Publication and Discovery XDS and DSUB

1. Publication and DiscoveryXDS and DSUB IHE IT Infrastructure Webinar Series

2. Cross-Enterprise Document Sharing XDS

3. What is XDS ? The Cross-Enterprise Document Sharing (XDS) IHE Integration Profile facilitates the registration, distributionand accessacross health enterprises of patient electronic health records It provides a standards-based specification for managing the sharing of documents between any healthcare enterprise Currently only one XDS profile, based on Web Services - XDS.b (original XDS.a is now depreciated)

4. XDS Affinity Domains Group of healthcare enterprises that have agreed to work together using a common set of policies and standards-based infrastructures for sharing patient clinical documents, using XDS: • Regional community of care • Nationwide EHR • Specialized or disease-oriented (cardio, diabetes, oncology) • Government-sponsored or federation of enterprises • Insurance provider supported communities XDS profile is designed to accommodate a wide range of policies on: • Patient identification and consent • Controlling access to information • Format, content, structure, and representation of clinical information

5. Some Common Scenarios • ePharmacy between ward and pharmacy departments within a hospital • eReferral between primary and secondary care providers • Patient Care Summary (e.g. within a region) • Publishing of Care Summaries by providers • Access to patient’s Care Summary in an emergency • Sharing of radiology reports and images between facilities

6. Main Entities and Responsibilities • A document Repositoryis responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests. • A document Registryis responsible for storing information about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored. Notes: • Analogous to a library (book repository) and catalog/index • The Registry does not have access to the documents – an important separation from security and privacy perspective • Multiple Repositories can be linked to one Registry

7. XDS Flow and Interactions Registry • XDS Document (Metadata): • Type • Patient • Author • Facility • Authenticator • … Consumer 3. Consumers search for documents with specific information 2. Repository registers the documents metadata and pointer with the Registry Source of Documents Repository 4. Consumers retrieve selected documents from Repository (-ies) 1. Sources post document packages to the Repository

8. XDS.b Formal Diagram Patient Identity Source Patient Identity Feed [ITI-8] Patient Identity Feed HL7v3 [ITI-44] Registry Stored Query [ITI-18] Document Registry Document Consumer Register Document Set-b [ITI-42] Integrated Document Source/Repository Retrieve Document Set [ITI-43] Document Source Document Repository Provide&Register Document Set-b [ITI-41]

9. XDS.b Actors • Document Source – producer and publisher of documents, responsible for sending documents and their metadata to a Document Repository actor • Document Repositoryis responsible for both the persistent storage of these documents as well as for their registration with the appropriate Document Registry • Document Registry maintains metadata about each registered document and a link to the Document in the Repository where it is stored. Responds to queries from Document Consumer actors about documents meeting specific criteria. • Document Consumer queries a Document Registry for documents meeting certain criteria, and retrieves selected documents from one or more Document Repository actors • Patient Identity Source facilitates the validation of patient identifiers by the Registry Actor in its interactions with other actors by providing unique identifier for each patient and maintaining a collection of identity traits • Integrated Document Source/Repository combines the functionality of the Document Source and Document Repository actors into a single actor that does not expose the Provide and Register Document Set transaction

10. XDS.b Transactions (1) • Provide and Register Document Set – For each document in the submitted set, the Document Source Actor provides both the documents as an opaque octet stream and the corresponding metadata to the Document Repository. The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction. • Register Document Set allows a Document Repository Actor to register one or more documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry.

11. XDS.b Transactions (2) • Patient Identity Feed conveys the patient identifier and corroborating demographic data, in order to populate the Document Registry with patient identifiers that have been registered for the XDS Affinity Domains. (At least one of the options [ITI-8] or [ITI-44] should be supported.) • Registry Stored Query is issued by the Document Consumer Actor to a Document Registry. It will return registry metadata containing a list of document entries found to meet the specified criteria including the locations and identifier of each corresponding document in one or more Document Repositories. • Retrieve Document Set – initiated by a Document Consumer. The Document Repository shall return the document set that was specified by the Document Consumer.

12. XDS Document Content Types XDS profile is content agnostic – it can be used with a variety of document types, e.g.: • XDS-SD: Scanned document, plain text or PDF/A, in HL7 CDA R2 format • XDS-MS: Medical summary in HL7 CDA format • XDS-I: Radiology report in plain text of PDF format, or reference to a collection of DICOM SOP Instances in a manifest document in the DICOM Key Object Selection format

13. XDS.b – Actors and Options

14. Security and Privacy Considerations • All actors be grouped with a ATNA Secure Node Actor • Each member of the XDS Affinity Domain should have audit and security mechanisms in place • Transactions used between different secure domains shall use the ATNA Encryption Option • Each transaction will result in audit records

15. XDS Workflow Health Information Exchange Network Patient Identity XRef Mgr Patient Demographics Supplier A87631 A87631 14355 14355 M8354673993 M8354673993 L-716 L-716 Time server XDS Affinity Domain PIX or PDQ Query PIX or PDQ Query PMS ED Application Physician Office Document Registry Document Repository PACS Document Repository Query Document (using Patient ID) Register Document (using Patient ID) EHR System PACS Retrieve Document Provide & Register Maintain Time Record Audit Event Lab Info. System Maintain Time Teaching Hospital Maintain Time Community Clinic Audit record repository CT ATNA Record Audit Event

16. References Infrastructure – see ITI TF-2x: Appendix V, including: • WS-I Profiles • WS-* Specifications Request/Response and Document Content • HL7 CDA • CEN ENV 13606 • ASTM 4400CCR • DCOM • ebRIM • ebRS

17. Flexible Infrastructure Send to Send to Switch Interchange Media Write Read Replace with agreed new version of this slide Health Information Exchange XDS Structuredobjects Pull Publish Pull XDR XDM

18. Who Is Using XDS? http://tinyurl.com/WWXDS

19. Document Metadata Subscription supplement DSUB

20. DSUB Overview The Document Metadata Subscription (DSUB) supplement contains two related parts: • Publish/Subscribe Infrastructure: General framework for defining web-services based publish/subscribe interactions • Document Metadata Subscription (DSUB) Integration Profile: Use of subscriptions within an XDS Affinity Domain or across communities

21. Publish/Subscribe Infrastructure • New Volume 3 section 4.4 • Presents a framework for building event-driven information exchange patterns using a publish/subscribe data exchange model • Defines the transport of publish, subscribe and notify messages. • Supports IHE profiles which define the use case specific content to be carried in the publish, subscribe and notify messages • Document Metadata Subscription (DSUB) first profile to use this framework.

22. Publish/Subscribe Infrastructure Actors and Transactions Publisher Publish 4.4.2.3 NotificationBroker Subscribe 4.4.2.1 Subscriber Notify 4.4.2.2 NotificationRecipient

23. Possible Combined Actors Publisher Publisher NotificationBroker Subscriber Subscribe Publish Notify NotificationBroker Subscribe NotificationRecipient Publisher Notify NotificationBroker Subscribe NotificationRecipient Subscriber Notify NotificationRecipient Subscriber

24. Document Metadata Subscription (DSUB) Integration Profile • Defines a subscription which allows for the matching of metadata during the publication of a new document for a given patient, and results in the delivery of a notification. • Enabled within an XDS Affinity Domain or XCA environment • Use Cases • Emergency Department: Notification of new document availability during treatment • Primary Care Management: PCP receives notification when new documents for patient are available

25. DSUB Actors and Transactions Document Metadata Publisher Document Metadata Subscriber Document Metadata Publish [ITI-54] Document Metadata Subscribe [ITI-52] Document Metadata NotificationBroker Document Metadata Notify [ITI-53] Document Metadata NotificationRecipient

26. Transactions • Document Metadata Subscribe : start a subscription for a particular topic and filtering within that topic. Supports full and minimal notifications and where to send the notification. • Document Metadata Notify : send a notification about the availability of a document or documents of interest, based on the subscribers' filters on selected topics • Document Metadata Publish : notify that an event occurred for which there may be a subscription.

27. DSUB Illustration of Use Notification Broker Subscriber Publisher Notification Recipient Subscribe Publish Notify Publish Notify Unsubscribe Publish

28. DSUB Implementation • DSUB topic tree • ihe:FullDocumentEntry : subscribes to Document Entry registration events; the notification shall contain the full metadata describing each matching Document Entry • ihe:MinimalDocumentEntry : subscribes to Document Entry registration events; the notification shall contain a minimal set of data (identifiers only) describing each matching Document Entry • DSUB Standards • Web Services Standards • WS-BaseNotification 1.3 OASIS Standard • WS-BrokeredNotification 1.3 OASIS Standard • WS-Topics 1.3 OASIS Standard • ITI TF-2x: Appendix V • Filter expression • Registry Stored Query [ITI-18]