September, 2005What IHE Delivers 1 IT Infrastructure Planning Committee Karen Witting – Ready Computing XDS & XCA: On-Demand Documents

On-Demand Documents Introduction Supports sources of healthcare data which can provide most recent or dynamic views of healthcare data Enables a new type of Document Entry, which provides access to a service to generate dynamic data rather than a single document containing historical data. The new source of data is similar to a static query with no arguments:  each defined service always generates the same set of data  the data will contain the most recent clinical data available Supported as part of the XDS and XCA profiles Currently supported through a supplement which is Trial Implementation

Profile updates Common to XDS and XCA  Defined on-demand DocumentEntry  Query: enhanced to support returning new type of Document Entry  Retrieve: enhanced to support return of on-demand/dynamic document  New On-Demand Document option XDS only  New transaction enables registration of on-demand Document Entries (ITI-61)  New Actor – On-Demand Document Source. Initiates new transaction and responds to retrieve requests. 3

Document Entry types Document Entry types defined  Stable Document Entry – metadata about a specific and already existing set of healthcare content formed into a document.  On-Demand Document Entry – metadata describing a type of healthcare content that could be created if requested.

Static vs On-Demand DocumentEntry 5 Static DocumentEntryOn-Demand DocumentEntry Original DocumentEntry used in XDS and XCA. New type of DocumentEntry created for support of on-demand documents. Represents a specific set of existing clinical data formatted in a document Defines a collection of clinical data that hasn’t been created yet Represents a document which presents a point in time view of the clinical data Used to create an updated view of the defined clinical data Created based on clinical eventsCreated once for each patient and clinical data collection type uniqueID used to retrieve the document represented which contains a point in time view of the data uniqueID used to retrieve a new document containing the most recent clinical information uniqueID is the identifier of the document retrieved uniqueID is never an identifier of any document, retrieved documents have a different identifier

Static vs On-Demand DocumentEntry 6 Static DocumentEntryOn-Demand DocumentEntry Future retrieve requests using the same uniqueID will always return exactly the same document Future retrieve requests using the same uniqueID will rarely return the same document, only if the clinical data has not changed since the last request

Static vs On-Demand DocumentEntry 7 Static DocumentEntryOn-Demand DocumentEntry creationTime, hash, size metadata required creationTime, hash, size not supported – would have no meaning repositoryUniqueId refers to a Document Repository Actor repositoryUniqueId refers to a On- Demand Document Source Actor serviceStartTime, serviceStopTime represents the actual service time of data in the document Not applicable for most On-Demand Documents Query parameter ('urn:uuid:7edca82f-054d-47f2-a032- 9b2a5b5186c1') Query parameter ('urn:uuid:34268e47-fdf5-41a6-ba c465248')

Query Transactions XDS (ITI-18) and XCA (ITI-38) Query transactions updated to support: New DocumentEntryType query parameter ('urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1‘, 'urn:uuid:34268e47-fdf5-41a6-ba c465248')  Static only – default New ExtrinsicObject ObjectType in return list. 8

Retrieve Transactions XDS (ITI-43) and XCA (ITI-39) Retrieve transactions updated to support retrieve of an On-Demand Document: NewDocumentUniqueId element in response contains uniqueID of document created in response to the retrieve of a On-Demand DocumentEntry NewRepositoryUniqueId used to identify the Document Repository containing the newly created document 9

XCA new option 10

XDS new option 11

Persistence of Retrieved Documents Adds the requirement that documents created in response to a retrieve of an on-demand entry uniqueID will be persisted and available for later retrieval through the newUniqueID returned in the retrieve transaction. XDS  The persistence must include a ITI-41 Provide and Register transaction submitting the Stable DocumentEntry reflecting the new document to the same Document Registry where the On-Demand Document is registered. XCA  The persistence is internal to the Responding Gateway and need only reflect the registration of the Stable DocumentEntry in response to query requests and the return of the identical document upon a retrieve request specifying the newUniqueID. 12

XDS On-Demand Documents Actors/Transactions 13

XCA workflow example – with persistence 14 Community A Initiating Community B Initiating Create On-Demand Entry # 5 XCA Query Community D Responding On-Demand Entry uniqueID=5 Reuse On-Demand Entry # 5 On-Demand Entry uniqueID=5 XCA Query Community C Initiating XCA Retrieve # 5 Create and save Stable Entry # 6 Reuse # 6 XCA Retrieve # 5 XCA Query uniqueID=5 & 6 Return On-Demand Entry # and Stable # 6 XCA Retrieve # 5 Returns # 6 Create and save Stable # 7 Returns # 7 Reuse # 7 XCA Query for id=7 Return Stable # 7 No new data available XCA Retrieve # 5 New data available No new data available

XCA workflow example – no persistence 15 Community A Initiating Community B Initiating Create On-Demand Entry # 5 XCA Query Community D Responding On-Demand Entry uniqueID=5 Reuse On-Demand Entry # 5 On-Demand Entry uniqueID=5 XCA Query Community C Initiating XCA Retrieve # 5 New document uniqueID=6 XCA Retrieve # 5 XCA Query uniqueID=5 Reuse On-Demand Entry # 5 XCA Retrieve # 5 Returns # 6 Returns # 7 Returns # 8 Returns # 9 XCA Query for id=9 Return no document found No new data available XCA Retrieve # 5 New data available No new data available New document uniqueID=7 New document uniqueID=8 New document uniqueID=9

XDS On-Demand Workflow 16 On-Demand Document Source with Persistence Document Consumer A Save On-Demand Entry # 5 Document Registry Register new Stable Entry #6 On-Demand Entry uniqueID=5 XDS Stored Query Document Consumer B XDS Retrieve # 5 Save Stable Entry # 6 XCA Retrieve # 5 XDS Stored Query uniqueID=5 & 6 Return all matching, On-Demand Entry # 5 and Stable # 6 XDS Retrieve # 5 Returns # 6 Save Stable Entry # 7 Returns # 7 XDS Stored Query for id=7 Return Stable # 7 XDS Retrieve # 5 Return all matching, only #5 New data available Register new Stable Entry #7 Register new On-Demand Entry #5 No new data available

Compatibility On-Demand is an option in XDS and XCA and is designed so that Actors not implementing the option are not effected. Query Transaction  The new parameter is ignored by a Document Registry/Responding Gateway not supporting the option.  A Document Consumer not supporting the new option will never specify the new parameter and thus will never receive the new DocumentEntry type Retrieve Transaction  A Document Consumer/Initiating Gateway not supporting the new option will never receive an On-Demand DocumentEntry and therefor will never initiate a retrieve request for an on-demand DocumentEntry. 17

18 More Information IHE Web site:   IHE official material   Technical Framework documents IHE Wiki site: wiki.ihe.net   IHE committee pages   Implementation Notes   Ongoing committee work IHE ITI technical committee mailing list     At the bottom of the page is a place to join the mailing list

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