1. Cross-Enterprise Document Sharing Cross-Enterprise Document Sharing Bill Majurski National Institute of Standards and Technology IT Infrastructure Co-Chair

2. June 28-29, 2005Interoperability Strategy Workshop2 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings

3. June 28-29, 2005Interoperability Strategy Workshop3 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) IT Infrastructure Profiles Cross-Enterprise Document Sharing (XDS) – Registration, distribution and access across health enterprises of clinical documents forming a patient EHR

4. June 28-29, 2005Interoperability Strategy Workshop4 Cross-Enterprise Document Sharing (XDS) Abstract / Scope Provide support for document-based patient EHR Support for document storage within existing products Provide support for indexing of patient documents Support query and retrieval of patient documents Scalable architecture

5. June 28-29, 2005Interoperability Strategy Workshop5 Cross-Enterprise Document Sharing (XDS) Value Proposition Points of view EHR-CR : Care-delivery Record –Patient information –Managed by a Care Delivery Organization EHR-LR : Longitudinal Record –Documents shared by EHR-CR(s) –Tracked by Registry Clinical Affinity Domain : –Group of healthcare enterprises (EHR-CR) –Common set of policies –Share a single registry

6. June 28-29, 2005Interoperability Strategy Workshop6 Cross-Enterprise Document Sharing (XDS) Value Proposition Foundation for Health IT Infrastructures: Shared Electronic Health Record, in a community, region, etc. Effective means to contribute and access: clinical documents across health enterprises. Scalable sharing of documents: between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems. Easy access: Care providers are offered means to query and retrieve clinical documents of interest.

7. June 28-29, 2005Interoperability Strategy Workshop7 Cross-Enterprise Document Sharing (XDS) Value Proposition Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source EHR-CR. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain (e.g. an LHII). Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA, ASTM-CCR, PDF, DICOM, etc.)

8. June 28-29, 2005Interoperability Strategy Workshop8 Cross-Enterprise Document Sharing (XDS) Transaction Diagram

9. June 28-29, 2005Interoperability Strategy Workshop9 Cross-Enterprise Document Sharing (XDS) Actors Document Source Source of documents and metadata about documents Document Repository Stores documents, requests indexing in Document Registry, supports retrieval Document Registry Indexes documents, supports search Patient Identity Source Feeds identity of known patients to Document Registry Document Consumer Initiates search and retrieval for consumer of documents

10. June 28-29, 2005Interoperability Strategy Workshop10 Cross-Enterprise Document Sharing (XDS) Value Proposition (cont) Document Content Neutral: Document content is processed only by source and consumer IT systems. Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.

11. June 28-29, 2005Interoperability Strategy Workshop11 Cross-Enterprise Document Sharing (XDS) Standards Used Healthcare Content Standards HL7 CDA, CEN EHRcom HL7, ASTM CCR DICOM … Internet Standards HTML, HTTP, ISO, PDF, JPEG … Electronic Business Standards ebXML, SOAP …

12. June 28-29, 2005Interoperability Strategy Workshop12 Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used XDS Infrastructure XDS Content

13. June 28-29, 2005Interoperability Strategy Workshop13 Cross-Enterprise Document Sharing (XDS) Standards Used XDS Infrastructure Standards OASIS/ebXML –Registry Information Model v2.0 Basis of XDS Registry Information Model –Registry Services Specifications v2.0 Registry Services –Messaging Services Specifications v2.0 Offline protocols ISO/IEC 9075 Database Language SQL –Registry Query Language SOAP with Attachments –Protocol for communication with XDS Registries and Repositories SHA-1 [ FIPS 180-1 ] –Document Hashes

14. June 28-29, 2005Interoperability Strategy Workshop14 Cross-Enterprise Document Sharing (XDS) Standards Used XDS Infrastructure Standards (cont) HL7 Version 2.3.1 –Messages for Patient Identity Management HL7 Version 2.5 –Datatypes for XDS Registry Attribute values HL7 CDA Release 1 –XDS Document concept definition –Source of XDS Document Entry Attributes DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom –Sources of XDS Document Entry Attributes

15. June 28-29, 2005Interoperability Strategy Workshop15 Cross-Enterprise Document Sharing (XDS) Standards Used HTTP –Protocol for Retrieve Document –Online SOAP bindings SMTP –Offline ebMS bindings IETF –Language Identifiers MIME –Document Type codes UTF-8 –Encoding of Registry Attributes XDS Infrastructure Standards (cont)

16. June 28-29, 2005Interoperability Strategy Workshop16 Cross-Enterprise Document Sharing (XDS) Standards Used XDS Content Standards Outside scope of XDS; layer on top of XDS Documented as Document Content Profiles –Document use cases and translation of document content into registry metadata –Publishable separately –Guide for writing DCPs available –Intended mostly for IHE domain committees Of concern only to Document Source and Document Consumer actors Examples include: HL7 CDA, DICOM, ASTM CCR

17. June 28-29, 2005Interoperability Strategy Workshop17 Cross-Enterprise Document Sharing (XDS) Proposed Options Options center around Document Source actor Basic operations Submit single document Replace existing document Optional features Off-line mode Multi-document submission Document life-cycle management –Submit addendum or transformation of document Folder management –Create folder, add to folder

18. June 28-29, 2005Interoperability Strategy Workshop18 Cross-Enterprise Document Sharing (XDS) Related Profiles Patient Identity Patient Identity Feed –Notification from ADT system to Document Registry of patient admission/registration –Submission to Registry requires validated patient ID Patient Demographics Query (PDQ) –Identify patient based on query of demographic information –Needed by Document Source: assign correct patient ID –Needed by Document Consumer: query against correct patient ID

19. June 28-29, 2005Interoperability Strategy Workshop19 Cross-Enterprise Document Sharing (XDS) Transaction Diagram

20. June 28-29, 2005Interoperability Strategy Workshop20 Cross-Enterprise Document Sharing (XDS) Patient ID Management

21. June 28-29, 2005Interoperability Strategy Workshop21 Cross-Enterprise Document Sharing (XDS) Related Profiles Time/Audit/Authentication Constant Time (CT) Audit Trail and Node Authentication (ATNA) Cross-Enterprise User Authentication (XUA)

22. June 28-29, 2005Interoperability Strategy Workshop22 Cross-Enterprise Document Sharing (XDS) Related Profiles New related profiles Notification of Availability (NAV) –Send notification that documents are available Digital Signature (DSG) –Signing of documents in repository/registry

23. June 28-29, 2005Interoperability Strategy Workshop23 Cross-Enterprise Document Sharing (XDS) Document Status XDS profile document being updated for this season Final collection of changes are being balloted now Final text of the profile and a catalog of changes from last year will be posted on the Web and announced in two weeks.

24. June 28-29, 2005Interoperability Strategy Workshop24 More information…. IHE Web sites: www.ihe.net www.ihe.net Technical Frameworks, Supplements –Fill in relevant supplements and frameworks Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements