Cross Domain Review PCC

1. Cross Domain Review PCC Christoph Dickmann IHE Technical Committee March 2007

2. PCC - overview

3. Domains used in PCC • IT Infrastructure • XDS, XDM, XDR, • NAV, • ATNA, CT • XDS-SD

4. IHE PCC Integration Profile Cross-enterprise Sharing of Medical Summaries (XDS-MS) • Cross-enterprise Sharing of Medical Summaries Defines a summary of patient data in narrative and/ or structured way that is used when transferring the patient from one care provider to another one for- general / specific audience - focused / broader range of patient problems.

5. XDS-MS Features • An XDS content profile • Uses & constraints the CDA R2 Care Record Summary (CRS) implementation guide • Render CDA R2 for viewing & printing consistently • Options to ITI XD* actors: • Source side • referral/ discharge summary content • support coded entries beyond XDS-MS defined codes • Consumer side • view/ print document (incl. linked documents) • import document, sections or individual entries • Defines 61 specific IHE CDA modules/ templates • Defines 11 specific IHE Act codes • Features similar to Radiology • XDS metadata • CDA content modules – similar to DICOM SR templates • Narrative text • Coded text – mainly LOINC and HL7 codes

6. IHE PCC Integration Profile Basic Patient Privacy Consents (BPPC) - TI • Basic Patient Privacy Consents Defines a mechanism to create and enforce patient consent policies for disclosing shared documents, including the necessary data to be used in documents that carry consent information

7. BPPC Features • An XD* content profile that adds options • Privacy Option for XDS Source, Consumer, Registry • Privacy Option for XDR Source and Consumer • Privacy Option for XDM Media Creator and Importer • Uniquely identifiable privacy policy that can be referenced from shared documents • Consents can be: • Scanned paper document (“wet signature”  XDS-SD) • CDA consent document that is digitally signed • Implied and not documented in the shared document • Explicit and documented/ referenced in the shared document • Specific CDA template (specific template ID) • CDA confidentiality code references the privacy policy OID (configuration issue) • Document Source sets the value appropriately for all documents • XDS Registry checks the validity of the code, and does code matching for queries • Doc. Consumer may include confidentiality code in queries, uses policy decision logic • Features similar to Radiology • XDS metadata • HL7 CDA and PDF documents

8. IHE PCC Integration Profile Emergency Department Referral (EDR) - TI • Emergency Department Referral Defines a referral document that provides summarizing information on a patient’s past medical problems, allergies, medications or assessment plan to the ED physician

9. EDR Features • An XD* content profile • Defines 4 CDA section templates for CDA body • Re-uses 3 section templates from XDS-MS • Features similar to Radiology • Content in the referral similar to DICOM Patient Medical Module • Note: I think the documentation is difficult to navigate and read (document > section > entry definitions are separate in TF-2)

10. IHE PCC Integration Profile Exchange of Personal Health Record Content (XPHR) • Exchange of Personal Health Record Content Defines summary information extracted from a PHR system used by a patient for import into healthcare provider information systems, and visa versa. PHR information typically used is address, telephone numbers, birth date, sex, marital status, emergency contacts, insurance information, a medical and family history, and current medications and allergies.

11. XPHR Features • An XD* content profile • Create / update PHR extracts (incl. functional requirement to add/ replace/ remove sections/ entries) • Import document/ section/ entry – equal to XDS-MS • View individually or consistently a PHR document • Use of DSG is recommended (option): Created PHR document should be signed, consumers should be able to verify a signature • Maps AHIM-PHR to ASTM CCR, HL7 CCR/CRS and HL7 PHR • Extends HL7 CDA by • Document section updates (replacementOf) • insurance identifiers, • patient identifiers of different providers • Features similar to Radiology • None found (potentially some content) • Note: Options and “bindings” may be difficult to understand, e.g. why can’t I exchange PHR information by using basic XDS?

12. IHE PCC Integration Profile Pre-procedure History and Physical (PPHP) - TI • Pre-procedure History and Physical Defines patient data necessary to evaluate/ ameliorate the risk for ambulatory procedures that require anesthesia. It is used for preparing the procedure and patient. Such information can be: diagnoses, proposed procedure, laboratory and imaging studies, history & physical examinations.

13. PPHP Features • An XD* content profile • Defines a CDA template with ~ 50 sections (many of those optional) • No specific behavior defined;Incorrect reference to “binding” to other (XD*) profiles • Features similar to Radiology • None found (potentially some content)

14. IHE PCC Actors • Actors that are different • Content Creator – create and provide a • medical summary (XDS-MS) • consent document (BPPC) • ED referral (EDR) • Content Consumer – view, import or process a medical summary, similar as above for XDS-MS, BPPC, EDR • PHR Manager creates and provides a PHR extract; imports/ consumes PHR data/ updates • PHR Reviewer consumes PHR extracts, and may be able to update an extract • Actors from non RAD-domains • Required grouping of Content Creator with: XDS/ XDR Doc. Source or XDM Media Creator • Required grouping of Content Consumer with: XDS/ XDR Doc. Consumer or XDR Media Importer • Optional grouping of Content Creator/ Consumer with: NAV Notif. Sender/ Receiver or DSG Doc. Source/ Consumer • List of Actors extensively the same as Radiology • none

15. IHE PCC TransactionsNote: Options are documented in Profile descriptions • List of transactions that are different • none • List of transactions that are extensively the same • Re-use of XDS, XDM, XDR transactions • List of Transactions are extensively the same as Radiology • none

16. Standards Used in PCC Note: references to standards may be improved, e.g. PPHP 5.4.1.8.1

17. Summary of PCC

18. Key to Domain issues • Issue should result in CP in Radiology • Consider addition in Radiology • Conflict between Radiology and other Domain • Radiology Profile should be handed-off to other Domain • Gap has been identified that may result in New Opportunity