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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. XDS Cross-Enterprise Document Sharing Integration Profile Standards &Transactions & Implementation Bill Majurski – NIST IHE IT Infrastructure Technical Committee. Introduction. Registry Standard Things XDS adds to the Registry Standard

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise XDS Cross-Enterprise Document Sharing Integration Profile Standards &Transactions & Implementation Bill Majurski – NIST IHE IT Infrastructure Technical Committee IHE Interoperability Worshop

  2. Introduction • Registry Standard • Things XDS adds to the Registry Standard • Structure of Actors and Transactions • Implementation • High-level focus – minimal XML IHE Interoperability Worshop

  3. Registry Standard • ebXML Registry • OASIS Standard • OASIS (Organization for the Advancement of Structured Information Standards) is a not-for-profit, international consortium that drives the development, convergence, and adoption of e-business standards • http://www.oasis-open.org • Adopted by ISO • Specifically a Document Registry • Focus on business documents IHE Interoperability Worshop

  4. ebXML Registry Component Standards • ebRIM – Registry Information Model • Metadata • Data about documents • Defines basis for searches • ebRS – Registry Services • Interfaces • Protocols • Actions/verbs • Query language IHE Interoperability Worshop

  5. ebXML Registry defines Integrated Registry & Repository • Registry holds Metadata • Repository holds Documents IHE Interoperability Worshop

  6. Metadata Building Blocks Large collection of small objects • Document (ExtrinsicObject) • Association – Link between two objects • External Link – URI – link to web resource • Classification Scheme – Taxonomies • Classification – Link to term in taxonomy • RegistryPackage – Bundle of objects IHE Interoperability Worshop

  7. Common Registry Object Attributes • Id – object identifier (UUID) • Name – label only – not used in identification • Description – free text • objectType • Status – submitted/approved/deprecated… • Slots – name/value pairs • External Identifiers – primary search indexes IHE Interoperability Worshop

  8. Common Registry Object Attribute Size Limitations • Name – 128 chars • Description – 256 chars • Slots • name – 128 chars • value – 128 chars • External Identifiers – 64 chars • External Link (URI) – 256 chars IHE Interoperability Worshop

  9. General Document Registry Operations • Submit metadata and documents • Update metadata and documents • Query metadata • Retrieve Documents IHE Interoperability Worshop

  10. How does XDS relate to ebXML Registry? • Applies • Constrains • Extends • Reconfigures • Integrates IHE Interoperability Worshop

  11. ebXML Registry -> XDS • Reconfigures: • Registry and repository as separate actors • Benefits: • Repository may already be part of another product/system. • Common registry for many repositories IHE Interoperability Worshop

  12. ebXML Registry -> XDS • Constrains: • Metadata design • Benefits: • Establishes mandatory metadata • Relevant to medical documents • Restriction on how documents may relate • Defines reasonable space for queries IHE Interoperability Worshop

  13. ebXML Registry -> XDS • Extends: • Metadata submission to registry guaranteed atomic • Benefits: • Simpler registry client • Well defined responsibilities IHE Interoperability Worshop

  14. ebXML Registry -> XDS • Integrates: • With other IHE profiles • Benefits: • Integrate once – at specification level IHE Interoperability Worshop

  15. ebXML Registry -> XDS • Extends: • By introducing the Submission Set (record of what was submitted together) • Benefits: • Related by medical event, parameters of the submission, support for transactions IHE Interoperability Worshop

  16. ebXML Registry -> XDS • Extends: • By introducing the Folder with constraints on its contents • Benefits: • Restricted content, standard parameters IHE Interoperability Worshop

  17. ebXML Registry -> XDS • Extends: • By introducing new terminology • Benefits: • Terms now exist to describe subtle issues in standard • New terms to describe how XDS deploys and integrates ebXML Registry IHE Interoperability Worshop

  18. New Terms • XDS Document • XDS Repository Submission Request • XDS Registry Submission Request • XDS Submission Set • XDS Folder • XDS Registry Adaptor Function IHE Interoperability Worshop

  19. What does XDS Not Change? • Messages – all messages conform to standard • Protocols - unchanged • Information Model – restricted but unaltered IHE Interoperability Worshop

  20. XDS Actors Patient Identity Source Document Registry Document Consumer Document Source Document Repository IHE Interoperability Worshop

  21. XDS Actors and Transactions Patient Identity Source Patient Identity Feed Query Registry Document Registry Document Consumer Register Document Set Provide & Register Document Set Retrieve Document Document Source Document Repository IHE Interoperability Worshop

  22. Document Source Actor Transactions • Provide & Register Document Set IHE Interoperability Worshop

  23. Provide & Register Document Set Transaction • Document Source has responsibility for generating metadata • Send Repository Submission Request containing metadata and documents to repository • Status returned IHE Interoperability Worshop

  24. Repository Submission Request Repository Submission Request Metadata Submission Set Document 1 Document 2 IHE Interoperability Worshop

  25. Document Repository Actor Patient Identity Source Patient Identity Feed Query Registry Document Registry Document Consumer Register Document Set Provide & Register Document Set Retrieve Document Document Source Document Repository IHE Interoperability Worshop

  26. Document Repository Actor Transactions • Provide & Register Document Set • Register Document Set • Retrieve Document IHE Interoperability Worshop

  27. Provide & Register Document Set Transaction • Documents stored in repository • Knows location of the cross-enterprise registry • Invoke Register Document Set Transaction • Success means documents accepted by repository and metadata accepted by registry IHE Interoperability Worshop

  28. Register Document Set Transaction • Compute • Document address (URI) within repository • Document size • Document hash • Metadata amended to include URI, size, hash • Reject submission if document ID already present in repository with different size/hash (optional) • Passes metadata to registry IHE Interoperability Worshop

  29. Retrieve Document Transaction • Documents retrievable via HTTP GET request • Uses URI generated by Document Repository in Register Document Set Transaction • Exact byte stream is returned IHE Interoperability Worshop

  30. Document Consumer Actor Patient Identity Source Patient Identity Feed Query Registry Document Registry Document Consumer Register Document Set Provide & Register Document Set Retrieve Document Document Source Document Repository IHE Interoperability Worshop

  31. Document Consumer Actor Transactions • Query Registry • Retrieve Document IHE Interoperability Worshop

  32. Query Registry Transaction • SQL query language • ebRIM defines information model for queries • ebRIM defines subset of SQL that applies • Return is by reference or by value IHE Interoperability Worshop

  33. Simple SQL Query Select all documents for patient ID 12345.34.259373 SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID WHERE doc.objectType=XDSDocumentEntry AND patID.identificationScheme=XDSPatientID AND patID.registryObject=doc.id AND patID.value=‘12345.34.259373’ AND doc.status=‘Approved’ XDSDocumentEntry and XDSPatientID are coded as UUIDs IHE Interoperability Worshop

  34. XDSQueryKeys Doc-level IHE Interoperability Worshop

  35. Retrieve Document Transaction • Query Registry Transaction • Can return metadata including document URI • Retrieve Document via HTTP GET • Returns exact byte stream that was delivered to Repository in Provide & Register Document Set Transaction • Not related to IHE RID Profile IHE Interoperability Worshop

  36. Document Registry Actor Patient Identity Source Patient Identity Feed Query Registry Document Registry Document Consumer Register Document Set Provide & Register Document Set Retrieve Document Document Source Document Repository IHE Interoperability Worshop

  37. XDS Registry Actor Structure Document Registry Actor Registry Adaptor Function ebXML Registry Function ebXML Registry DocumentRepository Actor IHE Interoperability Worshop

  38. Document Registry Actor Transactions • Register Document Set • Query Registry • Patient Identity Feed IHE Interoperability Worshop

  39. Register Document Set Transaction • Receives metadata from Repository Actor • Validates metadata • Stores metadata in registry as atomic operation IHE Interoperability Worshop

  40. Registry Submission Request Registry Submission Request Metadata Submission Set IHE Interoperability Worshop

  41. Document Availability Management SubmittedRegistration in progress ApprovedAvailable for Patient Care Availability Status Visible to a Document Source Availability Status Visible to a Document Consumer Deprecated Obsolete Deleted Registry Status attribute: Life Cycle Status indicator IHE Interoperability Worshop

  42. Registry Adaptor Function Validate Metadata • Valid patient ID • Required attributes • Valid coded values IHE Interoperability Worshop

  43. Registry Adaptor Function (Cont) Validate Metadata (Cont) • Submission Set semantics • Example – all new documents for same patient • Folder semantics • Example – all documents for same patient Document Resubmission • Implement resubmission semantics IHE Interoperability Worshop

  44. Registry Adaptor Function (Cont) XDS Submission is atomic • ebXML Registry submission is not • Use Status Attribute as control • Submitted – submission in progress • Approved – submission complete - available to query IHE Interoperability Worshop

  45. Registry Adaptor Function (Cont) Use two registry operations to store metadata • Submit – store data, set status to submitted • Approve – change status to Approved IHE Interoperability Worshop

  46. Query Registry Transaction • Process SQL query against registry contents • Return list of • Objects formatted in XML • Object references • Remember to search for Approved objects IHE Interoperability Worshop

  47. Simple SQL Query Select all documents for patient ID 12345.34.259373 SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID WHERE doc.objectType=XDSDocumentEntry AND patID.identificationScheme=XDSPatientID AND patID.registryObject=doc.id AND patID.value=‘12345.34.259373’ AND doc.status=‘Approved’ XDSDocumentEntry and XDSPatientID are coded as UUIDs IHE Interoperability Worshop

  48. Patient Identity Feed Transaction • Notification on • Patient registration • Updated Patient Information • From Patient Identity Source (ADT) • Registry Adaptor Function maintains list of valid patient IDs IHE Interoperability Worshop

  49. Primary XDS Concepts • Submission Request • Submission Set • Document • Folder • Document Life Cycle Management IHE Interoperability Worshop

  50. Submission Requests Patient Identity Source Document Registry Document Consumer Registry Submission Request Repository Submission Request Document Source Document Repository IHE Interoperability Worshop

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