Consistent Time

1. IHE Integration Profiles for Health Info NetsWhat is available, has been added in 2006, planned for 2007 Patient Identifier Cross-referencing Cross-Enterprise Document Sharing Map patient identifiers across independent identification domains Imaging Information Basic Patient Privacy Consents 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 Sign, Assign, Access Control Audit Trail & Node Authentication Format of the Document Content and associated coded vocabulary Centralized privacy audit trail and node to node authentication to create a secured domain. Consistent Time Notification of Document Availability StoredQueries Notification of a remote provider/ health enterprise Coordinate time across networked systems Info Exchange Security Id Mgt Content Emergency Referrals Cross-enterprise User Authentication PHR Extracts Format of the Document Content and associated coded vocabulary Authentication & Auditing: Enhanced Access Control ECG Report Document Format of the Document Content and associated coded vocabulary V3Option Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content and associated coded vocabulary Format of the Document Content Document Digital Signature Attesting “true-copy and origin Cross-Community Access Request Formfor Data Capture External form with custom import/export scripting Cross-enterpriseDocument Interchange Media-CD/USB & e-mail push

2. PreSurgery PPHP Consent BPPC Emergency EDR Scanned Doc XDS-SD Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Doc Sharing XDS Pt-Pt DocInterchange XDR MediaInterchange XDM Document Content and Modes of Document Exchange Doc Content Profiles Doc Exchange Integration Profiles

3. Basic Patient Privacy ConsentsAbstract • The Basic Patient Privacy Consents (BPPC) profile provide mechanisms to: • Record the patient privacy consent(s), • Mark documents published to XDS with the patient privacy consent that was used to authorize the publication, • Enforce the privacy consent appropriate to the use.

4. Basic Patient Privacy ConsentsScope • Document Sources and Document Consumers in an XDS Affinity Domain • Document Sources and Document Receivers using Cross Enterprise Point-to-Point Document Sharing

5. Basic Patient Privacy ConsentsValue Proposition • an Affinity Domain can • develop privacy policies, • and implement them with role-based or other access control mechanisms supported by EHR systems. • A patient can • Be made aware of an institutions privacy policies. • Have an opportunity to selectively control access to their healthcare information.

6. Basic Patient Privacy ConsentsKey Technical Properties • Human Readable Consents • Machine Processable • Support for standards-based Role-Based Access Control

7. Basic Patient Privacy ConsentsStandards and Profiles Used • CDA Release 2.0 • XDS Scanned Documents • Document Digital Signature • Cross Enterprise Document Sharing • Cross Enterprise Point-to-Point Document Sharing

8. Basic Patient Privacy ConsentsExample • Encounter 1(Requires A) Consent A Consent B • Encounter 2(OK with B)

9. Which registry holds records for a patient ? Documents Registry Documents Registry Documents Registry RegistryLocator service Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters National Network A Long Term Care Long Term Care Long Term Care National or Regional Network B Acute Care (Inpatient) Acute Care (Inpatient) Acute Care (Inpatient) Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services Non-IHE National EHR PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) Cross-Domain Bridge IHE Transactions Cross-Domain Bridge Cross-Domain Bridge DocumentRepository DocumentRepository DocumentRepository RegistryLocator service National Network C IHE based Sub-Networks Non-IHE Sub-Net Integrated Delivery Network XDS Affinity Domain (NHIN sub-network) XDS Affinity Domain (NHIN sub-network) Federation of XDS and non-XDS DomainsLeverage Cross-Community Sharing Architecture • National or Regional Networks not required to be IHE-based • Mapping to & from IHE Transactions performed by X-Domain bridges • Mapping practical as most European projects use variants of structured document sharing

10. Which registry holds records for a patient ? Documents Registry Documents Registry Documents Registry RegistryLocator service (PIX Mgr) Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Long Term Care Long Term Care Long Term Care Regional Network A Regional Network B Regional Network C Acute Care (Inpatient) Acute Care (Inpatient) Acute Care (Inpatient) Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) Cross-Domain Bridge IHE XDS Transactions Cross-Domain Bridge Cross-Domain Bridge DocumentRepository DocumentRepository DocumentRepository Federation of XDS and non-XDS DomainsLeverage Cross-Community Sharing Architecture • IHE White Paper on Cross-Community Federation. Hierarchical Federation shown here. • Cross-Community Bridge (may be grouped with Domain XDS Registry) spawns queries (security) to other XDS doc registries (based on x-ref patient id-domains. • Registry Locator is PIX Mgr.

11. 2007 Work Plan – IT Infrastructure • Web Services Transport for XDS - step 2: • Next step after WS for Stored Query (2006) • Move Provide & Register, Register and Retrieve Transactions from SOAP 1.1 to SOAP 1.2/MTOM/XOP per WS-I • XDS Federation: Cross- Community Access • Builds upon Federation White Paper; does not assume hierarchical federation • PIX and PDQ using HL7 v3/Web Services • XUA – Cross-Enterprise User Authentication • Profiles SAML, • Risk Management White Paper • WS Roadmap • Configuration Mgt White Paper (Enterprise & X-enterprise). • Aggregate Data White Paper • Monitoring (Notifications) for Public Health Surveillance, Quality Mgt, Clinical Research in an XDS Affinity Domain. Public Comments June 2007 – Trial Implementation August 2007

12. 2008-2009 Work Plan – IT Infrastructure • Web Services and SOA for Healthcare - step 3: • Broader effort (to be launched in March 2007). • XDS Federation: Cross-Community Location • Builds upon Federation White Paper and X-Community Access • Aggregate Data Monitoring • Monitoring (Rules & Notifications) for Public Health Surveillance, Quality Mgt, Clinical Research in an XDS Affinity Domain. • XDS Affinity Domains Configuration • X-Enterprise Ordering & Scheduling (in Conjunction with Patient Care Coordination) Planning Decisions October-December 2007