1. Document Registry Framework Il Kon Kim, PhD & Il Kwang Kim PhD Kyungpook National Univ. IHIS, dinosa@daum.net © Copyright, 2006, IHIS. Total Health Care Service Provider

2. Total Health Care Service Provider in u-Health - 2 - IHIS, Korea. IHIS IHE-XDS: Cross-Enterprise Document Sharing one of the IHE Integration Profile (like RID, EUA, PIX, etc) IHE-IP facilitates the registration, distribution and access across health enterprises of patient electronic health records.  IT-I XDS is focused on providing a standards-based specification for managing the sharing clinic to an acute care in-patient facility. based on ebXML

3. DRF: Clinical Document Registry Framework based on ebXML

4. Total Health Care Service Provider in u-Health - 4 - IHIS, Korea. IHIS DRF: What’s the problem? “ Why is this research important? and What ‘s the problem? ” a highly focused issue in EHR but, there’re too many problems to be solved (reconciliation of patient ID from different source, ownership, lots of standards, Inconsistency, ontological problems, Authentication, Privacy and Security, de-Identification, patient access to their records is desired but difficult to achieve, etc) not much outstanding results about EHR-Registry there’s no standard for EHR-Registry

5. Total Health Care Service Provider in u-Health - 5 - IHIS, Korea. IHIS DRF: What is our solution? “ What is our solution ? ” document-centric approach minimum CDA Header Parsing XDSObjectEntry has too many attributes so that cause ontological problems – very hard to implement left the ontological things for content retrieval and knowledge management suggest a new way to store CDA concerning privacy & security

6. Total Health Care Service Provider in u-Health - 6 - IHIS, Korea. IHIS DRF: What is a DRF? “ What is a DRF ? ” A Document Repository for storing CDA documents and responding to document retrieval requests. A Document Registry for storing information about CDA documents. directory server for finding, selecting and retrieving of documents. Data Type Any type of document and clinical information without regard to content and representation is supported.

7. Total Health Care Service Provider in u-Health - 7 - IHIS, Korea. IHIS Medical staff Patient/Guardian Corporation/Government Repository List Client Search Application Regional Repository Hospital 1 Regional Repository Registry Registry Registry Hospital 2 Hospital 3 Hospital 4 Hospital5 Hospital 1 Hospital 2 Hospital 3 Hospital 2Hospital 1 환자의 이동 DRF: Distributed Registry & Repository

8. Total Health Care Service Provider in u-Health - 8 - IHIS, Korea. IHIS DRF: Layered Structure Public Health Services Hospital HIS Physician Office EMR Pharmacy Service Public Health Provider Physician/ Provider Pharmacist Document Provider View Document Provider Layer Document Transport Layer Data Base (RDB/ODB) File System Repository Service Layer Retrieving Service Persistence Service Resource Location Service Document Registry Service Client/ Provider Registry Service HTTP/SOAP Messaging Parse & Validation Security/Privacy Services Transformation Services JAXR Interface Registry & Repository View Document Provider Registry Service Layer ebXML UDDI Document Consumer Layer Registry Browser Web Browser Other Thick Clients Document Consumer View Document Consumer Content/ Knowledge Management Service Mobile Device

9. Total Health Care Service Provider in u-Health - 9 - IHIS, Korea. IHIS DRF: DRF Functional Model Document Provider Provide Documents Manage Document Life Cycle Manage Folders DRF Registry DRF Repository «extends» CDA Separation and Encryption Query Documents Retrieve Documents Validate & Store Documents Register Documents Document Consumer Validate & Register Documents «extends»

10. Total Health Care Service Provider in u-Health - 10 - IHIS, Korea. IHIS DRF: DRF Functional Model Other Registries Document Provider DRF Registry DRF Repository Document Consumer User System based on ebXML 3.O RIM/RS Query Documents Retrieve Documents Provide Documents Register Documents User System Provider Registry Patient Registry Client Registry Resource Registry

11. Total Health Care Service Provider in u-Health - 11 - IHIS, Korea. IHIS DRF: Document Concept documents provided by Document Provider actor minimal Data Entity to be stored into Repository and registered in Registry have no limitation of Document type, any type of document can be registered when retrieved, should be provide original byte stream location transparency – ISO 8824 OID DRF Document Concept

12. Total Health Care Service Provider in u-Health - 12 - IHIS, Korea. IHIS DRF: Basic Transactions ActorsTransactionsOption Document Provider Provide DocumentsR CDA Separation and EncryptionR Manage Document Life CycleO Manage Folders/DirectoriesO Document Consumer Query DocumentsR Retrieve DocumentsR DRF Repository Register DocumentsR Retrieve DocumentsR DRF Registry Register DocumentsR Query DocumentsR Other Registries Identify Actors (Patient, Provider, Consumer)R

13. Total Health Care Service Provider in u-Health - 13 - IHIS, Korea. IHIS DRF: Basic Transactions example :DRF Repository 1: Provide Documents 4: Return ACKs :Document Provider 2: Validate Documents 3: Store Documents Provide Documents ebXML RS SubmitObjectRequest ebRIM based MetaData (DRFObjectEntry) ebXML RS RegistryRespons e

14. Total Health Care Service Provider in u-Health - 14 - IHIS, Korea. IHIS DRF: Basic Transactions example Register Documents :DRF Registry 1: Register Documents 4: Return ACKs :DRF Repository 2: Validate & Register Documents 3: Create DRFObjectEntry DRFObjectEntry MetaData including URI Single or Composite Multiple Documents

15. Total Health Care Service Provider in u-Health - 15 - IHIS, Korea. IHIS DRF: DRF Data Model DRFObjectEntry ExtrinsicObject DRF Document (CDA Body) Repository References 1 1 DRF Document (CDA Header) Repository 1 References 1 RegistryPackage is a 1 * is associated with Submission Set References 1..n 1 was submitted in DRFOrganization DRFUser is reponsible for 1 1 is owner of 1 patient employee of document provider is submitter of document provider 1 was initially submitted in 1 medical institute Other contents (images, sound, etc) Repository 1 1 * owner of 11 1 Classification 1 * is classified with

16. Total Health Care Service Provider in u-Health - 16 - IHIS, Korea. IHIS DRF: DRFObjectEntry DRFObjectEntry Document UUID Document ID Submission ID Double Hash Value Date of Document Registration Expiration Date Document Status Stability Document Version Object Type URI Mime Type Universal ID allocated by Registry for management ‘Clinical Document > id’ of CDA, ISO 8824 OID (for location transparency) for CDA Separation Transaction Document Life Cycle : Submitted-Approved- Deprecated-Removed Static, Dynamic, Dynamic Compatible Reference of a document

17. Total Health Care Service Provider in u-Health - 17 - IHIS, Korea. IHIS DRF: Extended Transactions Provide and Register Documents by CDA Separation :DRF Repository :Document Provider 1: Separate Header & Body 2: Provide Documents (CDA Header) :DRF Repository :DRF Registry 3: Register Documents (CDA Header) 4: Create DRFObjectEntry 4’: Update DRFObjectEntry 2’: Provide Documents (CDA Body) 3’: Register Documents (CDA Body) Return ACKs

18. Total Health Care Service Provider in u-Health - 18 - IHIS, Korea. IHIS DRF: Extended Transactions Query and Retrieve CDA Documents :DRF Repository :Document Consumer :DRF Repository :DRF Registry 3: Retrieve Documents (CDA Header) 1: Query Documents (CDA) 3’: Retrieve Documents (CDA Body) 4: Retrieved Documents (CDA Header) 4’: Retrieved Documents (CDA Body) 2: Return Query Results

19. Total Health Care Service Provider in u-Health - 19 - IHIS, Korea. IHIS DRF: a New strategy for CDA security CDA Document Header Encounter Service Actors Service Targets Body Structured (Narrrative) Text, Coded Entries Document Information CDA Document Provider ’ s Information Patient Identification data, etc patient treatment and care information CDA contains very sensitive data that cause Privacy Problem!!

20. Total Health Care Service Provider in u-Health - 20 - IHIS, Korea. IHIS Header Encounter Service Actors Service Targets Document Information Body Structured (Narrrative) Text, Coded Entries DRF: a New strategy for CDA security What could be the solution? Provider ’ s Information Patient Identification data, etc patient treatment and care information Never know whose clinical data is… Doesn’t know what kind of treatment has be done…

21. Total Health Care Service Provider in u-Health - 21 - IHIS, Korea. IHIS DRF: a New strategy for CDA security Scenario for CDA Separation Document Consumer Document Provider :User System :DRF Repository :DRF Repository :DRF Registry 1: Request Registration 3: Provide Documents (Encrypted CDA Header) 9: Request CDA 11: Retrieve Documents (CDA Header) 10: Query Documents (CDA) 12: Retrieve Documents (CDA Body) 6: Provide Documents (Encrypted CDA Body) CDA Header CDA Body CDA 2: Separate Header & Body 4: Register Documents (CDA Header) 5: Create CDRObjectEntry 8: Update CDRObjectEntry 7: Register Documents (CDA Body)

22. Total Health Care Service Provider in u-Health - 22 - IHIS, Korea. IHIS Operation in DRF Client CDA Header (Demographics) CDA Body (Clinical Info.) HDHV BDHV HDHV BDHV Hash One time Secrete Key Repository’s Public Key CDA Body One time Secrete Key Repository’s Public Key DBHV CDA Header One time Secrete Key DBHV BDHV DBHV HDHV: HeaDer Hash Value BDHV: BoDy Hash Value DBHV: DouBle Hash Value SID: Submission ID DRF: a New strategy for CDA security (1/3) SID

23. Total Health Care Service Provider in u-Health - 23 - IHIS, Korea. IHIS Operation in DRF Repository CDA Body ( 진단정보 ) One time Secrete Key Repository’s Public Key CDA Body One time Secrete Key Repository’s Public Key CDA Header One time Secrete Key HDHV BDHV DBHV Repository1 or Repository2 Repository’s Private Key Hash New HDHV Hash New DBHV Provider’s Public Key DBHV Equal ? CDA Header Decryption CDA Header Registry DRFObjectEntry Head’s URI Body’s URI DBHV DRF: a New strategy for CDA security (2/3) HDHV Equal ? Header Registration SID from Repository 1 from Repository 2 Client Repository2: CDA Body Validation HDHV BDHV SID Repository2: SIDHV

24. Total Health Care Service Provider in u-Health - 24 - IHIS, Korea. IHIS Strategy for enhancing CDA security level DRF: a New strategy for CDA security (3/3)