -> ClinicalRepDoc3ClinicalRepDoc3

XDW profile and Workflow Definition profile

Cross Enterprise Document Workflow is: a framework to manage workflows a platform upon which a wide range of specific workflows can be

defined with minimal specification and implementation efforts workflow independent applicable on different document sharing infrastructures

Workflow Definition Profile is: the definition of a specific clinical process a set of rules and task definition which characterize the process the definition of the actors involved in the process and their roles

XDWXDW

EvolutionEvolutionof sharedof sharedWorkflowWorkflowDocumentDocument

XDWXDW

EvolutionEvolutionof sharedof sharedWorkflowWorkflowDocumentDocument

WorkflowWorkflowDescriptionDescriptionWorkflowWorkflowDescriptionDescription

Use Case: an example of eReferral workflow(2)Use Case: an example of eReferral workflow(2)

Selected Standards & Systems

XDW Supplement introduces a new content framework profile for a workflow management document OASIS Human Task for task structure and encoding HL7 CDA for provider description HL7 R-MIM for patient and author description

No new transactions are introduced. Leverages existing ITI IHE Profiles: XDS.b, DSUB, XDR, XDM, BPPC, ATNA

No XDS Metadata extension, but specific rules about XDS Metadata content for the registry entry associated to the XDW Workflow Document

XDW Security/Privacy

XDW relies on the security controls in the underlining transport (e.g. XDS)

In order to adhere to the principle of least privilege, organizations will want to prevent clinical documents from being replaced by other organizations while allowing XDW Workflow Documents to be replaced (exception based on classCode)

When a Workflow Description Profile is created a risk assessment following the Security Cookbook may result in additional security considerations beyond those for the usual clinical report

XDW references

Trial Implementation status Primary Content

XDW Supplement Underlying technical framework content

ITI XDS.b profile

XDW profile – Domain ActivitiesXDW activity PCC Domain: creation of the “Workflow Definition Whitepaper”, in which it

is defined the guide lines and the structure to write a Workflow Definition Profile

Example of XDW Definition Profiles PCC Domain

XBeR-WD Cross Enterprise Basic eReferral Workflow Definition Profile

XTHM-WD Cross Enterprise TeleHomeMonitoring Workflow Definition Profile

XTB-WD Cross Enterprise Tumor Board Workflow Definition Profile Radiology Domain

XSM Cross Enterprise Screening Mammography Workflow Definition Profile (White Paper)

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