XDM / XDR Point-to-Point Transmission of Documents INTEGRATING THE HEALTHCARE ENTERPRISE XDM / XDR Point-to-Point Transmission of Documents IHE IT Infrastructure Webinar Series

Contents Introduction XDM XDR Summary References 2

Introduction Point-to-Point Transmission of Documents refers to: Cross-Enterprise Document Media Interchange (XDM) Cross-Enterprise Document Reliable Interchange (XDR) Based on XDS XDM = exchange of XDS metadata and documents on media XDR = exchange of XDS metadata and documents over reliable protocols Maximal re-use of XDS objects & meta-data As with XDS both are “document content agnostic” All XDS “content profiles” apply (e.g., XDS-MS, XD-Lab, XPHR, etc.) When to use When document sharing infrastructure not in place Where XDS is not desirable or available to one of the participants Complementary to sharing documents via XDS 3

Cross-Enterprise Document Media Interchange (XDM) Documents and metadata shared using standard media types (e.g., email, CD, USB) Intended to be easy to implement using: Existing email clients CD burners USB ports Meant for person-to-person communication In pocket media Send via email Imposes common file and directory structure 4

XDM Supports transfer of data about multiple patients within one exchange Multiple submission sets Requires recipient to support human intervention to control importing of data Manual operation Works with XDS XDS Query/Retrieve can feed XDM transmission Point-to-point transfer via XDM can feed XDS submission 5

XDM Use Cases Physician to Patient to Specialist Patient Visiting ED Test result and referral information given to patient on CD-R to be taken to specialist of his choice. Patient Visiting ED Patient maintains copy of his EHR at home and brings a memory stick with him to the ED. Physician to Physician Primary physician emails zip file attachment about his patient to specialist 6

XDM Actors & Transaction Options 7

XDM XDM Exchange of Health Information Home Hospital Physician Office Read Hospital Write Interchange Media Discharge summary + Lab report Discharge summary +Lab report Read Physician Office

XDM Standards DICOM PS 3.10 Media Storage and File Format for Data Interchange (DICOM file format). http://dicom.nema.org/ DICOM PS 3.12 Media Formats and Physical Media for Data Interchange, Annex F - 120mm CD-R media, Annex R - USB Connected Removable Devices, Annex V - ZIP File Over Media, and Annex W - Email Media. http://dicom.nema.org/ XHTML™ 1.0 The Extensible HyperText Markup Language (Second Edition). A Reformulation of HTML 4 in XML 1.0. W3C Recommendation 26 January 2000, revised 1 August 2002. http://www.w3.org/TR/xhtml1. XHTML™ Basic. W3C Recommendation 19 December 2000. http://www.w3.org/TR/xhtm-basic. MDN: RFC 3798 Message Disposition Notification. http://www.rfc-editor.org/rfc/rfc3798.txt 9

XDM Security & Privacy The Portable Media Importer shall check the hash value and size as found in the XDS metadata to detect corruption within the metadata or media. Basic Patient Privacy Enforcement Option In the case of physical media, encryption of the CD-R or USB shall not be used. In the case the media used is the ZIP file over Email, the transaction shall be secured by S/MIME (see IHE ATNA) and comply with the security process as defined in the DICOM Part 15 Appendix (Secure Use of ZIP File Media over Email) Portable Media Importers/Exporters that import/export media shall generate one or more ATNA “Import”/”Export” events into the audit trail to describe the media event. 10

Cross-Enterprise Document Reliable Interchange (XDR) Documents and metadata shared using a reliable messaging system Permits interchange between EHRs, PHRs, and other health IT systems in the absence of XDS infrastructure Allows for automatic transfer of documents for a single patient (one submission set) Supports the reuse of the Provide and Register Document set (ITI-41) with web services as transport 11

XDR More like XDS than XDM Optionally identify intended recipients Direct transfer between source and consumer No registry or repository actors involved Optionally identify intended recipients Works with XDS XDS Query/Retrieve can feed XDR transmission Point-to-point transfer via XDR can feed XDS submission 12

XDR Use Cases Primary Physician to Specialist Referral information for patient sent to specialist ahead of visit Hospital to Long-term Care Patient summary information sent to long-term care facility upon patient transfer from hospital Physician to Physician Patient MRI test results sent from physician in specialized care facility to another specialist for consultation 13

XDR Actors & Transaction Options 14

XDR Exchange of Health Information Physician Office Specialist Office Send Existing Reliable Messaging System Receive A referral summary A referral summary

XDR Standards ebRIM - OASIS/ebXML Registry Information Model v3.0 ebRS- OASIS/ebXML Registry Services Specifications v3.0 Appendix V - ITI TF-2x:Appendix V Web Services for IHE Transactions. Contains references to all Web Services standards and requirements of use MTOM - SOAP Message Transmission Optimization Mechanism http://www.w3.org/TR/soap12-mtom/ XOP - XML-binary Optimized Packaging http://www.w3.org/TR/2005/REC-xop10-20050125/ 16

XDR Security & Privacy Basic Patient Privacy Enforcement Option Relevant XDS Affinity Domain security considerations are discussed in the XDS Security Considerations Section (see ITI TF-1: 10.7) 17

Health Document Exchange Options - Flexible Infrastructure Summary Health Document Exchange Options - Flexible Infrastructure XDS XDS INFRASTRUCTURE Query/Retrieve M8354673993 A87631 14355 L-716 Publish Query/Retrieve XDR Existing Reliable Messaging System Send to Send to XDM Interchange Media Write Read

**** Update **** Summary Combining XDM / XDR Consulting to referring physicians GP / PCP Doctor A Specialist, Radio or Lab Hospital-doctor communication Remote advice Patient Transfer Hospital Acute Care / ED Personal Health Record (PHR) to ED/Primary Care EMR Care Facility Acute Care Discharge to Extended Care Facility (ECF)

References To learn more about IHE… IHE web site: www.ihe.net IHE official material Frequently Asked Questions Technical Framework documents Integration Profiles See Volume 1 of each for Use cases Vendor Products Integration Statements IHE IT Infrastructure Wiki: http://wiki.ihe.net/index.php?title=IT_Infrastructure IHE committee pages Implementation Notes Ongoing committee work 20 20