IHE Overview of Cross Enterprise Document sharing XDS and related profiles

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IHE Overview of Cross Enterprise Document sharing
(XDS) and related profiles

• HIMSS Interoperability Showcase May 17, 2007
• Didi Davis, Director, IHE

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A Framework for Interoperability

• Integrating the Healthcare Enterprise
• An initiative that improves patient care by
  harmonizing healthcare information exchange
• Provides a common standards-based framework for
  seamlessly passing health information among care
  providers, enabling local, regional and national
  health information networks
• Promotes the coordinated use of established
  standardsHealth Level 7, ASTM, DICOM, CDISC,
  W3C, IEEE, etc.to address specific clinical
  needs

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IHE - Connecting standards to care

• Care providers and IT professionals work with
  vendors to coordinate the implementation of
  standards to meet their needs
• Care providers identify the key interoperability
  problems they face
• Drive industry to develop and make available
  standards-based solutions
• Implementers follow common guidelines in
  purchasing and integrating systems that deliver
  these solutions

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Sharing and Accessing Electronic Health Records

• IHE offers interoperability for local, regional,
  specific, or national health information exchange
• Goal is to enable exchange between providers
  clinical and administrative systems and ancillary
  IT systems (EHRs,Lab, Pharma, Payers, etc.) and
  personal health record systems.
• Objective is to empower the consumers in having
  shared EHR information between all of its
  potential healthcare providers (if authorized)
  and self.
• Objective is to empower the providers in choosing
  when and what information to share, and to trust
  the information they may use in the care of their
  patients.

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Categories of Healthcare Communication Services
HIEs and RHIOs
Hospitals
Patient and Provider ID Mgt
e.g. access to last 6 months historical labs and
encounter summaries
e.g. order a lab test, track status and receive
results
e.g. get a current list of allergies or med list
from a source
Security
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
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Introduced at HIMSS in 2005 IHE-XDS
Community or sub-network
Repository ofDocuments
Repository ofDocuments
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Introduced at HIMSS in 2005 IHE-XDS
Community or sub-network
Repository ofDocuments
Repository ofDocuments
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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 (health records). Complements to
  interactive workflow or dynamic access to data.

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Cross-Enterprise Document Sharing (XDS)
Standards Used
HealthcareContent Standards HL7 CDA, CEN
EHRcomHL7, ASTM CCRDICOM
Internet Standards HTML, HTTP,ISO, PDF, JPEG
Electronic BusinessStandards ebXML Registry,
SOAP, Web Services

• Implemented world-wide by more than 50
  vendors/open source. Final text published
  December 2006.
• Adopted in several national regional projects
  (Italy, France, Canada, Austria, USA, Japan,
  Netherlands, Sweden, etc.)
• IHE XDS 42,300 Google references (Feb 07)

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Cross-Enterprise Document Sharing (XDS)
Standards Used

• Two categories of standards used

XDS Doc Content
XDS Infrastructure (Document sources,
consumers,registries, repostories)
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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.

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XDS Scenario use of ATNA CT
PMS
XDS Document Registry
Register Document
Query Document
Secured Messaging
Retrieve Document
Provide Register Docs
Maintain Time
Maintain Time
Record Audit Event
Maintain Time
Record Audit Event
Record Audit Event
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XDS Scenario use of PIX PDQ
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
Register (using Pt ID)
Query Document (using Pt Id)
Provide Register Docs
Retrieve Document
PACS
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IHE-XDS is part of a family of profiles

• Regional, national, local or disease centric
  networks need a consistent set of Integration
  Profiles
• Eight Integration Profiles completed and tested,
  plus ten ready to implement Standards-based
  interoperability building blocks for
• Rich Document Content for end-to-end application
  interoperability.
• Patient identification management
• Security and privacy
• Notification and data capture

IHE-XDS related IHE Integration profiles
provide a complete interoperability solution
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IHE Integration Profiles for Health Info Nets
What is available and is added in 2006-2007
Clinical and PHR Content
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content and associated
coded vocabulary
ECG Report Document
Format of the Document Content and associated
coded vocabulary
Lab Results Document Content
Format of the Document Content and associated
coded vocabulary
Scanned Documents
Format of the Document Content and associated
coded vocabulary
Imaging Information
Format of the Document Content
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Content and associated
coded vocabulary
Format of the Document Content and associated
coded vocabulary
Health Data Exchange
Cross-Enterprise Document Sharing
Registration, distribution and access across
health enterprises of clinical documents forming
a patient electronic health record
Final Text Approved
Trial Implementation-2006 Final Txt 2007
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Cross-Enterprise Document Sharing (XDS)
Standards Used

• Two categories of standards used

XDS Doc Content
XDS Infrastructure (Document sources,
consumers,registries, repostories)
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Combining IHE ProfilesDocument Content Modes
of Document Exchange
Doc Content Profiles (Semantics content)
Scanned Doc XDS-SD
Consent BPPC
Emergency EDR
Pre-Surgery PPHP
PHR Exchange XPHR
Discharge Referrals XDS-MS
Imaging XDS-I
Laboratory XD-Lab
Document Exchange Integration Profiles
Document SharingXDS
MediaInterchange XDM
Reliable Pt-PtInterchange XDR
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XDS-MS Medical Summary or PHR Extract
ExchangeProfile based on HL7 CDA Rel 2 and
ASTM/HL7 CCD


Level 1
Structured and Coded Header


Patient, A
uthor, Authenticator, Institution,
Header always structured and coded


Time of Service, etc.



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Reason for Referral

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Vital Signs


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Level 3
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Allergies have a


fine-grain structure with
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Social History

Scheme explicitly identified.




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XDS-MS and XPHR enable both semantic
interoperability simple viewing !




Care Plan

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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 !
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HIMSS RHIO Network of networksThe largest
multi-vendor RHIO Prototype ever built !
3 infrastructure systems
18 edge systems4 infrastructure systems
13 edge systems3 infrastructure systems
5 edge systems 4 infrastructure systems
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IHE, the only sets of harmonized global standards
already adopted by several national regional
projects
Italy (Conto Corrente Salute)
UK CfH (Radiology WF)
Denmark (Funen) Italy (Veneto) Spain (Aragon)
FranceDMP
Quebec, Toronto,Alberta, British ColumbiaCanada
Infoway
Austria
MA-Share MA
State Project NY
Philadelphia HIE
JAPAN-Nogaya Imaging Info Sharing
THINC- New York NCHICA N. Carolina
CHINA-MoH Lab results sharing
CHINA-Shangai Imaging Info Sharing
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How can I participate?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

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IHE Web site www.IHE.net

• Frequently Asked Questions
• Integration Profiles in Technical Frameworks
  See Volume 1 of each TF for Use cases
• Cardiology
• Eye Care
• IT Infrastructure
• Laboratory
• Patient Care Coordination
• Radiation Oncology
• Radiology
• Connectathon Result www.ihe.net/Events/connectath
  on_results.cfm
• Vendor Products Integration Statements
• Participation in Committees Connectathons

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