XDS & XCA: On-Demand Documents Option

1. XDS & XCA: On-Demand Documents Option IT Infrastructure Planning Committee Karen Witting – Ready Computing

2. Why On-Demand? • Supports sources of healthcare data which can provide most recent or dynamic views of healthcare data • When the restrictions of XDS and XCA stable document sharing are not acceptable: • XDS/XCA stable document exchange supports only point-in-time documents containing historical clinical data • XDS/XCA stable document exchange is not designed to provide most up-to-date data at the time of the request • Allows an organization to provide a dynamic view of the clinical data for a patient where, through a single request mechanism, they provide the most current content available at the time of the request. • What on-demand can’t do: • Not designed to deliver Documents created prior to the request • Cannot provide robust source attestation because content generatedthrough automation

3. On-Demand Documents Overview • Enables a new type of Document Entry, which provides access to a service to generate dynamic data rather than a single document containing historical data. • The On-Demand Document Entry references a service which is similar to a clinical query with no arguments: • each defined service always generates the same document type • the data will contain the most recent clinical informationavailable • Supported as an option of the XDS and XCA profiles • Status: Trial Implementation

4. Overview of Profile updates • Common to XDS and XCA • Defined on-demand DocumentEntry • Query: enhanced to support returning new type of Document Entry • Retrieve: enhanced to support return of on-demand/dynamic document • New On-Demand Document option • XDS only • New transaction enables registration of on-demand Document Entries (ITI-61) • New Actor – On-Demand Document Source. Initiates new transaction and responds to retrieve requests.

5. Document Entry types • Document Entry types defined • Stable Document Entry – metadata about a specific and already existing set of healthcare content formed into a document. • On-Demand Document Entry – metadata describing a type of healthcare content that could be created if requested.

6. Static vs. On-Demand DocumentEntry (1)

7. Static vs. On-Demand DocumentEntry (2)

8. Static vs. On-Demand DocumentEntry (3)

9. Query Transactions XDS (ITI-18) and XCA (ITI-38) Query transactions updated to support: • New DocumentEntryType query parameter <Slot name="$XDSDocumentEntryType"> <ValueList><Value> ('urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1‘, 'urn:uuid:34268e47-fdf5-41a6-ba33-82133c465248') </Value> <ValueList> </Slot> • Static only – default • New ExtrinsicObject ObjectType in return list.

10. Retrieve Transactions XDS (ITI-43) and XCA (ITI-39) Retrieve transactions updated to support retrieve of an On-Demand Document: • NewDocumentUniqueId element in response contains uniqueID of document created in response to the retrieve of a On-Demand DocumentEntry • NewRepositoryUniqueId used to identify the Document Repository containing the newly created document

11. XCA new option

12. XDS new option and Actor NOTE: Large type means a new option or Actor

13. Persistence of Retrieved Documents • Adds the requirement that documents created in response to a retrieve of an on-demand entry uniqueID will be persisted forever and available for later retrieval through the newUniqueID returned in the retrieve transaction. • XDS • The persistence must include a ITI-41 Provide and Register transaction submitting the Stable DocumentEntry reflecting the new document to the same Document Registry where the On-Demand Document is registered. • XCA • The persistence is internal to the Responding Gateway and need only reflect the registration of the Stable DocumentEntry in response to query requests and the return of the identical document upon a retrieve request specifying the newUniqueID.

14. XDS On-Demand Documents Actors/Transactions

15. XCA workflow example – with persistence Community A Initiating Community B Initiating Community C Initiating Community D Responding XCA Query Created new document #6 from the most current clinical information. There is no document #5. On-Demand Entry uniqueID=5 Create On-Demand Entry # 5 XCA Query Reuse On-Demand Entry # 5 On-Demand Entry uniqueID=5 XCA Retrieve # 5 Create and save Stable Entry # 6 Returns # 6 Since no new data available chose to reuse #6 - optional XCA Retrieve # 5 No new data available Returns # 6 Reuse # 6 Assumes Query asks for both stable and on-demand XCA Query Return On-Demand Entry # and Stable # 6 uniqueID=5 & 6 Must create new document since new data is available. New data available XCA Retrieve # 5 Create and save Stable # 7 Returns # 7 Allows initiator to access metadata for dynamically created document #7 No new data available XCA Retrieve # 5 Returns # 7 Reuse # 7 XCA Query for id=7 Return Stable # 7

16. XCA workflow example – no persistence Community A Initiating Community B Initiating Community C Initiating Community D Responding XCA Query On-Demand Entry uniqueID=5 Create On-Demand Entry # 5 Since persistence is not supported the new document is not saved for later retrieval XCA Query Reuse On-Demand Entry # 5 On-Demand Entry uniqueID=5 XCA Retrieve # 5 New document uniqueID=6 Since #6 was not saved it cannot be re-used so create a new document even though the data has not changed. Returns # 6 XCA Retrieve # 5 No new data available New document uniqueID=7 Returns # 7 XCA Query Reuse On-Demand Entry # 5 uniqueID=5 New data available XCA Retrieve # 5 New document uniqueID=8 Returns # 8 Since persistence not supported, there is no metadata saved for the dynamically created object. No new data available XCA Retrieve # 5 New document uniqueID=9 Returns # 9 XCA Query for id=9 Return no document found

17. XDS On-Demand Workflow On-Demand Document Source with Persistence Document Registry Document Consumer B Document Consumer A Register new On-Demand Entry #5 Save On-Demand Entry # 5 Source adds on-demand document for patient XDS Stored Query Return all matching, only #5 XDS Retrieve # 5 On-Demand Entry uniqueID=5 Create dynamic document and persist as stable Register new Stable Entry #6 Save Stable Entry # 6 Returns # 6 XDS Retrieve # 5 No new data available Returns # 6 XDS Stored Query Return all matching, On-Demand Entry # 5 and Stable # 6 uniqueID=5 & 6 XDS Retrieve # 5 Create new, updated dynamic document and persist as stable New data available Register new Stable Entry #7 Save Stable Entry # 7 Returns # 7 XCA Retrieve # 5 No new data available Returns # 7 XDS Stored Query for id=7 Return Stable # 7

18. Compatibility • On-Demand is an option in XDS and XCA and is designed so that Actors not implementing the option are not effected. • Query Transaction • The new parameter is ignored by a Document Registry/Responding Gateway not supporting the option. • A Document Consumer not supporting the new option will never specify the new parameter and thus will never receive the new DocumentEntry type • Retrieve Transaction • A Document Consumer/Initiating Gateway not supporting the new option will never receive an On-Demand DocumentEntry and therefor will never initiate a retrieve request for an on-demand DocumentEntry.

19. More Information • IHE Web site: www.ihe.net • IHE official material • Technical Framework documents • IHE Wiki site: wiki.ihe.net • IHE committee pages • Implementation Notes • Ongoing committee work • IHE ITI technical committee mailing list • http://www.ihe.net/IT_infra/committees • At the bottom of the page is a place to join the mailing list