IHE IT Infrastructure Domain Update

1. IHE IT Infrastructure Domain Update Karen Witting – IBM IT Infrastructure Technical Committee co-chair

2. IHE - Connecting standards to care • Care providers work with vendors to coordinate the implementation of standards to meet their needs • Care providers identify the key interoperability problems they face • Drive industry to develop and make available standards-based solutions • Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions

3. IT Infrastructure Domain (ITI) • Supports profiles which supply necessary infrastructure for sharing healthcare information. • IT Infrastructure domain began in 2003 and now has 21 profiles that it supports. • Key ITI profiles demonstrated today: • Information Exchange: XDS (XDS.a & XDS.b), XDM, XDR, XDS-SD, RFD • Security: ATNA, CT, XUA, BPPC • Identity Management: PIX, PDQ (HL7 V2 & V3)

4. 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

5. Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Document Content and Modes of Document Exchange Doc Content Profiles PreSurgery PPH P Consent BPPC Emergency EDR Scanned Doc XDS-SD Document Exchange Integration Profiles Document SharingXDS.a XDS.b ReliableInterchange XDR MediaInterchange XDM Cross-Community AccessXCA XDS Stored Query & Patient Identity Merge

6. New/updated in 2007 • Information Exchange • Cross-Enterprise Document Sharing - b (XDS.b) ☼ • Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼ • XDS Stored Query Transaction (addition to XDS) ☼ • XDS Patient Identity Merge (addition to XDS) • Cross Community Access (XCA) ☼ • Retrieve Form for Data Capture (RFD) ☼ • Cross-Enterprise Document Media Exchange (XDM) ☼ • Cross-Enterprise Document Reliable Interchange (XDR) • HL7 V3 based PIX and PDQ transactions ☼ • Security/Privacy • Cross-Enterprise User Assertion (XUA) ☼ • Basic Patient Privacy Consents (BPPC) ☼ ▀ colored text designates 2006 profiles which were updated this year ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2008

7. 2003-2005 • Information Exchange • Retrieve Information for Display (RID) • Patient Identifier Cross-Referencing (PIX)☼ • Patient Synchronized Applications (PSA) • Cross-Enterprise Document Sharing (XDS.a) ☼ • Patient Demographics Query (PDQ) ☼ • Notification of Document Availability (NAV) • Patient Administration Management (PAM) • Security/Privacy • Enterprise User Authentication (EUA) • Consistent Time (CT) ☼ • Audit Trail and Node Authentication (ATNA) ☼ • Personnel White Pages (PWP) • Document Digital Signature (DSG) ▀ colored text designates profiles still in Trial Implementation ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2008

8. Categories of Healthcare Communication Services HIEs and RHIOs Hospitals Patient and Provider ID Mgt e.g. access to last 6 months historical labs and encounter summaries e.g. get a current list of allergies or med list from a source e.g. order a lab test, track status and receive results Security/Privacy Document Sharing Dynamic Information Access Workflow Management Source persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task

9. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing • Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution • Patients have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment • Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations • Addresses the need for a longitudinal healthcare data and its intend is for support of archival data. It does not address workflow or dynamic data access. • Meets both the needs of point-to-point push communication and on-demand pull in a variety of centralized or distributed architectures. • Workflows addressed in a second step in a much simpler manner.Point-to-Point messages best suited for workflows mgt

10. Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … • Implemented world-wide by more than 30 vendors/open source. Final text published December 2006. • Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, etc.) • IHE XDS: 42,500 “Google” references (Feb’ 08) Electronic BusinessStandards ebXML Registry, SOAP, Web Services … Internet Standards HTML, HTTP,ISO, PDF, JPEG …

11. XDS Scenario + use of ATNA & CT EHR System ED Application Physician Office XDS Document Repository PACS XDSDocument Repository EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record repository CT Time server PMS XDS Document Registry Query Document Register Document Secured Messaging Retrieve Document Provide & Register Docs Maintain Time Maintain Time Record Audit Event Maintain Time Record Audit Event Record Audit Event

12. XDS Scenario + use of PIX & PDQ A87631 A87631 A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 EHR System ED Application Physician Office XDS Document Repository PACS XDS Document Repository EHR System PACS Lab Info. System L-716 L-716 L-716 Teaching Hospital Community Clinic ATNA Audit record repository CT Time server PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed Affinity Domain Patient Identity Source Patient Identity Feed Patient Identity Feed PIX Query Document Registry PIX Query Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PACS

13. XDS.a and XDS.b • Actors are the same in both XDS.a and XDS.b • Metadata is the same in both XDS.a and XDS.b • XDS.a • Original XDS profile, pre 2007 • Based on ebXML Reg/Rep 2.1 • SOAP with attachments based Provide and Register • Retrieve is HTTP GET • XDS.b • Based on a use of the Web Services and ebXML Reg/Reg standards that is consistent with the current developments and best practices in the industry • Based on ebXML Reg/Rep 3.0 • MTOM based Provide and Register • MTOM based retrieve • HL7 V3 Patient Identity Feed

14. XDS.a Transactions Diagram

15. XDS.b Transactions Diagram

16. Cross Community Access (XCA) • Sharing of documents across communities • Re-use of XDS.b transactions. • Document Consumer consistency • Requirements of Document Consumer are the same as for local document query and retrieval • Out of scope: • How to identify which communities to interact with • How to identify the patient id to use when interacting

17. Cross Community AccessActors and Transactions • Initiating Gateway • On behalf of internal actors, initiates all transactions leaving the community • Receives Registry Stored Query and Retrieve Document Set from Document Consumer • Propagates transaction to local Document Registry and Repository, if appropriate • Propagates transaction to other communities by contacting their Responding Gateway and sending: Cross Gateway Query and Cross Gateway Retrieve • Responding Gateway • Single contact point for all transactions coming in to the community. • Propagates incoming transactions to local actors • New Transactions: • Cross Gateway Query: from Initiating Gateway to Receiving Gateway, mimics Registry Stored Query • Cross Gateway Retrieve: from Initiating Gateway to Receiving Gateway, mimics Retrieve Document Set • Document Consumer • Supports Registry Stored query and Retrieve Document Set • New requirement: propagation of the homeCommunityId requirement • Applies to XDS.a, XDS.b and XCA profiles

18. XCA Process Flow RSQ – Registry Stored Query XGQ – Cross Gateway Query RDS – Retrieve Document Set XGR – Cross Gateway Retrieve Community B Responding Gateway RSQ XDS Registry XGQ Community A Initiating Gateway RSQ RDS XDS Registry XDS Repository XDS Repository RSQ Community C RDS XGQ Responding Gateway RSQ XDS Registry XGR Document Consumer RDS XDS Repository

19. Basic Patient Privacy Consents BPPC • XDS Affinity domain defines a small number of appropriate use policies • Each document is labeled with the appropriate use policy • Edge systems are configured to enforce these use policies • Supports: Opt-In, Opt-Out, emergency data set, research use allowed, de-identified data, direct care providers, etc • Supports emergency override use case • Does not support patient directed exceptions

20. Cross-Enterprise User Assertion XUA • Supporting Centralized and Federated Identity Management • Conveys the user’s trusted identity to the HIE infrastructure systems • Example: provides consumer’s identity from a PHR system to HIE infrastructure systems • Constrained to IHE XDS.b • Uses OASIS SAML 2.0 Identity Assertions

21. IHE IT Infrastructure – Schedule for 2007 • Development Schedule: • Planning Committee decision: December 2007 • Issue Public Comment version: June 2008 • Public Comment Due: July 2008 • Issue Trial Implementation version: August 2008 • IHE Connectathon: January 2009 • HIMSS Demo: April 2009

22. IHE IT Infrastructure – Plan for 2008 • New Supplements For 2008 • Sharing of Value Sets • Referral Request • Emergency Contact Registry Query • Asynchronous XDS.b • Extended PDQ • Significant updates to previous years profiles • XDS-SD conformance to PCC TF • New White Papers for 2008 • Publish/Subscribe Infrastructure for XDS