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Overview of XDS and Related Profiles

Overview of XDS and Related Profiles. IHE Vendors Workshop 2006 IHE Cardiology Education John Donnelly, IntePro Solutions [co-chair PCC Plng Cmmte] (Contributing authors Didi Davis, Glenn Marshall, Charles Parisot). Agenda. XDS as Information Exchange Foundation

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Overview of XDS and Related Profiles

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  1. Overview of XDS and Related Profiles IHE Vendors Workshop 2006 IHE Cardiology Education John Donnelly, IntePro Solutions [co-chair PCC Plng Cmmte] (Contributing authors Didi Davis, Glenn Marshall, Charles Parisot)

  2. Agenda • XDS as Information Exchange Foundation • XDS Demonstration Scenarios and Related Profiles • XDS-I Actors and Transaction Option • Cross-Enterprise Document Point-to-Point Interchange (XDP) • Leveraging XDS in IHE Cardio

  3. Why is IHE-XDS a breakthrough ? • Based on International Standards; ebXML registry: OASIS and ISO standard-15000, Web Service/Soap/XML. • Sharing of digital documents as “attested by the source”, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Message feeding a central web server hinders use of EHRs). • Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured. • Meets both the needs of point-to-point push communication and on-demand pull in a variety of centralized or distributed architectures. Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems

  4. Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … • Implemented world-wide by more than 30 vendors/open source. Final text published August 2005. • Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, etc.) • IHE XDS : 15800 “Google” references (Jan’ 06) Electronic BusinessStandards ebXML Registry, SOAP … Internet Standards HTML, HTTP,ISO, PDF, JPEG …

  5. Medical Summaries (HL7 CDA/CRS+V3) • Imaging (DICOM) • ECG Reports (PDF+) • Lab, nursing, etc. Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used XDS Doc Content XDS Infrastructure (Document sources, consumers,registries, repostories)

  6. An Infrastructure Component Is… • An infrastructure 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

  7. IHE IT Infrastructure Profiles • EHR Profiles (2003-2005) • Retrieve Information for Display (RID) • Patient Identifier Cross-Referencing (PIX) • Patient Synchronized Applications (PSA) • Cross-Enterprise Document Sharing (XDS) • Patient Demographics Query (PDQ) • Notification of Document Availability (NAV) • Patient Administration Management (PAM) • Security & Privacy Profiles (2003-2005) • Enterprise User Authentication (EUA) • Consistent Time (CT) • Audit Trail and Node Authentication (ATNA) • Personnel White Pages (PWP) • Cross-Enterprise User Authentication (XUA) • Document Digital Signature (DSG)

  8. 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.

  9. IHE Patient Care Coordination Profiles • Content Integration Profiles (2005) • Medical Summaries (XDS-MS) • PCP to Specialist Referral • Acute Care Discharge (to PCP) • Unstructured Document Exchange (XDS-pdf) • Content Integration Profiles (in-progress 2006) • Medical Summaries (XDS-MS) • PCP to ED Referral • Pre-procedure History & Physical (PPHP) • Exchange of Personal Health Record (XPHR) • Basic Patient Privacy Consents (BPPC) • Sharing of Lab Reports (XDS-LAB)

  10. IHE Radiology • Cross Enterprise Sharing of Imaging Information (XDS-I) Options (at least one): • Extensive Set of DICOM Instances • PDF Report • Text Report • Multipart Text/PDF Report

  11. XDS Demonstration Scenarios and Related Profiles

  12. 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 XDS Affinity Domain (NHIN sub-network) XDS Scenario + use of ATNA & CTShowcased at HIMSS 2006 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

  13. 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 XDS Affinity Domain (NHIN sub-network) XDS Scenario + use of PIX & PDQ Showcased at HIMSS 2006 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

  14. X-Enterprise Sharing of Medical Summaries XDS-MS Showcased at HIMSS 2006 Patient Examination or Discharge Discharge or Referral Document Created Referred Physician Notification Document Registry EMR EMR Review ofMedical Summary Report Repository MedicalSummary The Cross-Enterprise Sharing of Medical Summaries Integration Profile solves the problem of transferring summary patient information between providers in different clinical settings.

  15. PCC Technical Framework • Reuse of ITI Profiles • ITI Cross Enterprise Document Sharing (XDS) • ITI Cross Enterprise Point-to-Point Sharing (XDP) • New Actors / Transactions • None Yet, but… • Content Integration Profiles • XDS Medical Summaries • Bindings • Binds Content to IHE Transactions • Medical Document to XDS • Medical Document to XDP • Declared in Integration Statements • Options • Some options defined for XDS, XDP

  16. Content Integration Profiles • Content using a Specific Standard • CDA Release 2.0 • HL7 Care Record Summary • ASTM/HL7 Continuity of Care Document • Others as Needed (e.g., ASTM CCR, DICOM …) • Library of Reusable Parts • Document Types • Sections • Entries

  17. Content Integration Profiles 2005-2006 XDS-MS 2006-2007 MedicalDocuments PPHP BCCP MedicalSummaries History andPhysical Consent EDR XPHR Referral DischargeSummary EmergencyDepartmentReferral PHR Extract PreprocedureHistory andPhysical XDS-LAB PHR Update Lab Report

  18. Level 3 Text Structure Med, Problems and Allergies Entry required as highly structured Coded Section Coded Section Coded Section text. Text easy to import/parse Entry Entry Entry Level 3 Text Structure Entry Med Problems a nd Allergies have a required fine - grain structure with optional coding. Coding Scheme not standardized, Text Structure but explicitly identified. Entry XDS-MS Medical Summary Level 1 Structured and Coded Header Patient, A uthor, Authenticator, Institution, Header always structured and coded Time of Service, etc. Level 2 S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : S t r u c t u r e d C o n t e n t w i t h c o d e d s e c t i o n s : Title - coded sections with non - structured · Reason for Referral nor coded content (text, lists, tables). · · Vital Signs  Simple Viewing (XML Style sheet) · · M e d i c a t i o n M e d i c a t i o n · Studies · · A l l e r g i e s A l l e r g i e s · Social History · · P r o b l e m s P r o b l e m s XDS-MS enables both semantical interoperability and simple viewing ! · Care Plan

  19. Medical Summary Rendered with XSLT

  20. XDS-I Actors and Transaction Options Contributing author: Rita Noumeir (Softmedical)

  21. Use of a shared XDS infrastructure to access Radiology Reports and Images (XDS-I) Between Radiology and : • Imaging specialists • Non-imaging clinicians Hospital PACS Y Radiology -to-Radiology Radiology -to-Physicians PACS Z Imaging Center Physician Practice Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !

  22. XDS-I Dependencies • XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS) • Same Actors as in XDS • Document Source • Document Consumer • Document Registry • Document Repository • Added extension to support imaging data (images and reports)

  23. XDS-I Actors and Transactions Patient Identity Source Patient Identity Feed Query Document Documents Document Consumer Registry Register Document Set Retrieve Provide & Register Document Document Set Document Document Repository Source Retrieve Images Image Manager Image Archive Retrieve Presentation States Retrieve Key Image Note Retrieve Evidence Documents WADO Retrieve

  24. Sharing of Report • The shared Report Document format is • PDF, Text, or multipart PDF + Text • A report can • embed selected images in its PDF format • include fully resolved hyperlinks (interactively clickable) that point to the selected images • Document Source is responsible • for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document • Document Source is required • to ensure that image references are valid links

  25. XDS-I Actors / Grouping • Sharing of an Extensive DICOM set • Document Source shall be grouped with an Image Manager/Image Archive • Sharing of a report that references selected images • Document Source shall be grouped with an Image Manager/Image Archive • Sharing of a report that references selected images from previously published extensive DICOM set • Document Source can be grouped with a Document Consumer

  26. SubmissionSet DocumentEntry DocumentEntry Study Manifest Report Linking Report to Complete Set of Images Document Registry Document Repository

  27. SubmissionSet 1 SubmissionSet 2 DocumentEntry Report Study Manifest Linking Report to Complete Set of Images Document Registry DocumentEntry Document Repository

  28. SubmissionSet 3 SubmissionSet 1 SubmissionSet 2 SubmissionSet 4 DocumentEntry DocumentEntry DocumentEntry Prior Study Manifest Prior Report Report Study Manifest Linking Report to Prior Images and Prior Report Document Registry DocumentEntry Document Repository

  29. BPD ... ….. Linking Report to Selected Images Radiology Report Header: Report Type: OB / Gyn ….. Findings: Gestational WADO URI Link to image Age ... Relevant Image Radiology system Report Source

  30. XDS-I Metadata • Radiology specific (currently) • Acquisition Modality (e.g. CT, MR) • Anatomic Region (e.g. Arm, Elbow, Hand) • Requested procedure (e.g. MRI Knee with contrast) • Query example • find all “CT of the Head” of patient John Doe for the last 2 years

  31. Cross-Enterprise Document Point-to-Point Interchange (XDP) Contributing authors: David HEANEY (McKesson), Emmanuel CORDONNIER (ETIAM)

  32. Consulting to referring physicians Specialist, Radio or Lab GP / PCP Doctor A Remote advice Hospital-doctor communication Patient Transfer Personal Health Record (PHR)to ED/Primary Care EMR Acute Care Dischargeto Extended Care Facility (ECF) Hospital Acute Care / ED Care Facility XDPUses Cases

  33. XDP Value proposition • Complementary to sharing documents (XDS), point-to-point communication of documents • Both transports: secured mail & media (CD…) • As XDS, “document content agnostic” • Maximal re-use of XDS objects & meta-data • Compatible with exchange of images (PDI…) • All XDS “content profiles” apply

  34. XDP Key Technical Properties • Re-uses XDS approach for documents • SubmissionSet, DocumentEntry • ebRS based XML meta-data w. limited extensions • Secure e-mail (ebMS over SMTP, S/MIME) • Optional on-line protocol (similar to XDS) • PDI like media profile with XDS meta-data • Potential association of XDS and PDI at the actor level (Document Source…) • Further evolution possible for direct interchange over web services (MTOM…)

  35. XDP Actor Diagram Send Document Set [ITI-32]  Document Source Document Recipient Portable Media Creator Distribute Document Set on Media [ITI-33]  Portable Media Importer

  36. XDP Actors and Transactions

  37. Protocol encapsulation in SMTP/ESMTP SOAP with MIME attachments (multipart/related) text/xml SOAP:Envelope SOAP:Header, with Service=LifeCycleManager and Action=submitObjects Part1 (start) SOAP:Body, with Manifest=list of attachments (e.g. ebXML Reg. Msg + Documents) Part2 text/xml SubmitObjectRequest (ebXML Registry Message) Part3 Document 1 .. . Part n+2 Document n XDP off-line message

  38. XDP Actors and Options Note 1: At least one of these options is required for each Actor.

  39. XDP Integration Profile Options • Multiple Documents Submission Option • Offers the ability to include multiple documents in a single Submission Request • On-Line Mode Option • Offers the ability to send the set of documents to one unique recipient, using a HTTP web-service based on-line transmission mode. • USB Option • Portable Media Creator writes a set of documents on USB media • CD-R Option • Portable Media Creator writes a set of documents on CD-R media.

  40. Leveraging XDS in IHE Cardio

  41. IHE Integration Profiles for Health Info NetsWhat is available and has been added in 2005 and is for 2006 Lab Results Document Content ECG Report Document Patient Created Summaries Emergency Referrals Scanned Documents Cross-enterprise User Authentication Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content and associated coded vocabulary Format of the Document Content Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Authentication & Auditing: Enhanced Access Control Cross-Enterprise Document Sharing V3Option Map patient identifiers across independent identification domains Imaging Information Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Demographics Query Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Request Formfor Data Capture Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting StoredQueries XDS/RLSFederation Consistent Time Notification of Document Availability Cross-enterpriseDocument Interchange Notification of a remote provider/ health enterprise Coordinate time across networked systems Media-CD/USB & e-mail push

  42. How can XDS/XDP help Cardio? • Provides IT Infrastructure Framework for Inter-Facility Cardiovascular Information Exchange • Patient ID Reconciliation • Secure System Identification • Integration Profiles for Carrying CV Document Content • Provides Conduit to Participation in Regional Health Information Networks • Provides Framework for Capture and Distribution of ACC Regency Data • Retrieve Form for Data Entry (RFD) • Medical Summaries and Other Content Profiles for Clinical Research, Public Health Data, etc

  43. How can Cardio help XDS/XDP? • Provide Use Cases for Development of Content Integration Profiles for Cardiovascular Services (jointly with PCC Domain) • Review and Provide Feedback on Technical Framework Documents in ITI and PCC domains to Reflect CV Requirements • “Bind” IHE Cardio with XDS Actor Functionality in Own Product Offering or with Business Partners • Include XDS/XDP as Integral Part of Interoperability Showcases at CV Venues (ACC, ASE, etc)

  44. IHE Web site: http://www.ihe.net http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm Technical Frameworks Technical Framework Supplements – Trial Implementation 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 More information…. Questions?

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