Cross-enterprise Document Workflow

1. Cross-enterprise Document Workflow Brief Profile Proposal for 2009/10 presented to the IT Infrastructure Planning Committee Charles Parisot, Claudio Saccavini, Luca Zalunardo, Arianna Cocchiglia September, 27th 2010

2. The Problem • At the moment, with existing profiles, it is difficult to manage the status of workflowswith associated documents. • Note: The metadata associated with a document entry such as “availabilityStatus” is related to the sharing of documents and not intended to be used (nor extended) to manage the different steps in a clinical workflow where such document has been produced or used. • Addressing such a gap would complement the use of all profiles which produce and manage the sharing/interchange of clinical documents (XDS, XCA, PCC, Pharmacy, etc.) • Adding such a profile that would be sufficiently flexible to manage a broad range of workflows is a logical next step.

3. Use Case • A patient attends a consultation with his General Practitioner (GP) • The GP produces a eReferral (e.g. XDS-MS) which is published in the affinity domain. This profile would allow to also publish a related Workflow Document which contains information about the workflow (current and possibly intended) • At the moment of booking, the HCP retrieves the eRef Doc and Workflow Doc (WD), updates the content (e.g. status) and replaces the previous WD with this updated one. • The same action is done at the moment of the visit • All the documents are grouped in a same folder (clinical documents and workflow document)

4. Use Case Workflow Document Consumer Document Source Document Repository Document Registry Document Consumer Document Source Create a folder [ITI – 42] Register Document Set-b [ITI – 42] Register Document Set-b [ITI – 42] Register Document Set-b [ITI – 42] Register Document Set-b [ITI – 41] Provide & Register Document Set-b [ITI – 41] Provide & Register Document Set-b [ITI – 41] Provide & Register Document Set-b Pubblishing of eRefeeral [ITI – 18] Registry Stored Query [ITI – 18] Registry Stored Query [ITI - 43] Retrieve Document Set Pubblishing of WD [ITI - 43] Retrieve Document Set Query and Retieve WD Query and Retrieve eRefeeral [ITI – 41] Provide & Register Document Set-b_RPLC Replace of WD

5. The structure of the Wokflow Document Section 1 General and common data (patient data, author data, institution data, etc) Section 2…n One section for any performed Workflow Step (e.g. ePrescription, eReferral) which contains: • Internal management properties about workflow step (status, author, date/time of the change, relationship with previous workflow step, expected upcoming workflow steps..) • Reference to the shared documents that were used as input to the workflow step (if any) • Reference to the documents that were shared as a result of the workflow step

6. Proposed Standards & Systems • Afferent IHE Profiles: XDS.b, DSUB, NAV, XCA, BPPC, CMPD, ATNA, XDR • Other standards items: HL7 CDA • Existing IHE Actor used: XDS/XDR Document Source, XDS Document Repository, XDS Document Registry, XCA Initiating and Responding GW, XDR Document Recipient • New IHE Actor: Workflow Document Consumer (XDS Doc Consumer and Source grouped together) • IHE Transaction used: ITI-41, ITI-42, ITI-43, ITI-18 • No XDS Metadata extension expected, but specific rules about Metadata content for the Workflow Document

7. Discussion • The work effort (in term of documentation) for profiling the XDW is low because there aren’t new transactions and the new actor, the Workflow Doc Consumer, is only assemblage of two already existing actors. • The work will be focused on the definition of a basic workflow document structure, its document entry metadata rules and the principles to define “workflow content” profiles by ITI and other IHE Domains (e.g. definition of the possible status in the specific) clinical process • Profile editors: • Luca Zalunardo, Arsenàl.IT, lzalunardo@consorzioarsenal.it • Arianna Cocchiglia, Arsenàl.IT, acocchiglia@consorzioarsenal.it • Organization: Arsenàl.IT, www.consorzioarsenal.it