IHE IT Infrastructure Domain Update

1. IHE IT Infrastructure Domain Update Karen Witting – IBM IT Infrastructure Technical Committee co-chair

2. IT Infrastructure Domain (ITI) Supports profiles which supply necessary infrastructure for sharing healthcare information. IT Infrastructure domain began in 2003 and now has 27 profiles that it supports. Key ITI profiles demonstrated today: Information Exchange: XDS.b, XDM, XDS-SD, RFD Security: ATNA, CT, XUA, BPPC Identity Management: PIX, PDQ (HL7 V2 & V3)

3. An Infrastructure Interoperability Component Is… An infrastructure Interoperability component… Represents a common IT function or service that is used as a building block for a variety of use cases May be imbedded in an application, but is often deployed as a shared resource within a RHIO or Health Information Exchange Is a necessary ingredient, but is rarely visible to the end user

4. Categories of Healthcare Communication Services Patient and Provider Identity Management HIEs and RHIOs Hospitals Security/Privacy e.g. order lab test, track status and receive results e.g. access last 6 mo. historical labs & encounter summaries e.g. get current list of allergies or med list from source Document Sharing Dynamic Information Access Workflow Management Source persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task

5. ITI Profiles Security/Privacy Cross-Enterprise User Assertion (XUA) ☼ Basic Patient Privacy Consents (BPPC) ☼ Enterprise User Authentication (EUA) Consistent Time (CT) ☼ Audit Trail and Node Authentication (ATNA) ☼ Document Digital Signature (DSG) Identify Management Personnel White Pages (PWP) Patient Identifier Cross-Referencing (PIX)☼ Patient Demographics Query (PDQ) ☼ Patient Identifier Cross-Referencing HL7 V3 (PIX V3)☼ Patient Demographics Query HL7 V3 (PDQ V3) ☼ Patient Administration Management (PAM) Pediatric Demographics Option Cross-Community Patient Discovery (XCPD) ☼ ▀ colored text designates 2009 new profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

6. ITI Profiles (continued) Information Exchange Cross-Enterprise Document Sharing - b (XDS.b) ☼ Cross-Enterprise Sharing of Scanned Documents (XDS-SD)☼ Cross Community Access (XCA)☼ Document Metadata Subscription (DSUB) ☼ Multi-Patient Queries☼ Cross-Enterprise Document Media Exchange (XDM) ☼ Cross-Enterprise Document Reliable Interchange (XDR) Notification of Document Availability (NAV) Retrieve Form for Data Capture (RFD) ☼ Retrieve Information for Display (RID) Patient Synchronized Applications (PSA) Terminology Sharing Value Sets ▀ colored text designates 2009 new profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

7. Document Content & Modes of Exchange Document Content Profiles PreSurgery PPH P Consent BPPC Emergency EDR Scanned Doc XDS-SD Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Document Exchange Integration Profiles Document SharingXDS ReliableInterchange XDR MediaInterchange XDM Cross-Community AccessXCA

8. XDS Scenario + Use of ATNA & CT EHR System ED Application Physician Office XDS Document Repository PACS XDSDocument Repository EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record repository CT Time server PMS XDS Document Registry Query Document Register Document Secured Messaging Retrieve Document Provide & Register Docs Maintain Time Maintain Time Record Audit Event Maintain Time Record Audit Event Record Audit Event

9. XDS Scenario + Use of PIX & PDQ A87631 A87631 A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 EHR System ED Application Physician Office XDS Document Repository PACS XDS Document Repository EHR System PACS Lab Info. System L-716 L-716 L-716 Teaching Hospital Community Clinic ATNA Audit record repository CT Time server PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed Affinity Domain Patient Identity Source Patient Identity Feed Patient Identity Feed PIX Query Document Registry PIX Query Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PACS

10. HIMSS 10 Cross-CommunityDemonstrating Sharing across regional boundaries Gateway CALIFORNIA Document Registry Practice Practice Hospitals Practice Hospitals Practice Hospitals Hospital Practice Hospital Hospital Patient ID services Clinic Clinic Clinic Repository Clinic Repository NEW YORK Document Registry ILLINOIS IHE transactions Document Registry Practice Practice Hospitals Practice Hospitals Practice Hospitals Gateway Hospital Practice Hospital Hospital Patient ID services Practice Gateway Practice Hospitals Clinic Practice Hospitals Clinic Practice Hospitals Clinic Repository Clinic Repository Patient ID services Clinic Clinic Repository Repository NORTH CAROLINA Document Registry Gateway Practice Practice Hospitals Practice Hospitals Hospitals Patient ID services Clinic Repository

11. 2009 New Work Cross-Community Patient Discovery (XCPD) Document Metadata Subscriptions (DSUB) Multi-Patient Query

12. XCPD Actors and Transactions

13. XCPD Illustration of Use (Informative) Steps 1 - 10

14. XCPD Illustration of Use (Informative) Steps 11-13

15. DSUB Overview The Document Metadata Subscription (DSUB) supplement contains two related parts Publish/Subscribe Infrastructure: General framework for defining web-services based publish/subscribe interactions Document Metadata Subscription (DSUB) Integration Profile: Use of subscriptions within an XDS Affinity Domain or across communities

16. Publish/Subscribe Infrastructure Actors and Transactions

17. DSUB Actors and Transactions

18. DSUB Illustration of Use

19. Multi-Patient Query Actors and Transactions

20. Multi-Patient Queries - New Stored Queries FindDocumentsForMultiple Patients Equivalent to FindDocuments but $XDSDocumentEntryPatientId parameter: is optional (zero values)‏ may have multiple values specified At least one of the following parameters is required: ClassCode, EventCodeList, HealthcareFacilityTypeCode More of a medical event based query than a patient based query FindFoldersForMultiplePatients Equivalent to FindFolders but $XDSFolderPatientId parameter: is optional (zero values)‏ may have multiple values specified At least one of the following parameters is required: folderCodeList More of a medical event based query than a patient based query

21. IHE IT Infrastructure Schedule for 2010 • Development Schedule: • Planning Committee decision ……… December 2009 • Issue Public Comment version …….. May 2010 • Public Comment Due ……………….. June 2010 • Issue Trial Implementation version … August 2010 • IHE Connectathon …………………… January 2011 • HIMSS Demo ………………………… February 2011

22. IHE IT Infrastructure Plan for 2010 • New Supplements For 2010 • Enhanced Sharing Value Set (Enhanced SVS) • Add supports for registering and updating value sets • Healthcare Provider Directory (HPD) • Supports healthcare provider search and feed • System Directory for Document Sharing (SDDS) • Supports directory of services used in document sharing environments • XDS Metadata Update Service • Supports update of metadata registered in a XDS Document Registry • Dynamic/Deferred Document Sharing (D3S) • Supports registration, query and retrieve of document content that is created at time of retrieval. • XUA Extension for Access Control • Extend XUA SAML assertion with authorization attributes