IHE Overview of Cross Enterprise Document sharing XDS and related profiles

1. 1 IHE Overview of Cross Enterprise Document sharing (XDS) and related profiles HIMSS Interoperability Showcase May 17, 2007 Didi Davis, Director, IHE

2. 2 A Framework for Interoperability Integrating the Healthcare Enterprise: An initiative that improves patient care by harmonizing healthcare information exchange Provides a common standards-based framework for seamlessly passing health information among care providers, enabling local, regional and national health information networks Promotes the coordinated use of established standards–Health Level 7, ASTM, DICOM, CDISC, W3C, IEEE, etc.—to address specific clinical needs What is IHE? Optimal patient care requires efficient access to comprehensive electronic health records (EHRs). The Integrating the Healthcare Enterprise (IHE) initiative accelerates the adoption of the information standards needed to support EHRs. More than 100 vendors have implemented and tested products based on IHE. IHE improves patient care by harmonizing healthcare information exchange. IHE provides a common standards-based framework for seamlessly passing health information among care providers, enabling local, regional and national health information networks.What is IHE? Optimal patient care requires efficient access to comprehensive electronic health records (EHRs). The Integrating the Healthcare Enterprise (IHE) initiative accelerates the adoption of the information standards needed to support EHRs. More than 100 vendors have implemented and tested products based on IHE. IHE improves patient care by harmonizing healthcare information exchange. IHE provides a common standards-based framework for seamlessly passing health information among care providers, enabling local, regional and national health information networks.

3. 3 IHE - Connecting standards to care Care providers and IT professionals 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 To meet these requirements, the IHE process has proven its efficiency in involving users, vendors in order to precisely define the interoperability needed and the standards to assemble in a very precise implementation guide.To meet these requirements, the IHE process has proven its efficiency in involving users, vendors in order to precisely define the interoperability needed and the standards to assemble in a very precise implementation guide.

4. 4 Sharing and Accessing Electronic Health Records

5. 5 Categories of Healthcare Communication Services The different services performing health information exchange fall in three categories. Hospitals have traditionally use primarily Workflow Mgt type and Dynamic Query services. Document Sharing, little used in hospitals, is however one of the primary mode of information exchange is the sharing of persisted and attested health records among independent organizations. We will focus on Document sharing in the next few slides.The different services performing health information exchange fall in three categories. Hospitals have traditionally use primarily Workflow Mgt type and Dynamic Query services. Document Sharing, little used in hospitals, is however one of the primary mode of information exchange is the sharing of persisted and attested health records among independent organizations. We will focus on Document sharing in the next few slides.

6. 6 The key concepts of Cross-Enterprise document sharing rely on an index of documents that holds minimal metadata about the documents that are placed either in a shared repsoitory or in repositories in the edge systems (Step 1).The key concepts of Cross-Enterprise document sharing rely on an index of documents that holds minimal metadata about the documents that are placed either in a shared repsoitory or in repositories in the edge systems (Step 1).

7. 7 Then any edge systems, such as this clinical systems, may query the document registry (Step 2), and then retrieve documents of interest through their pointer provided by the registry (Srep 3). Finaly, the resulting information is presented to the resuesting physician in our example (Step 4).Then any edge systems, such as this clinical systems, may query the document registry (Step 2), and then retrieve documents of interest through their pointer provided by the registry (Srep 3). Finaly, the resulting information is presented to the resuesting physician in our example (Step 4).

8. 8 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 (health records). Complements to interactive workflow or dynamic access to data. Behind XDS, there are rather fundamental principles that ensure a cost-effective and flexible infrastructure that supports a broad range of centralized and decentralized configurations.Behind XDS, there are rather fundamental principles that ensure a cost-effective and flexible infrastructure that supports a broad range of centralized and decentralized configurations.

9. 9 Cross-Enterprise Document Sharing (XDS) Standards Used Implemented world-wide by more than 50 vendors/open source. Final text published December 2006. Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, Japan, Netherlands, Sweden, etc.) IHE XDS: 42,300 “Google” references (Feb’ 07) XDS relies on an array of solid and world-wide adopted standards. Since its initial definition, XDS has been widely implemented and now reached full maturity. Adoption by national and regional projects, is now significant and continues to expand.XDS relies on an array of solid and world-wide adopted standards. Since its initial definition, XDS has been widely implemented and now reached full maturity. Adoption by national and regional projects, is now significant and continues to expand.

10. 10 Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used

11. 11 IHE-XDS Infrastructure Components Audit Record Repository (ATNA) – Receive audit records from other actors and securely store for audit purposes. ATNA also authenticates peer-nodes and encrypt communications. Time Server (CT) – Provides consistent definition of date/time enabling time synchronization across multiple systems. Enables events associated with patients to be sorted reliably in chronological order. Document Registry (XDS) – Queryable index of metadata and references to all documents shared within a connected community (XDS Affinity Domain) Document Repository (XDS) – Supports storage and retrieval of clinical information (as documents). May be centralized or distributed. Patient Identifier Cross Reference Manager (PIX) – Reconciles information on patients from multiple domains to a single, cross referenced set of IDs for each given patient. Patient Demographics Supplier (PDQ) – Returns demographic information and identifiers for patients based on specified demographic criteria.

12. 12 XDS Scenario + use of ATNA & CT Lets lift the cover and get a peek into some of the details that enable secured sharing of health records. Animated, but automatic, only two clicks: First Click: start placing the three infrastructure components: registry, audit trail repository and cosnsitent time server, then publishes a document and registers it with appropriate security Second Click: serach documents, retrieve them and impoirt them into the community clinic EMR.Lets lift the cover and get a peek into some of the details that enable secured sharing of health records. Animated, but automatic, only two clicks: First Click: start placing the three infrastructure components: registry, audit trail repository and cosnsitent time server, then publishes a document and registers it with appropriate security Second Click: serach documents, retrieve them and impoirt them into the community clinic EMR.

13. 13 XDS Scenario + use of PIX & PDQ Sharing documents in an environment of fragmented patient identification is addressed by integrating the linking of patients ids. Automatic animation: three clicks only First Click: patient consent to having his information shared in the Community. Registered demographics fed to the Id X-referencing (MPI) Second Click: to publish a document, the PIX/MPI is queried, than the XDS transactions performed with the repository and registry. Third Click: to query for records of a patient, the PIX/MPI is queried, then the registry is queried and finally the document retrieved from the distributed (in this example) repositories.Sharing documents in an environment of fragmented patient identification is addressed by integrating the linking of patients ids. Automatic animation: three clicks only First Click: patient consent to having his information shared in the Community. Registered demographics fed to the Id X-referencing (MPI) Second Click: to publish a document, the PIX/MPI is queried, than the XDS transactions performed with the repository and registry. Third Click: to query for records of a patient, the PIX/MPI is queried, then the registry is queried and finally the document retrieved from the distributed (in this example) repositories.

14. 14 IHE-XDS is part of a family of profiles Regional, national, local or disease centric networks need a consistent set of Integration Profiles Eight Integration Profiles completed and tested, plus ten ready to implement = Standards-based interoperability building blocks for Rich Document Content for end-to-end application interoperability. Patient identification management Security and privacy Notification and data capture XDS is one integration profile among a consistent and growing family of profiles. When used together these profiles provide a solid basis for building a health information exchange.XDS is one integration profile among a consistent and growing family of profiles. When used together these profiles provide a solid basis for building a health information exchange.

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16. 16 Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used

17. 17 IHE Integration Profiles offer flexibility in that they can be mixed and matched to meet a broad range need. This slide illustrates that not only XDS may be used to exchange documents, by interchange media such as USB keys and CDs are specified by the XDM Integration Profile. Likewise a varity of contentIHE Integration Profiles offer flexibility in that they can be mixed and matched to meet a broad range need. This slide illustrates that not only XDS may be used to exchange documents, by interchange media such as USB keys and CDs are specified by the XDM Integration Profile. Likewise a varity of content

18. 18 XDS-MS Medical Summary or PHR Extract ExchangeProfile based on HL7 CDA Rel 2 and ASTM/HL7 CCD One of the most common information exchange neeed is to create an summary of a patient chart and share for other care provider to import. In this type of document, it is clear that the information content is not only textual information, but highly structured information for the most important information, medication, allergies, diagnosis, and patient demographics informations. This IHE medical summary, XDS-MS is based on the HL7 CDA release 2 standard, just like the PHR extract, XPHR, which is aligned on the ASTM/HL7 CCD implementation guide.One of the most common information exchange neeed is to create an summary of a patient chart and share for other care provider to import. In this type of document, it is clear that the information content is not only textual information, but highly structured information for the most important information, medication, allergies, diagnosis, and patient demographics informations. This IHE medical summary, XDS-MS is based on the HL7 CDA release 2 standard, just like the PHR extract, XPHR, which is aligned on the ASTM/HL7 CCD implementation guide.

19. 19 Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) The very same IHE XDS infrastructure used to share medical summaries, may alos be used to share diagnosis images and imaging reports. This is specified by the XDS-I integration proifile.The very same IHE XDS infrastructure used to share medical summaries, may alos be used to share diagnosis images and imaging reports. This is specified by the XDS-I integration proifile.

20. 20 HIMSS RHIO: Network of networksThe largest multi-vendor RHIO Prototype ever built ! This demonstration is introducing the ability to federate different Communities, each served by a different document registry from a different vendor. This represents fairly accurately a state RHIO that include three distinct communities. The number of different systems, not only different infrstrature systems but also edge systems such as EMR and other clinical systems that have reached full connnectivity makes this demonstration a multi-vendor RHIO protoptype, with tyhe largest variety of systems, ever built in the world.This demonstration is introducing the ability to federate different Communities, each served by a different document registry from a different vendor. This represents fairly accurately a state RHIO that include three distinct communities. The number of different systems, not only different infrstrature systems but also edge systems such as EMR and other clinical systems that have reached full connnectivity makes this demonstration a multi-vendor RHIO protoptype, with tyhe largest variety of systems, ever built in the world.

21. 21 IHE, the only sets of harmonized global standards already adopted by several national & regional projects

22. 22 As a Provider or Vendor Contributor Offer Clinical Use Case Input to Drive IHE Profile Development Become a member of relevant domain’s Planning or Technical Committees Become a member of relevant Regional/National Committees Help to shape IHE’s future direction As a Vendor Participant Respond to Public Comments of Domain Supplements Attend the June Educational Workshop Participate in Connect-a-thons and Demonstrations As a Provider/Consultant Participant Respond to Public Comments of Domain Supplements Attend the June Educational Workshop Attend Demonstrations and include IHE Integration Profiles in your RFPs and Integration Projects. How can I participate?

23. 23 IHE Web site: www.IHE.net

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