IHE Radiology –2007What IHE Delivers 1 Christoph Dickmann IHE Technical Committee March 2007 Cross Domain Review PCC

IHE Cross-Domain Review 2 PCC - overview

IHE Cross-Domain Review 3 Domains used in PCC IT Infrastructure  XDS, XDM, XDR,  NAV,  ATNA, CT  XDS-SD

IHE Cross-Domain Review 4 IHE PCC Integration Profile Cross-enterprise Sharing of Medical Summaries (XDS-MS) Cross-enterprise Sharing of Medical Summaries Defines a summary of patient data in narrative and/ or structured way that is used when transferring the patient from one care provider to another one for - general / specific audience - focused / broader range of patient problems.

IHE Cross-Domain Review 5 XDS-MS Features An XDS content profile  Uses & constraints the CDA R2 Care Record Summary (CRS) implementation guide  Render CDA R2 for viewing & printing consistently  Options to ITI XD* actors: Source side –referral/ discharge summary content –support coded entries beyond XDS-MS defined codes Consumer side –view/ print document (incl. linked documents) –import document, sections or individual entries  Defines 61 specific IHE CDA modules/ templates  Defines 11 specific IHE Act codes Features similar to Radiology  XDS metadata  CDA content modules – similar to DICOM SR templates Narrative text Coded text – mainly LOINC and HL7 codes

IHE Cross-Domain Review 6 IHE PCC Integration Profile Basic Patient Privacy Consents (BPPC) - TI Basic Patient Privacy Consents Defines a mechanism to create and enforce patient consent policies for disclosing shared documents, including the necessary data to be used in documents that carry consent information

IHE Cross-Domain Review 7 BPPC Features An XD* content profile that adds options  Privacy Option for XDS Source, Consumer, Registry  Privacy Option for XDR Source and Consumer  Privacy Option for XDM Media Creator and Importer  Uniquely identifiable privacy policy that can be referenced from shared documents  Consents can be: Scanned paper document (“wet signature”  XDS-SD) CDA consent document that is digitally signed Implied and not documented in the shared document Explicit and documented/ referenced in the shared document  Specific CDA template (specific template ID)  CDA confidentiality code references the privacy policy OID (configuration issue) Document Source sets the value appropriately for all documents XDS Registry checks the validity of the code, and does code matching for queries Doc. Consumer may include confidentiality code in queries, uses policy decision logic Features similar to Radiology  XDS metadata  HL7 CDA and PDF documents

IHE Cross-Domain Review 8 IHE PCC Integration Profile Emergency Department Referral (EDR) - TI Emergency Department Referral Defines a referral document that provides summarizing information on a patient’s past medical problems, allergies, medications or assessment plan to the ED physician

IHE Cross-Domain Review 9 EDR Features An XD* content profile  Defines 4 CDA section templates for CDA body  Re-uses 3 section templates from XDS-MS Features similar to Radiology  Content in the referral similar to DICOM Patient Medical Module Note: I think the documentation is difficult to navigate and read ( document > section > entry definitions are separate in TF-2 )

IHE Cross-Domain Review 10 IHE PCC Integration Profile Exchange of Personal Health Record Content (XPHR) Exchange of Personal Health Record Content Defines summary information extracted from a PHR system used by a patient for import into healthcare provider information systems, and visa versa. PHR information typically used is address, telephone numbers, birth date, sex, marital status, emergency contacts, insurance information, a medical and family history, and current medications and allergies.

IHE Cross-Domain Review 11 XPHR Features An XD* content profile  Create / update PHR extracts (incl. functional requirement to add/ replace/ remove sections/ entries)  Import document/ section/ entry – equal to XDS-MS  View individually or consistently a PHR document  Use of DSG is recommended (option): Created PHR document should be signed, consumers should be able to verify a signature  Maps AHIM-PHR to ASTM CCR, HL7 CCR/CRS and HL7 PHR  Extends HL7 CDA by Document section updates (replacementOf) insurance identifiers, patient identifiers of different providers Features similar to Radiology  None found (potentially some content) Note: Options and “bindings” may be difficult to understand, e.g. why can’t I exchange PHR information by using basic XDS?

IHE Cross-Domain Review 12 IHE PCC Integration Profile Pre-procedure History and Physical (PPHP) - TI Pre-procedure History and Physical Defines patient data necessary to evaluate/ ameliorate the risk for ambulatory procedures that require anesthesia. It is used for preparing the procedure and patient. Such information can be: diagnoses, proposed procedure, laboratory and imaging studies, history & physical examinations.

IHE Cross-Domain Review 13 PPHP Features An XD* content profile  Defines a CDA template with ~ 50 sections (many of those optional)  No specific behavior defined; Incorrect reference to “binding” to other (XD*) profiles Features similar to Radiology  None found (potentially some content)

IHE Cross-Domain Review 14 IHE PCC Actors Actors that are different  Content Creator – create and provide a medical summary (XDS-MS) consent document (BPPC) ED referral (EDR)  Content Consumer – view, import or process a medical summary, similar as above for XDS-MS, BPPC, EDR  PHR Manager creates and provides a PHR extract; imports/ consumes PHR data/ updates  PHR Reviewer consumes PHR extracts, and may be able to update an extract Actors from non RAD-domains  Required grouping of Content Creator with: XDS/ XDR Doc. Source or XDM Media Creator  Required grouping of Content Consumer with: XDS/ XDR Doc. Consumer or XDR Media Importer  Optional grouping of Content Creator/ Consumer with: NAV Notif. Sender/ Receiver or DSG Doc. Source/ Consumer List of Actors extensively the same as Radiology  none

IHE Cross-Domain Review 15 IHE PCC Transactions IHE PCC Transactions Note: Options are documented in Profile descriptions List of transactions that are different  none List of transactions that are extensively the same  Re-use of XDS, XDM, XDR transactions List of Transactions are extensively the same as Radiology  none

IHE Cross-Domain Review 16 Standards Used in PCC StandardStd. VersionProfile(s) Used HL7 CDAR 2.0XDS-MS, BPPC, EDR, PPHP XHTML BasicXDS-MS DEEDS (CDC)1.0 (1997)EDR HL7 CCD/ CRS/ PHR ?XPHR AHIMA-PHR?XPHR LOINC?XPHR (any CDA) Note: references to standards may be improved, e.g. PPHP

IHE Cross-Domain Review 17 Summary of PCC ProfileIssue DescriptionHow to Handle XDS- MS Relation of RAD reports to medical summaries. Investigate if section contents are usable for IHE/ RAD reporting. 5 ( clarify if this is consi-dered a gap by PCC ) BPPCReference BPPC in XDS-I?Potentially 1 EDRAlign patient EDR referral information to OMI when a “SWF 2” is created? Potentially 2 XPHRAlign CDA extensions for Insurance or Other Providers’ identifier for “SWF 2”? Potentially 2 PPHPProcedure = invasive / surgical CP on missing actor specification ? 3

IHE Cross-Domain Review 18 Key to Domain issues 1. Issue should result in CP in Radiology 2. Consider addition in Radiology 3. Conflict between Radiology and other Domain 4. Radiology Profile should be handed-off to other Domain 5. Gap has been identified that may result in New Opportunity

IHE Cross-Domain Review 19