XDM / XDR Point-to-Point Transmission of Documents ITI Planning Committee

Point-to-Point Transmission of Documents XDS is the base XDM = exchange of XDS metadata and documents on Media XDR = exchange of XDS metadata and documents over reliable protocols 2

XDM XDM – Media Interchange (email, CD, etc.) Documents and XDS Metadata shared via media Options USB CD-R ZIP over email Imposes File/Directory structure on the media Transport Multiple XDS Submission Sets Each Submission Set has Metadata describing documents Documents Protocol structure of XDS imposed on file/directory organization

XDM XDM – Media Interchange (email, CD, etc.) Uses Works with XDS Release of documents to patient Manual (in pocket or email) transfer of documents Local display after receipt Index.htm file required to support display These are manual operations! Works with XDS XDS Query/Retrieve can feed XDM transmission Point-to-point transfer via XDM can feed XDS submission 4

Health Information Exchange XDM Health Information Exchange e.g. A Hospital e.g. Home Read Discharge summary + Lab report Write Interchange Media Discharge summary +Lab report Read e.g. Physician Office Generally more than two trading partners,

XDR XDR – Reliable Interchange Single Submission Set per transfer Optionally identify intended recipients More like XDS than XDM Reliable asynchronous point-to-point transmission of XDS content (metadata and documents) over reliable communications A new profile but really just documents how to use Provide and Register transaction [ITI-15] (same as XDS) to perform point-to-point transfers. 6

XDR XDR – Reliable Interchange Reliable transfer comes from ebMS Messaging Services Specification v2.0 Online vs. Offline Online = over direct TCP connection Offline = over SMTP Works with XDS XDS Query/Retrieve can feed XDR transmission Point-to-point transfer via XDR can feed XDS submission 7

Health Information Exchange XDR Health Information Exchange e.g. A Specialist Office e.g. A Clinic Send to Send to Switch A referral summary + lab report A referral summary + lab report Two specific trading partners,

Specialist, Radio or Lab Hospital Acute Care / ED Combining XDM / XDR Consulting to referring physicians Specialist, Radio or Lab GP / PCP Doctor A 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)

Flexible Infrastructure Health Information Exchange XDS Structured objects Pull Publish Pull Send to Switch XDR Write Read Interchange Media XDM

Point-to-Point Transmission of Documents Complementary to sharing documents (XDS), point-to-point communication of documents Both transports: secured mail & media (CD…) As XDS, “document content agnostic” Maximal re-use of XDS objects & meta-data Compatible with exchange of images (PDI…) All XDS “content profiles” apply

Point-to-Point Transmission of Documents Interchange of patient centered documents Transmission of results, discharge letters or patient referrals (not the "workflow" itself but all the medical information associated with - e.g. reports, results, images, signals…) Personal Health Record medical information (history, etc), snapshots of clinical information (medication list, immunization records, etc), current observations from home care medical devices (e.g. blood pressure, blood sugar level, etc).