1. IHE IT Infrastructure Domain Update
Karen Witting – IBM IT Infrastructure Planning Committee co-chair 1

2. IT Infrastructure Domain (ITI)
Supports profiles which supply common infrastructure for sharing healthcare information.
IT Infrastructure domain began in 2003 and now has 27 profiles that it supports.
Key ITI profiles demonstrated today (and tested at Connectathon):
Information Exchange: XDS, XDM, XDR, XCA, XDS-SD, RFD, DSUB
Security: ATNA, CT, XUA, BPPC
Identity Management: PIX, PDQ (HL7 V2 & V3), HPD

3. An Infrastructure Interoperability Component Is…
Represents a common IT function or service that is used as a building block for a variety of use cases
May be imbedded in an application, but is often deployed as a shared resource within a Health Information Exchange
Is a necessary ingredient, but is rarely visible to the end user

4. ITI Strategic Focus Categories
Patient and Provider Identity
support the management of patient, provider and healthcare organization identity including their localization. This includes the ability to look up, cross-reference, update, remove, merge, link and general management of identities.
PIX, PDQ, PAM, PWP, XCPD, HPD, PIX/PDQ HL7 v3
Health Record Sharing
support the ability to share patient specific healthcare information within and across enterprises. This includes the ability to submit, locate/list, push, pull and retrieve patient specific healthcare information.
XCA, XDM, XDR, XDS, XDS-SD, MPQ, RID
Security and Privacy
support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies .
ATNA, BPPC, XUA, DSG, EUA
Workflow Enablers
support standard sequences for performing workflow activities.
DRR, DSUB, NAV, PSA, RFD
Support Management
support the ability to share information needed for interoperable healthcare management such as clinical coding, technical or IT management information
CT, SVS

5. Different Information Exchange Approaches
Point –to- Point
Health Information Sharing
One to Many, Pull
Known Partners
Patient Association May Be “Out-of-Band”
Document Content: “Blind” or Labelled
EMPI
Document Registry / Record Locator
1-n Document Repositories 5

6. Point-to-point Deployment Models
Secure … Direct Project w/o Document Metadata Option
IHE Cross-Enterprise Document Exchange - Option (XDM- )
IHE Cross-Enterprise Reliable Exchange (XDR) w Patient ID Reconciliation (PIX/PDQ)
Known partners, patient ID out-of-band, “blind” document Known partners, patient ID out-of-band, labelled document Known partners, linked patient, labelled document
Direct moving to the next level
IHE takes Direct to the next level 6

7. Health Information Sharing Deployment Models
Many potential partners, linked patient, labelled documents Centralized services (registry/EMPI) Nationwide Health Information Network Exchange / FHA CONNECT™
IHE Cross-Enterprise Document Sharing (XDS) (On-Demand Document Option and Document Subscription / Notification (DSUB))
IHE Patient ID Cross-reference (PIX) and Patient Demographics Query (PDQ)
IHE Cross-Community Exchange (XCA)
IHE Cross-community Patient Discovery (XCPD)
IHE takes Direct to the next level 7

8. Direct Project, Nationwide/Exchange and IHE Profiles
XDS Metadata
Direct Project
Option in Direct
Pt-to-Pt
Push
IHE XDM ( )
Nationwide/Exchange
IHE XDR (Web Service)
Share
& Pull
IHE XCA (cross-HIE)
IHE XDS (Intra-HIE)
 Direct is aligned with XDM: recommends but does not require metadata
 Nationwide/Exchange is aligned with XCA and XDR
 XDR may be bridged into Direct Project with metadata option

9. XDS Scenario + Use of ATNA & CT
Physician Office
EHR System
Teaching Hospital
PACS
ED Application
EHR System
PMS
XDS Document Repository
Community Clinic
Lab Info. System
PACS
XDS Document Registry
Query Document
Register Document
Secured Messaging
Retrieve Document
Provide & Register Docs
Maintain Time
ATNA Audit record repository
CT Time server
Maintain
Time
Record Audit
Event
Maintain
Time
Record Audit
Event
Record Audit
Event

10. Document Content & Modes of Exchange
Document Content Profiles
Pre Surgery
PPH P
Consent
BPPC
Emergency
EDR
Scanned Doc
XDS-SD
Laboratory
XD*-Lab
Imaging
XDS-I
Discharge & Referrals
XDS-MS
PHR Exchange
XPHR
Document Exchange Integration Profiles
Document
Sharing XDS
Reliable Interchange
XDR
Media Interchange
XDM
Cross-Community
Access XCA

11. XDS Scenario + Use of PIX & PDQ
PDQ Query to Acquire Affinity Domain Patient ID
Patient Identity Feed M
Patient Identity XRef Mgr
14355 M
L-716
A87631
Physician Office
EHR System
Patient Identity Feed M
A87631
L-716
Teaching Hospital
PACS
ED Application
EHR System
Affinity Domain Patient
Identity Source M
Patient Identity Feed
Patient Identity Feed
Community Clinic
Lab Info. System
PACS
XDS Document Repository
XDS
Document Repository
PIX
Query
A87631
L-716
Document Registry
PIX
Query
Query Document (using Pt Id)
Register (using Pt ID)
Provide & Register Docs
PACS
Retrieve Document
ATNA Audit record repository
CT Time server

12. Cross-Community Demonstrating Sharing across regional boundaries
NEW YORK
Document
Registry
ILLINOIS
Document
Registry
XCPD / XCA / XDR transactions
Practice
Practice
Practice
Hospitals
Practice
Hospitals
Hospitals
Gateway
Practice
Hospital
Hospital
Hospital
Patient ID
services
Gateway
Practice
Clinic
Practice
Hospitals
Clinic
Practice
Clinic
Repository
Practice
Hospitals
Hospitals
Clinic
Repository
Patient ID
services
Clinic
Clinic
Repository
Repository
NORTH CAROLINA
Document
Registry
Practice
Clinic
Hospitals
Hospital
Repository
Patient ID
services
CALIFORNIA
Gateway
Document
Registry
Gateway
Practice
Practice
Hospitals
Practice
Hospitals
Hospitals
Patient ID
services
Clinic
Repository

13. IT Planning Committee Activities
2010 ITI Planning Committee
ITI Strategic Planning
Definition of ITI Categories
Development of Liaisons and Outreach plan
Selection of new work for 2011
review proposals and identify new work for each development cycle
2011 ITI Planning Committee
Preparation of Educational Material – development of reusable PPT decks on key ITI topics
Strategic Planning and Liaison Activity – build liaisons with other IHE committees
Selection of Trial Implementation Supplements to become Final Text Profiles
Selection of new work for 2012

14. ITI Technical Committee Activities
Delivered new supplements for 2010 (next charts)
Delivered 2010 versions of Technical Framework and Supplements
Processing of numerous Change Proposals (CPs)
Integration of CPs into 2010 versions of documentation
2011 ITI Technical Committee
New Supplements/Handbook For 2011 (next charts)
Change Proposal processing
Delivery of 2011 updated version of Technical Framework and prior year Supplements

15. IHE ITI Completed Work for 2010
Healthcare Provider Directory (HPD)
Supports interoperable feed and query transactions for healthcare provider information
Supports individual and organizational providers
Transactions are based on LDAP and DSML
Cross-Enterprise User Assertion - Attribute Extension (XUA++)
Extends XUA based on feedback on attributes
Adds attributes supporting Role-Based-Access Control , Consent/Authorization, Purpose of Use and general descriptive attributes
XDS Metadata Update
Enables update and deletion of metadata in the XDS/XCA/XDR profiles
SVS Extension
Update integrated directly into SVS supplement
Adds value set metadata and search capability in support of publication and distribution of value sets.
On-Demand Documents
Supports sources of healthcare data which prefer to build most up-to-date document content at the time of retrieve, on-demand
Delayed Document Assembly
Allows source systems to register the existence of stable document content but defer actually assembling the document content only if and when it is retrieved. This approach is adopted for efficiency reasons.

16. IHE ITI New Work for 2011
XDS Affinity Domain Patient Identifier Change Management (XPID)
Communication of link, unlink and merge events to XDS Document Registry
Cross-Enterprise Document Workflow (XDW)
Tracking the steps of workflows to support care coordination and clinical pathways
XCA Query and Retrieve
Combining XCA Query and XCA Retrieve transactions
Direct Project Push use of XDS Metadata
Adjustment of XDS metadata requirements when used in XDR and XDM environments with minimal metadata knowledge
Document Encryption
Standard mechanism for encrypting health documents
Pseudonymisation and De-Identification in IHE Profiles (Handbook)
Providing guidelines to industry on the application of pseudonymisation

17. ITI Profiles Security/Privacy Cross-Enterprise User Assertion (XUA) ☼
Basic Patient Privacy Consents (BPPC) ☼
Enterprise User Authentication (EUA)
Consistent Time (CT) ☼
Audit Trail and Node Authentication (ATNA) ☼
Document Digital Signature (DSG)
Identify Management
Personnel White Pages (PWP)
Patient Identifier Cross-Referencing (PIX)☼
Patient Demographics Query (PDQ) ☼
Patient Identifier Cross-Referencing HL7 V3 (PIX V3)☼
Patient Demographics Query HL7 V3 (PDQ V3) ☼
Patient Administration Management (PAM)
Pediatric Demographics Option
Cross-Community Patient Discovery (XCPD) ☼
Healthcare Provider Directory (HPD) ☼
▀ colored text designates 2010 new and updated profiles
☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2011

18. ITI Profiles (continued)
Information Exchange
Cross-Enterprise Document Sharing - b (XDS) ☼
Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼
Cross Community Access (XCA) ☼
Document Metadata Subscription (DSUB) ☼
Multi-Patient Queries ☼
Cross-Enterprise Document Media Exchange (XDM) ☼
Cross-Enterprise Document Reliable Interchange (XDR)
Notification of Document Availability (NAV)
Retrieve Form for Data Capture (RFD) ☼
Retrieve Information for Display (RID)
Patient Synchronized Applications (PSA)
XDS Metadata Update
On-Demand Documents
Delayed Document Assembly
Terminology
Sharing Value Sets
▀ colored text designates 2010 new and updated profiles
☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2011

19. IHE IT Infrastructure Schedule for 2011
Development Schedule:
Planning Committee decision ……… December 2010
Issue Public Comment version …….. May 2011
Public Comment Due ……………….. June 2011
Issue Trial Implementation version … August 2011
IHE Connectathon …………………… January 2012
HIMSS Demo ………………………… February 2012

20. Learn More and Start to Participate
Join the ITI Planning Committee at our HIMSS 11 Recruitment Meeting
Meet key IT Infrastructure Committee participants
Q&A on any ITI related topic
Tuesday 10:30 – 11:30 Room 305 A&B
Q&A