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 HIEs and RHIOs Hospitals Patient and Provider Identity Management e.g. access to last 6 months historical labs and encounter summaries e.g. get a current list of allergies or med list from a source e.g. order a lab test, track status and receive results Security/Privacy 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 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

6. ITI Profiles (continued) Identify Management 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) ☼ 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) ☼ Personnel White Pages (PWP) Document Digital Signature (DSG) ▀ colored text designates 2009 new profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

7. Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Document Content and Modes of Document Exchange Doc Content Profiles PreSurgery PPH P Consent BPPC Emergency EDR Scanned Doc XDS-SD 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 NEW YORK ILLINOIS Document Registry Document Registry Practice Practice Hospitals Practice Hospitals Practice Practice Hospitals Gateway Gateway Practice Hospitals Hospital Practice Practice Hospitals Hospital Practice Hospitals Hospital Patient ID services Patient ID services Clinic Clinic Clinic Repository Clinic Clinic Repository Clinic Repository Repository Gateway CALIFORNIA Document Registry Practice Practice Hospitals Practice Hospitals Practice Hospitals Hospital Practice Hospital Hospital Patient ID services Clinic Clinic Clinic Repository Clinic Repository IHE transactions NORTH CAROLINA Document Registry Gateway Practice Practice Hospitals Practice Hospitals Hospitals Patient ID services Clinic Repository

11. XCPD Actors and Transactions

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

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

14. 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

15. Publish/Subscribe Infrastructure Actors and Transactions

16. DSUB Actors and Transactions

17. DSUB Illustration of Use

18. Multi-Patient Query Actors and Transactions

19. 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

20. 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

21. 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

22. BACKUP What follows is content from the 2009 ITI Update version and kept for reference in case someone thinks the content is still necessary Will be removed from the final version

23. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution Patients have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations Addresses the need for a longitudinal healthcare data and its intend is for support of archival data. It does not address workflow or dynamic data access. Meets both the needs of point-to-point push communication and on-demand pull in a variety of centralized or distributed architectures. Workflows addressed in a second step in a much simpler manner.Point-to-Point messages best suited for workflows mgt

24. Cross Community Access (XCA) Sharing of documents across communities Re-use of XDS.b transactions. Document Consumer consistency Requirements of Document Consumer are the same as for local document query and retrieval Out of scope: How to identify which communities to interact with How to identify the patient id to use when interacting

25. Cross Community AccessActors and Transactions Initiating Gateway On behalf of internal actors, initiates all transactions leaving the community Receives Registry Stored Query and Retrieve Document Set from Document Consumer Propagates transaction to local Document Registry and Repository, if appropriate Propagates transaction to other communities by contacting their Responding Gateway and sending: Cross Gateway Query and Cross Gateway Retrieve Responding Gateway Single contact point for all transactions coming in to the community. Propagates incoming transactions to local actors New Transactions: Cross Gateway Query: from Initiating Gateway to Receiving Gateway, mimics Registry Stored Query Cross Gateway Retrieve: from Initiating Gateway to Receiving Gateway, mimics Retrieve Document Set Document Consumer Supports Registry Stored query and Retrieve Document Set New requirement: propagation of the homeCommunityId requirement Applies to XDS.a, XDS.b and XCA profiles

26. XCA Process Flow RSQ – Registry Stored Query XGQ – Cross Gateway Query RDS – Retrieve Document Set XGR – Cross Gateway Retrieve Community B Responding Gateway RSQ XDS Registry XGQ Community A Initiating Gateway RSQ RDS XDS Registry XDS Repository XDS Repository RSQ Community C RDS XGQ Responding Gateway RSQ XDS Registry XGR Document Consumer RDS XDS Repository

27. Basic Patient Privacy Consents BPPC XDS Affinity domain defines a small number of appropriate use policies Each document is labeled with the appropriate use policy Edge systems are configured to enforce these use policies Supports: Opt-In, Opt-Out, emergency data set, research use allowed, de-identified data, direct care providers, etc Supports emergency override use case Does not support patient directed exceptions

28. Cross-Enterprise User Assertion XUA Supporting Centralized and Federated Identity Management Conveys the user’s trusted identity to the HIE infrastructure systems Example: provides consumer’s identity from a PHR system to HIE infrastructure systems Constrained to IHE XDS.b Uses OASIS SAML 2.0 Identity Assertions