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Cross-Enterprise Document Sharing

Cross-Enterprise Document Sharing. Bill Majurski National Institute of Standards and Technology IT Infrastructure Co-Chair. W W W . I H E . N E T. Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings.

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Cross-Enterprise Document Sharing

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  1. Cross-Enterprise Document Sharing Bill Majurski National Institute of Standards and Technology IT Infrastructure Co-Chair

  2. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings Interoperability Strategy Workshop

  3. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) • Cross-Enterprise Document Sharing (XDS) – Registration, distribution and access across health enterprises of clinical documents forming a patient EHR Interoperability Strategy Workshop

  4. Cross-Enterprise Document Sharing (XDS)Abstract / Scope • Provide support for document-based patient EHR • Support for document storage within existing products • Provide support for indexing of patient documents • Support query and retrieval of patient documents • Scalable architecture Interoperability Strategy Workshop

  5. Cross-Enterprise Document Sharing (XDS) Value Proposition Points of view • EHR-CR : Care-delivery Record • Patient information • Managed by a Care Delivery Organization • EHR-LR : Longitudinal Record • Documents shared by EHR-CR(s) • Tracked by Registry • Clinical Affinity Domain : • Group of healthcare enterprises • Common set of policies • Share a single registry Interoperability Strategy Workshop

  6. Cross-Enterprise Document Sharing (XDS) Value Proposition Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc. Effective means to contribute and access clinical documents across health enterprises. Scalable sharing of documents between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems. Easy access: Care providers are offered means to query and retrieve clinical documents of interest. Interoperability Strategy Workshop

  7. Cross-Enterprise Document Sharing (XDS) Value Proposition Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.) Interoperability Strategy Workshop

  8. Cross-Enterprise Document Sharing (XDS) Transaction Diagram Interoperability Strategy Workshop

  9. Cross-Enterprise Document Sharing (XDS) Actors Document Source Source of documents and metadata about documents Document Repository Stores documents, requests indexing in Document Registry, supports retrieval Document Registry Indexes documents, supports search Patient Identity Source Feeds identity of known patients to Document Registry Document Consumer Initiates search and retrieval for consumer of documents Interoperability Strategy Workshop

  10. Cross-Enterprise Document Sharing (XDS) Value Proposition (cont) Document Content Neutral: Document content is processed only by source and consumer IT systems. Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches. Interoperability Strategy Workshop

  11. Cross-Enterprise Document Sharing (XDS) Standards Used Electronic BusinessStandards ebXML, SOAP … Internet Standards HTML, HTTP,ISO, PDF, JPEG … HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … Interoperability Strategy Workshop

  12. Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used XDS Content XDS Infrastructure Interoperability Strategy Workshop

  13. Cross-Enterprise Document Sharing (XDS) Standards Used XDS Infrastructure Standards • OASIS/ebXML • Registry Information Model v2.0 • Basis of XDS Registry Information Model • Registry Services Specifications v2.0 • Registry Services • Messaging Services Specifications v2.0 • Offline protocols • ISO/IEC 9075 Database Language SQL • Registry Query Language • SOAP with Attachments • Protocol for communication with XDS Registries and Repositories • SHA-1 [FIPS 180-1] • Document Hashes Interoperability Strategy Workshop

  14. Cross-Enterprise Document Sharing (XDS) Standards Used XDS Infrastructure Standards (cont) • HL7 Version 2.3.1 • Messages for Patient Identity Management • HL7 Version 2.5 • Datatypes for XDS Registry Attribute values • HL7 CDA Release 1 • XDS Document concept definition • Source of XDS Document Entry Attributes • DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom • Sources of XDS Document Entry Attributes Interoperability Strategy Workshop

  15. Cross-Enterprise Document Sharing (XDS) Standards Used HTTP Protocol for Retrieve Document Online SOAP bindings SMTP Offline ebMS bindings IETF Language Identifiers MIME Document Type codes UTF-8 Encoding of Registry Attributes XDS Infrastructure Standards (cont) Interoperability Strategy Workshop

  16. Cross-Enterprise Document Sharing (XDS) Standards Used XDS Content Standards • Defined separately as Document Content Profiles • Not constrained by XDS • Examples include: • HL7 CDA Release 1 • HL7 CDA Release 2 • DICOM • ASTM CCR • Document content formats defined by Document Content Profiles Interoperability Strategy Workshop

  17. Cross-Enterprise Document Sharing (XDS) Related Profiles Patient Identity • Patient Identity Feed • Notification of patient admission/registration • Supports document registration • Patient Demographics Query (PDQ) • Identify patient based on query of demographic information • Supports document registration and query Interoperability Strategy Workshop

  18. Patient Identification ManagementPIX Cross Referencing (coexist with PDQ) Patient Identity Feed Dm=XAD, Pid=Px Patient Identity X-Ref Mgr Patient Identity X-Ref Mgr DocumentEntry Dm=XAD Pid=Px XDS Document Consumer XDS Document Source Query Docs Dm=XAD Pid=Px Patient ID Consumer Dm=XAD Pid=Px Provide&Register Doc Set Patient ID Consumer XDS Doc XDS Doc Patient Identity Source Patient Identification Domain C Patient Identification Domain D2 Patient Identification Domain XAD XDS Document Registry Dm=D2 Pid=Pd Dm=C Pid=Pc XDS Document Repository Interoperability Strategy Workshop

  19. Patient Identification ManagementPDQ Discovery + Local mapping (coexist with PIX) Patient Identity Feed Dm=XAD, Pid=Px Patient Demographics Supplier DocumentEntry Dm=XAD Pid=Px XDS Document Consumer XDS Document Source Query Docs Dm=XAD Pid=Px PatientDemo Consumer Dm=XAD Pid=Px Provide&Register Doc Set Demo graphics Patient Demo Consumer Demo graphics XDS Doc XDS Doc Patient Identity Source Patient Identification Domain C Patient Identification Domain D2 Patient Identification Domain XAD XDS Document Registry XDS Document Repository Interoperability Strategy Workshop

  20. Cross-Enterprise Document Sharing (XDS) Related Profiles Time/Audit/Authentication • Constant Time (CT) • Audit Trail and Node Authentication (ATNA) • Cross-Enterprise User Authentication (XUA) Interoperability Strategy Workshop

  21. Cross-Enterprise Document Sharing (XDS) Related Profiles New related profiles • Notification of Availability (NAV) • Send notification that documents are available • Digital Signature (DSG) • Signing of documents in repository/registry Interoperability Strategy Workshop

  22. Cross-Enterprise Document Sharing (XDS) Document Status • XDS profile document being updated for this season • Final collection of changes are being balloted now • Final text of the profile and a catalog of changes from last year will be posted on the Web and announced in two weeks. Interoperability Strategy Workshop

  23. More information…. • IHE Web sites: www.ihe.net • Technical Frameworks, Supplements • Fill in relevant supplements and frameworks • Non-Technical Brochures : • Calls for Participation • IHE Fact Sheet and FAQ • IHE Integration Profiles: Guidelines for Buyers • IHE Connect-a-thon Results • Vendor Products Integration Statements Interoperability Strategy Workshop

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