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

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

3. An Infrastructure Interoperability Component Is… An infrastructure Interoperability component… – 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. Categories of Healthcare Communication Services Security/Privacy Document Sharing Patient and Provider Identity Management Dynamic Information Access Workflow Management Source persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task e.g. access last 6 mo. historical labs & encounter summaries e.g. order lab test, track status and receive results e.g. get current list of allergies or med list from source Hospitals Exchange of Health Information

6. 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

7. ITI Profiles (continued) Information Exchange – Cross-Enterprise Document Sharing - b (XDS.b) ☼ – 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

8. 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 Maintain Time Maintain Time Record Audit Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

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

10. Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + Use of PIX & PDQ A87631 PACS L-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

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

12. 2010 Committee Activities ITI Technical committee 2010 – Delivered 2010 versions of Technical Framework and Supplements Processing of numerous Change Proposals (CPs) Integration of CPs into 2010 versions of documentation – Delivered new supplements Healthcare Provider Directory (HPD) Cross-Enterprise User Assertion - Attribute Extension (XUA++) XDS Metadata Update SVS Extension On-Demand Documents Delayed Document Assembly ITI Planning Committee 2010 – 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

13. 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.

14. 2011 Committee Activities ITI Technical Committee – New Supplements/Handbook For 2011 (next chart) – Change Proposal processing – Delivery of 2011 updated version of Technical Framework and prior year Supplements 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

15. 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 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

16. 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

17. 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