1. September, 2005What IHE Delivers 1 XDS Document Source and Consumer Implementation Strategies IHE Vendors Workshop 2006 IHE IT Infrastructure Education George Cole (Allscripts) with thanks to Charles Parisot for many slides

2. 2 Overview Review XDS Related Profiles Implementation Strategies ResourcesQuiz

3. 3 Cross-Enterprise Document Sharing A baseline profile Focused on managing the sharing of patient healthcare documents Provides for Distributed Repositories Content Neutral Referenced and reused by other profiles

4. 4 XDS for Dummies Document Source submits to Repository Document Consumer queries Registry Document Consumer retrieves from Repository

5. 5 XDS Actors and Transactions

6. 6 Clinical Encounter Clinical IT System 1-Expression of a need for additional information Index of patients records (Document-level) Temporary Aggregate Patient History 3-DocumentsReturned Document Repositories 4-Patient data presented to Physician 3-Reference to Docs from Inquiry 2- Inquiry for Docs XDS in Action

7. 7 Related Profiles Patient Identifier Cross-referencing (PIX) or Patient Demographics Query (PDQ) Consistent Time (CT) Audit Trail and Node Authentication (ATNA) Document Digital Signature (DSG) Notification of Document Availability (NAV)

8. 8 XDS Affinity Domain (NHIN sub-network) Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of ATNA & CT PMS Retrieve Document Register Document Query Document XDS Document Registry ATNA Audit record repository CT Time server Record Audit Event MaintainTime MaintainTime Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

9. 9 XDS Affinity Domain (NHIN sub-network) Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + use of PIX & PDQ A87631L-716 Affinity Domain Patient Identity Source M8354673993 Retrieve Document Provide & Register Docs Register (using Pt ID) Query Document (using Pt Id) Patient Identity Feed Document Registry 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query PIX Query Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed PDQ Query to Acquire Affinity Domain Patient ID M8354673993 A87631 L-716 M8354673993 XDS Document Repository XDS Document Repository ATNA Audit record repository CT Time server

10. 10 IHE Integration Profiles for Health Info Nets What is available and has been added in 2005 and is for 2006 Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Patient Demographics Query Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extract Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Consent Management Patient consents Cross-enterprise Document Interchange Media-CD/USB & e-mail push Notification of Document Availability Notification of a remote provider/ health enterprise Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Document Digital Signature Attesting true-copy and origin

11. 11 XDS Actors and Transactions

12. 12 Document Availability Management Availability Status Visible to a Document Source Approved Available for Patient Care Availability Status Change under the Control of Original Document Source and Patient (if allowed in Affinity Domain) Deprecated Obsolete Submitted Registration in progress Availability Status Visible to a Document Consumer

13. 13 Document Life Cycle Management A two-way relationship between Original and Addendum Document Addendum Document 1 (Approved) Addendum Replacement Document Replacement Document 1 (Deprecated) Document 2 (transform) Transform Document 1 (Approved) A two-way relationship between Original and Replacement Document. A two-way relationship between Original and Transform (alternative format with same scope). Time Addendum to a registered document Replacing a registered document by a new document Registering an alternate form of a registered document Time

14. 14 Provide and Register Document Set Document Source to Document Repository Metadata describing zero or more new documents Submission Set defining linkage to new and references to existing documents Zero or more Folder definitions

15. 15 Created by a single Document Source. Issued by a single Provide & Register Document Set or Register Document Set transaction. Related to care event(s) of a uniquely identified patient. Records new documents. References prior documents. Associated with a content code (e.g. clinical meaning) by the Document Source. Accessible via the Query Registry transaction. XDS Submission Set

16. 16 Example: Document Source prepares a submission request : One Submission Set associated with two Documents and a Folder Document Document Entry Submission Set 1 Objects to be Registered Objects to be stored in the Repository Folder A

17. 17 A means to group one or more documents for any reason. Groups documents related to a single patient. May include contributions from one or more Document Sources. Can have new or existing documents inserted at anytime by a Document Source. Will be permanently known by the registry. Accessible via the Query Registry transaction. Associated with a code (e.g. clinical meaning) by Document Sources. XDS Folder

18. 18 Details and Examples National Institute of Standards and Technology (NIST) Notes on XDS http://hcxw2k1.nist.gov/wiki/index.php/Notes_o n_XDS_Profile http://hcxw2k1.nist.gov/wiki/index.php/Notes_o n_XDS_Profile SOAP with Attachments How to Construct XDS Metadata

19. 19 Implementation Strategies Project Management Corporate commitment Corporate commitment Applications, Fees, Deadlines, … (this costs $$s) Applications, Fees, Deadlines, … (this costs $$s) Signage, Marketing, Spin Doctors… Signage, Marketing, Spin Doctors… Software Development & Testing This is YOURS; is it yours alone ? This is YOURS; is it yours alone ? Success depends on many different skills Success depends on many different skills Teams ! Teams !

20. 20 Strategy: Divide and Conquer Before MESA Testing MESA Testing ConnectathonHIMSS Incorporation – IHE is not just for Demos

21. 21 Phase Activities Before MESA Testing Read, Read, Read the Profiles Read, Read, Read the Profiles Write Test Harnesses Write Test Harnesses Develop / Improve code base Develop / Improve code base MESA Testing Do the tests, in order Do the tests, in orderConnectathon Read the Test Plans Read the Test Plans Plan the week Plan the weekHIMSSIncorporation Write and publish IHE Integration Statements Write and publish IHE Integration Statements

22. 22 Deliverables by Phase Initial Development & Project Setup 09/05 – 11/01/05 Valid CDA/CRS; Valid multi-part mime XDS Message Pre-Connectathon Tests 11/01/05 – 12/01/05 Completion of all Required Tests (and several Optionals) Product Integration 12/01/05 – 01/11/06 A version of TouchWorks that incorporates Phases 1,2 Connectathon 01/16/06 – 01/20/06 Completion of IHE Profile Tests: XDS-MS, ATNA, CT Polish for HIMSS 01/23/06 – 02/08/06 Showcase ready laptops HIMSS 02/11/06 – 02/16/06 Successful Show Planning for 07 HIMSS 02/20/06 – 03/01/06 Rough Needs Analysis for 07 Requirements

23. 23 Progress (from the Scorecard)

24. 24 Component Examples Document Source Document Production Document Production Document Metadata Document Metadata Submission Set Submission Set Web Post (http://… and https://…) Web Post (http://… and https://…) Document Consumer AdHocQuery Generator AdHocQuery Generator Document List Document List Single Document Retrieve Single Document Retrieve Document Presentation Document Presentation Document Parser Document Parser Document Storage Document Storage Document Formatter Document Formatter Web Retrieval (http://… and https://…) Web Retrieval (http://… and https://…)

25. 25 Components – Dont forget PIX or PDQ ATNA – it is not a simple add-on or plug-in Certificate Management Logging – test documentation and verification Configurability – everything, yes, Everything that can be Configurable should be Configurable

26. 26 XDS-MS Document Source Create CDA/CRS documents Validate to CDA schema Use PCC-supplied Schematron Create Submission Set Review and check using NIST Tools Follow Tests in order

27. 27 XDS-MS Consumer Retrieve from file system and consume Test Consumer options: Display Display Import Import Import and parse structured items Import and parse structured items Query Registry Retrieve Document

28. 28 XDS Resources XDS Resources IHE IT Infrastructure Technical Framework, Volumes 1 and 2 National Institute of Standards and Technology (NIST) XDS Wiki http://hcxw2k1.nist.gov/wiki/index.php/XDS_- _Cross-Enterprise_Document_Sharing The people sitting next to you

29. 29 Content Resources Content Resources IHE Profiles CDA/CRS Quick Start Guide EHRVA Validator http://www.xmeta.com:8080/ehrva/ CDA/CRS Schematron IBM Deployment Guide The people sitting next to you

30. 30 Quiz What should you never do while getting ready for HIMSS ?

31. 31 Never Give Up Whatever it is you do for Stress Relief

32. 32 I Ride