1. 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

2. Contents
Introduction
XDM
XDR
Summary
References 2

3. 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

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

5. 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

6. 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 s zip file attachment about his patient to specialist 6

7. XDM
Actors & Transaction
Options 7

8. 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

9. XDM
Standards
DICOM PS 3.10 Media Storage and File Format for Data Interchange (DICOM file format).
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 - Media.
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
XHTML™ Basic. W3C Recommendation 19 December
MDN: RFC 3798 Message Disposition Notification. 9

10. 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 , 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 )
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

11. 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

12. 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

13. 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

14. XDR
Actors & Transaction
Options 14

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

16. 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
XOP - XML-binary Optimized Packaging 16

17. 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

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

19. **** 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)

20. 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:
IHE committee pages
Implementation Notes
Ongoing committee work 20 20