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Deferred Document Creation

This proposal aims to address the need for creating documents in response to specific requests, improving existing IHE profiles, and optimizing healthcare infrastructure. Examples of market readiness and potential risks are discussed.

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Deferred Document Creation

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  1. Deferred Document Creation Brief Profile Proposal for 2009/10 presented to the IT Infrastructure Planning Committee Vassil Peytchev, Epic September 30, 2009

  2. The Problem • What problem is this profile proposal hoping to address? • In certain cases, there is a need for a document to be created as result of a specific request, e.g. provide patient data snapshot. • In other cases, health care data is not organized as a collection of documents, and documents are created only for the purposes of sharing of data. It will be beneficial to allow for “announcing” the general availability of such documents, but only create them when they are actually requested. • Identify any existing IHE profile gaps/overlaps that this proposal will improve upon • Currently, the XDS-b and XCA profiles describe the sharing of documents after they have been created as a consequence of healthcare activity. This proposal adds the capability of creating documents when necessary to share data.

  3. The Problem • What is the market readiness for this IHE profile proposal? Please provide examples to illustrate • In the US, patient summaries based on the CCD specification are a fundamental part of interoperability requirements promoted by national initiatives. In Europe, the epSOS project also requires patient summaries to be shared across borders among the EU member countries. This supplement will provide a necessary component for these interoperability projects. • Many large healthcare organizations only need to create documents for a small fraction of their patients. This supplement will allow them to optimize their infrastructure for care delivery.

  4. The Problem • What is the risk of this proposal not being undertaken this cycle? • A delay in the undertaking of this proposal may cause multiple mutually incompatible solutions to this problem to be developed in order to meet the aggressive timelines of various initiatives (HITECH meaningful use, epSOS). • Other relevant comments • A white paper describing a solution to this problem in the XCA environment was published by IHE on September 29, 2009 http://www.ihe.net/Technical_Framework/upload/IHE_ITI_WhitePaper_XC_Dynamic_Data_2009-09-28.pdf

  5. Use Case - XCA • In an XCA environment, a large healthcare organization participates as a community of its own. Many of the patients who are admitted in any one of the organization’s hospitals receive some of their healthcare in other communities, so there is a need to provide relevant information to healthcare providers in other communities. • When a request for documents for a particular patient is received, the response is currently supposed to contain a list of matching documents, including the size and hash of each document. In many cases only a small subset of these documents are ever retrieved. In particular, non-recent discharge summaries may rarely be requested. This proposal allows the healthcare organization to indicate the availability of the matching documents for the particular patient, without actually creating the document until it is requested.

  6. Use Case - XDS • An XDS Affinity Domain consists of a large healthcare organization (L) and several small physician offices (PO1 … POn). Organization L has an integrated Document Source/Document Repository. Only a relatively small percentage of patients in the Affinity Domain are seen at both L and any one of the physician offices, so L only registers deferred/dynamic documents in the Affinity Domain registry. When a Retrieve Document Set transaction is received at the integrated Document Source/Document Repository, the document is generated and returned as a result of the request.

  7. Proposed Standards & Systems • What standards and/or systems should be considered in addressing this proposal? • This proposal will be an extension to the XDS.b and XCA profiles

  8. Discussion • What level of effort do you foresee in developing this profile? • Given the work completed for the White Paper, it is small to medium effort • Is there someone who is willing to act as profile editor? • Karen Witting, IBM, witting@us.ibm.com

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