bill majurski national institute of standards and technology (nist) it infrastructure: profiles for...

Bill MajurskiNational Institute of Standards and Technology (NIST)

IT Infrastructure: IT Infrastructure: Profiles for Health Profiles for Health

Information Information ExchangeExchange

Affinity Domain Profiles

HIE Profiles

Categories of Profiles

Basic XDS

Cross Community

Point-to-Point

Notification

Patient ID Management

All focus on or support Document Sharing

What is XDS?

XDS is Cross-Enterprise Document Sharing

Cross-Enterprise – Elements can be owned by different organizations

Document Sharing – Elements of patient record organized as 'Documents'

Basic XDS

XDS.a - Original

XDS.b – Updated technology

Cross Community

XCA – Cross Community Access

Point-to-Point

XDM – Media Interchange (email, CD, etc.)

XDR – Reliable networking

Notification

NAV – Notification of Document Availability

Patient ID Management

PDQ – Patient Demographics Query

PIX – Patient Identifier Cross-Referencing

What is a Document?

Cross-Enterprise Document Sharing

What is a Document?

Collection of bytes

Persistent/Unchangeable

Documented Format

What We Will Not Discuss

Document Content Format

Security

These are covered in other talks

XDS Content

XDS does not define content•...just like your PC filesystem does not define file types•PDF, Word, Text, JPEG files are just collections of bytes. The file type is what links the file to an application.•XDS Content Profiles define what the bytes mean

XDS Content Profiles

• Content Profiles define document formats and XDS extensions for specific applications:– XDS-MS: Medical Summaries– BPPC: Basic Patient Privacy Consents– XPHR: Exchange of Personal Health Record Content– PPHP: Pre-procedure History and Physical – EDR: Emergency Department Referral– XDS-SD: Scanned Documents– XDS-Lab: Lab Reports– XDS-I: DICOM Images

Security is still required

– ATNA: Audit Trail and Node Authentication

• Basic security functions: centralized audit trail,authentication of systems (not users),optional encryption for transport connections

• Required by IHE for all XDS implementations

What are we defining?

IHE Profiles are NOT an architecture

It is a collection of architectural components

To build into new or existing systems

To aid in integration

XDSXDSCross-enterprise Cross-enterprise

Document SharingDocument Sharing

XDS

• Big Picture

• Transactions and Actors

• Metadata

• How it integrates with PIX/PDQ

• Common configurations

XDS: Big Picture

• 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

XDS: Big Picture

• 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

• Archival

XDS: Big Picture

• 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.

XDS: Big Picture

• Distributed: Each Care delivery organization “publishes” clinical information for others. Actual documents may remain in the source system.

• Cross-Enterprise: A Registry provides an index for published documents that can be queried!

• Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (HL7-CDA/CCD, PDF, DICOM, etc.)

XDS: Big Picture

• Document Content Neutral: Document content is processed only by source and consumer systems. Infrastructure is generic.

• Standardized Registry Attributes: Documents are described by standardized set of attributes. Standardized queries supported by all vendors.

XDS Actors

• Document Source

• Document Repository

• Document Registry

• Document Consumer

Document Source

• Has document to store

• Creates description (metadata) for document

• Submits

Document Repository

• Accepts document and metadata from Document Source

• Stores document

• Forwards metadata to Document Registry

• Later, reproduces document on request (allows retrieval)

Document Registry

• Accepts metadata from Repository

• Stored metadata

• Accepts queries about metadata

• Returns metadata matching queries

Document Consumer

• Generates queries to Registry

• Accepts metadata back from Registry

• Displays list of documents for user to choose from (probably)

• When user selects document from list, retrieves and displays document

XDS Transaction Diagram

Patient Identity Source

Document Registry

Document Repository

Document Source

Document Consumer

Patient Identity Feed

Query Documents

Retrieve Document

Provide and Register

Document Set

Register Document Set

Patient Registration


Document Registry


Document Submission

Document Registry

Document Repository

Document Source


Document Set


Query and Retrieve

Document Registry

Document Repository

Document Consumer

Query Documents

Retrieve Document


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

Metadata Objects

• Metadata is data stored in the Registry• Document - represents a real document• Submission Set - included in all

submissions to document the submitted “package”

• Folder - for grouping documents (directory metaphor)

• Association - Links other objects together

Object Structure

• Each Metadata Object has internal structure

• ebRIM standard coding used (XML)

SubmissionSet

DocumentAssociation(HasMember)

Single Document Submission

Envelope Contents

Metadata

Submission Set Attributes

• Author – person, role,

specialty, institution

• Title, comments, submission time

• Availability Status– Submitted or

Approved

• Coded elements– contentType (type

of clinical activity)

• Identifiers– Patient ID, Source

ID, Unique ID, UUID

Document Attributes

• Author– Person, role, specialty,

institution

• Legal Authenticator• Title, comments,

creation time, service start/stop time

• Availability Status– Submitted, Approved,

Deprecated

• Identifiers– Patient ID, Unique

ID, UUID

• Demographics– Source Patient ID,

Patient Demographics

Document Attributes (cont)

• Coded Values– Kind of Document

• Class Code (general catagory)

• Type Code (more detail)

– Event Code (main clinical event)

– Healthcare Facility Type

– Practice Setting Type– Confidentiality Code

• Technical Details– MIME Type – Format Code (more

detail)– Size– Hash– URI– Language

Document Attributes (cont)

Document Metadatapoints to

Document

in Repository

Association Attributes

• Type– HasMember– RPLC (Replace)– APND (Appends)– XFRM (Transformation)– Signs

• SubmissionSetStatus– Original or Reference

• Pointers– sourceObject, targetObject

Multiple Document Submission

SubmissionSet

DocumentAssociation(HasMember)

DocumentAssociation

(HasMember)

SubmissionSet

Status = Approved

DocumentStatus = Approved

Association(HasMember)

SubmissionSet

Status = Approved



Association(RPLC)


Status = Deprecated

Document Replacement

Digital Signature

• Clinical Document Stored in Repository– Indexed in Registry

• Digital Signature (Document) Stored in Repository– Indexed in Registry

• How is Signature “attached” to Clinical Document?

Digital Signature (DSG Profile)

SubmissionSet

Status = Approved

ClinicalDocument

Status = Approved


SubmissionSet

Status = Approved

SignatureDocument

Status = Approved


Association(Signs)

XDS Metadata handling


Document Registry

Document Repository

Document Source

Document Consumer


Query Documents

Retrieve Document


Document Set


Generates

Stores

Interprets

Adds

XDS 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

Affinity Domain

• Set of organizations/systems organized around a single Registry

• Common set of Codes

• Single Patient ID Domain

• Involves business and legal agreements

• Security model/agreements

Enterprise

Enterprise

Enterprise

EnterpriseImaging Center

Hospital B

Hospital A

Emergency Room

PCP

PatientAdmin

Repository

Repository

Repository

Repository

Cross-Enterprise Document Registry(XDS)

-Cross Enterprise Document

Registry(XDS)

XDS Example

HealthcareContent Standards

HL7 CDA, CEN EHRcomHL7, ASTM CCR

DICOM …

Internet StandardsHTML, HTTP,

ISO, PDF, JPEG …

Electronic BusinessStandards

ebXML, SOAP …

XDS: Standards Used

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

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

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)

Two “categories” of standards used

XDS Infrastructure

XDS Content

XDS: Standards Used

XDS Content Profiles

• Outside scope of XDS; layer on top of XDS • Content Profiles

– Document use cases and translation of document content into registry metadata

– Publishable separately– Generated (mostly) by other committees (PCC,

Radiology, Lab etc)

• Of concern only to Document Source and Document Consumer actors

• Base standards for Content Profiles include: HL7 CDA, DICOM, ASTM CCR

XDSXDSQuery Catalog Query Catalog

supported by Stored Querysupported by Stored Query

Stored Query

• Defines a collection of queries– Name– Function/purpose they serve– Parameters they accept

• Must be supported by all XDS Registries!

Query Types

• Primary queries– Based on Patient ID

• Secondary queries– Based on registry identifiers

Primary Queries

• FindDocuments– Find documents for a patient

• FindSubmissionSets– Find submission sets for a patient

• GetAll– Get everything known about a patient

• Each have parameters to restrict documents ‘found’

Secondary Queries

• GetDocuments– Given the ids of the documents

• GetFolders– Given the ids of the folders

• GetAssociations– Related to a given

document/folder/submission set

Secondary Queries (cont)

• GetDocumentsAndAssociations– Combines GetDocuments and GetAssociations

queries

• GetSubmissionSets– For a collection of documents and/or folders

• GetSubmissionSetAndContents– Given the id of the submission set, return its

contents

Secondary Queries (cont)

• GetFolderAndContents– Given the id of a folder return the folder and its

contents

• GetFoldersForDocument– Given the id of a document return all folders

that ‘contain’ the document

• GetRelatedDocuments– Given the id of a document return all

documents that are related to the document through an association

XDS.a vs XDS.b

XDS.a• Older standards• Registry

(ebRIM/ebRS 2.1)

• Web Services (SOAP w Attachments)

• Most transactions are WS

• HTTP Retrieve

XDS.b• Newer Standards• Registry

(ebRIM/ebRS 3.0)

• Web Services (Addressing, MTOM/XOP)

• All transactions are WS

• WS Retrieve

XDS ConfigurationsXDS ConfigurationsUnderstanding how Understanding how

the actors work togetherthe actors work together



Document Registry

Document Repository

Document Source

Document Consumer


Query Documents

Retrieve Document


Document Set


Source/Consumer Grouping

• A single 'workstation' that can submit and access content.



Document Registry

Document Repository

Document Source

Document Consumer


Query Documents

Retrieve Document


Document Set


Registry/Repository Grouping

• Affinity Domain could offer a central Repository along with Registry to serve facilities that do not have local Repository.



Document Registry

Document Repository

Document Source

Document Consumer


Query Documents

Retrieve Document


Document Set


Source/Repository Grouping

A source of documents could be an existing EHR which

• Registers documents in Registry

• Allows document retrieval via Retrieve Document transaction

• Stores information internally in non-document formats

• Must manage document persistence

What is a Document?

• Content/Documents have 3 formats:– Storage – Transfer/interface– Display

• XDS constrains the transfer/interface through Content Profiles– Use of IHE published Content Profiles is a

local choice. It is not required by XDS.

• Transfer/interface formats are chosen locally by Affinity Domain

• IHE only makes recommendations

Support ProfilesSupport Profiles“Infrastructure for XDS”“Infrastructure for XDS”

XDS Support

Collection of profiles that support XDS• Globally Consistent Time (CT profile)• Patient Management (PIX/PDQ profiles)• Node Authentication (ATNA profile)• Audit Logging (ATNA profile)• Authorization Assertions (XUA profile)• Notification of Availability (NAV)• Digital Signature (DSG)

Support ProfilesSupport ProfilesConsistent Time (CT)Consistent Time (CT)

Consistent Time Profile

• XDS describes a distributed system - time synchronization is critical

• Network Time Protocol ( NTP) version 3 (RFC 1305) for time synchronization

• Actor must support manual configuration

• Required accuracy: 1 second

• Optionally Secure NTP may be used

Support ProfilesSupport ProfilesPatient Identifier Cross-referencing (PIX)Patient Identifier Cross-referencing (PIX)

Patient Identifier Cross-referencing (PIX)

• Allow all enterprise participants to register the identifiers they use for patients in their domain

• Participants retain control over their own domain’s patient index(es)

• Support domain systems’ queries for other systems’ identifiers for their patients

• Optionally, notify domain systems when other systems update identifiers for their patients

Patient Identifier Cross-referencing (PIX)

• Maintain all systems’ identifiers for a patient in a single location

• Use any algorithms (encapsulated) to find matching patients across disparate identifier domains

• Lower cost for synchronizing data across systems– No need to force identifier and format

changes onto existing systems

Patient Identity Feed [ITI-8]

PIX Query [ITI-9] PIX Update Notification [ITI-10]


Patient Identity Crossreference Manager

Patient Identity Consumer

PIX Transaction Diagram

XDS: PIX integration


Document Registry

Document Repository

Document Source

Document Consumer


Query Documents

Retrieve Document


Document Set


PIX XREF ManagerPIX Query

PIX Actors

• Patient Identity Source– Definition

• Assigns patient identities within its own domain• Notifies Patient Identifier Cross-reference Manager

of all events related to patient identification (creation, merge, etc.)

• Example: Registration (ADT) Actor in IHE Radiology Scheduled Workflow (SWF) Profile

– Transaction Supported - Required• Patient Identity Feed [ITI-8] (as sender)

PIX Actors

• Patient Identifier Cross-reference Consumer– Definition

• Requires information about patient identifiers in other domains

• Requests patient identifier information from Patient Identifier Cross-reference Manager

– Transaction Supported - Required• PIX Query [ITI-9] (as sender)

– Transaction Supported - Optional• PIX Update Notification [ITI-10] (as receiver)

PIX Actors

• Patient Identifier Cross-reference Manager– Definition

• Serves a well-defined set of Patient Identifier Domains

• Receives patient identifier information from Patient Identity Source Actors

• Manages cross-referencing of identifiers across domains

– Transactions Supported - Required• Patient Identity Feed [ITI-8] (as receiver)• PIX Query [ITI-9] (as receiver)• PIX Update Notification [ITI-10] (as sender)

PIX: Standard Used

• HL7 Version 2.5– ADT Registration and Update Trigger Events

• A01: inpatient admission• A04: outpatient registration• A05: pre-admission• A08: patient update• A40: merge patient

– Queries for Corresponding Identifiers (ADT^Q23/K23)

– Notification of Identifiers Lists Updates (ADT^A31)

PIX Summary

• Patient ID management

• Translation of Patient IDs across Patient ID domains

• Patient ID feed

• Query & Notification of Cross Referencing

PIX as seen from XDS

• NOT a requirement

• XDS Affinity Domain allows only a single Assigning Authority for Patient IDs

• Implication: do your complex Patient ID management outside of the XDS environment

• To 'do' XDS, translate your Patient IDs to the Patient ID Domain (Assigning Authority) defined for the Affinity Domain.

Patient ID Responsibilities

Who must manage?• Document Source• Document Consumer• (known as Edge Systems)

• Registry and Repository only see Assigning Authority defined for Affinity Domain

• (known as Infrastructure Systems)

Edge Systems

Must translate local Patient ID to Affinity Domain Patient ID

• Use request to PIX Cross-Reference Manager– Translate PID X in local domain– To domain Affinity Domain– Return is PID in Affinity Domain

Edge Systems

• Management of healthcare information always starts with a Patient

• Identified by name and demographics• PDQ query translates

name/demographics to pick-list of matching Patients

• Produces Patient ID in a domain

Registry

Registry has two uses for Patient ID• What are valid Patient IDs

– Consistency check against submitted documents

• Handle request to Merge two Patient IDs

• PIX profile supplies both of these to Registry

Support ProfilesSupport ProfilesPatient Demographic Query (PDQ)Patient Demographic Query (PDQ)

Patient Demographics Query (PDQ)

• Allow quick retrieval of a patient list including common patient names, identifiers, contacts, and visit information

• Enable selection of correct patient when full identification data may not be available

• Limits access to only a subset of demographic and visit information


• Enables access on demand to diverse systems and devices – Participants that do not need continual

synchronization of patient registration information

– Devices that cannot participate in monitoring of ADT feeds, e.g.:

• Small-footprint devices• Low-memory devices


• Allow search on full or partial data

• Retrieve information from any domain to which the client has query access

• Allows use of matching algorithm (e.g., soundex) to find near matches

Patient Demographics Supplier

Patient Demographics Consumer


Query

Patient Demographics and Visit Query

A departmental system that is connected on demand to the registration system.

Diverse systems including bedside monitors, physician office systems, lab applications, mobile blood bank registries; might be any system at the point of contact.

PDQ Transaction Diagram

PDQ Standards Used

• Employs HL7 Conformance Based Queries– Defined in HL7 Version 2.5, Chapter 5– Profiles Query by Parameter (QBP^Q22)

with Segment Pattern Response (RSP^K22)

PDQ Actors

• Patient Demographics Consumer • Definition

– Requestor of patient demographic (and perhaps current visit) information

– Allows user to associate information with a patient at the point of care

• Transaction Supported – Required– Patient Demographics Query (as sender)

• Transaction Supported – Optional– Patient Demographics and Visit Query (as sender)

PDQ Actors

• Patient Demographics Supplier • Definition

– Repository of patient information that can be searched on demographic or visit-related fields

• Transaction Supported – Required– Patient Demographics Query (as receiver)

• Transaction Supported – Optional– Patient Demographics and Visit Query (as

receiver)

PDQ Operation

• Patient Demographics Query • User enters full or partial demographic

information (e.g., partial last name and first initial) for patients of interest

• Application associated with Patient Demographics Consumer sends HL7 QBP^Q22 to Patient Demographics Supplier to find matching information– May request specific domains from which to

return identifier information

XDS: PIX/PDQ integration


Document Registry

Document Repository

Document Source

Document Consumer


Query Documents

Retrieve Document


Document Set



Supplier

PIX XREF ManagerPIX Query

Patient Demographics Query

Support ProfilesSupport ProfilesAudit Trail and Node Authentication (ATNA)Audit Trail and Node Authentication (ATNA)

Content ProfilesContent Profiles

Definition

• XDS defines a mechanism for sharing ‘Documents’

• ‘Document’ defined as a byte stream with a size, hash, and mime type

• Content Profiles are standardized document formats defined within IHE

Domains

• The following IHE Domains have defined XDS Content Profiles

• IT Infrastructure (ITI)

• Radiology

• Laboratory

• Patient Care Coordination (PCC)

IT Infrastructure

XDS-SD• Scanned document

• Stored in PDF format

• Wrapped in CDA/R2

Basic Patient Privacy Consents (BPPC)• More than a Content Profile

• Includes privacy processing rules enforced by the Document Registry in queries

Radiology

XDS-I (XDS for Imaging)• Normal XDS actors plus

– Image Document Source (extension to XDS Document Source)

– Image Document Consumer (extension to XDS Document Consumer)

– Image Document Source stores Radiology images locally in Image Archive

– Image Manifest Document stored in XDS Repository– Manifest (also called Key Object Select - KOS)

references specific DICOM content in Image Archive

Retrieving Radiology Content

• Query Registry, receive metadata – Metadata describes Image Manifests

• Choose and retrieve Image Manifest(s) from Document Repository

• Decode Manifest and retrieve Image content from Image Archive

Laboratory

• Lab Report

Patient Care Coordination

Many, many Clinically oriented Content Profiles

XDR / XDMXDR / XDMPoint-to-point transmissionPoint-to-point transmission

of documentsof documents

XDM

Cross-Enterprise Document Media Interchange

XDM

Big Picture

Documents and XDS Metadata shared via media

XDM

Cross-Enterprise Document Media Interchange (XDM)

Options

• USB

• CD-R

• ZIP over email

XDM

• Imposes File/Directory structure on the media

• Transport Multiple XDS Submission Sets • Each Submission Set has

– Metadata describing documents– Documents

• Protocol structure of XDS imposed on file/directory organization

XDM

Uses

• Release of documents to patient

• Manual (in pocket or email) transfer of documents

• Local display after receipt– Index.htm file required to support

display

• These are manual operations!

XDR

Cross-Enterprise Document Reliable Interchange

XDR

Cross-Enterprise Document Reliable Interchange (XDR)

• Point-to-point transmission of XDS content over reliable communications

• Uses Provide and Register transaction (from XDS)

• A new profile but really just documents how to use Provide and Register to perform point-to-point transfers.

XDR

Reliable asynchronous point-to-point transfer of XDS metadata and documents

• Reliable transfer comes from ebMS Messaging Services Specification v2.0

XDR

• Single Submission Set per transfer– More like XDS than XDM

• Optionally identify intended recipients

XDS + XDR + XDM

How do XDR and XDM work with XDS?

• XDS Query/Retrieve can feed XDR/XDM transmission

• Point-to-point transfer via XDR/XDM can feed XDS submission

XCAXCACross-Community Cross-Community

AccessAccess

XCA

Big Picture

• XDS defines the operation of an Affinity Domain (single Registry + ...)

• XCA defines interchange between multiple communities. An Affinity Domain is one type of community.

XCA

Features of an XCA community• Accept Query and Retrieve

transactions from other communities– Allows sharing of local documents

• A community could be an Affinity Domain...or not.

XCA

A few details• Uses Stored Query and XDS.b

Retrieve to access foreign community content

• A query can be broadcast to multiple communities (document discovery)

• Introduces homeCommunityId to identify/address communities

• Uses ebRIM/ebRS 3.0 (like XDS.b)

XCA

Tough problems still to be solved• Patient ID management

– How to manage translation between communities

– PIX/PDQ provide some of the necessary features

• Configuration Management– How to translate/manage coding

Community Community Network BNetwork B

Document Registry

PracticePracticePractice

ClinicClinicClinicClinic

HospitalsHospitalsHospitalsHospital

Diag Test

Other

PracticePractice HospitalHospital

Community Community Network CNetwork C

Document Registry

PracticePractice

Clinic

Hospitals

Hospitals

IHE transactions (future)

CrossCommunityGateway



National Network ANational Network A

Non-IHE Non-IHE National National EHREHR

Which community holds records for a patient ?

XDS Cross Community…Access

• Cross-Community Gateways query and retrieve records (2007 & future)

• National or Regional Networks not required to be IHE-based

• Mapping to & from IHE Transactions performed by X-Community Gateways

Regional Network BRegional Network B

Acute Care (Inpatient)

PCPs and Clinics (Ambulatory)

Long Term Care

Other Specialized Careor Diagnostics Services

Document Registry

DocumentRepository

Longitudinal Recordas usedacross-encounters

Regional Network CRegional Network C



Long Term Care


Document Registry

DocumentRepository


Regional Network ARegional Network A



Long Term Care


Document Registry

DocumentRepository


Cross Community Cross Community GatewayGateway

Which community holds records for a patient ?

CrossCrossCommunityCommunityGatewayGateway

CrossCrossCommunityCommunityGatewayGateway

CommunityCommunityLocator serviceLocator service

IHE TransactionsIHE Transactions(future)(future)

Cross-Community…Location

• Each region notifies Community Location Service when new patient is registered or first data is stored.

• Cross Community Gateways query Community Locator Service (future)

• Cross-Community Gateways query and retrieve records (2007 & future)

Other Cross-community Issues…

• Management of Patient IDs– Normally managed within Affinity

Domain

• Clinical Coding– Normally managed within Affinity

Domain

Cross Community Access: Value Proposition

• Sharing of documents beyond the XDS Affinity Domain (community) boundary.

• Part of a larger vision for regional and national sharing – 2006 whitepaper on Cross Community Information Exchange– Cross Community Access (2007)– Cross Community Location (2008)

• Scoped to document sharing between XDS Affinity Domains. Future goal to define sharing with other types of communities.

Cross Community Access: Technical Solution

• Cross Community Gateway– A new actor which supports all inter-community

communications. Encapsulates in one actor all activities required to communicate outside the community.

– Every community would have one cross community gateway which would interact with actors within the community and remote cross community gateways.

• Cross Community Consumer– Initiator of a request for information beyond the community.

• Technical Issues:– Need for asynchronous transactions in the cross community

environment– Interaction with existing XDS actors– Reliable identification of the patient

Community Community Network BNetwork B

Document Registry

PracticePracticePractice


HospitalsHospitalsHospitalsHospital

Diag Test

Other

PracticePractice HospitalHospital

Community Community Network CNetwork C

Document Registry

PracticePractice

Clinic

Hospitals

Hospitals

18 edge systems4 infrastructure systems

5 edge systems 4 infrastructure systems

13 edge systems3 infrastructure systems

3 infrastructureSystems

Community Community Network ANetwork A

Document Registry

PracticePracticePracticePracticePractice


HospitalsHospitalsHospitals

Diag Test

HIMSS Interoperability ShowcaseThe largest multi-vendor prototype ever built !

Patient Information Options

• PIX Feed to Document Source/Consumer

• PDQ queries from Document Source/Consumer

• Use of Patient ID Cross-Referencing by Document Source/Consumer

These are all optional within XDS!

Patient ID Patient ID MergeMerge

Merge

Issues• Patient Management is an imperfect

art• Documents get assigned to the wrong

Patient ID• Multiple Patient IDs identify single

Patient• Single Patient ID identifies content for

multiple Patients

Merge

• Merge Supplement starts to offer tools to manage these issues in XDS

• Relies on PIX notification of Patient ID related problem

• Current scope is to merge two Patient IDs that are found to represent same Patient

• Early work ... still evolving

bill majurski national institute of standards and technology (nist) it infrastructure: profiles for...

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