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IT Infrastructure for the Enterprise Mike Henderson Principal Consultant, Eastern Informatics Past co-Chair, IT Infrastructure Technical Committee Integration Profiles PDQ PIX PAM EUA PWP PSA RID CT + ATNA (Already Addressed) IT Infrastructure Profiles 2004

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IT Infrastructure for the Enterprise

Mike Henderson

Principal Consultant, Eastern Informatics

Past co-Chair, IT Infrastructure Technical Committee


Integration profiles l.jpg
Integration Profiles

  • PDQ

  • PIX

  • PAM

  • EUA

  • PWP

  • PSA

  • RID

  • CT + ATNA (Already Addressed)


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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Patient Demographic Query (PDQ)

Patient name, Patient ID


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Patient Demographics QueryAbstract / Scope

  • 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


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Patient Demographics QueryValue Proposition

  • 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


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Patient Demographics QueryTransaction Diagram

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

HL7 Version 2.5, Chapter 5

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


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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Patient Identifier Cross-referencing for MPI (PIX)

(Map patient identifiers across independent identification domains)


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Patient Identifier Cross-referencing for MPIAbstract / Scope

  • 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


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Patient Identifier Cross-referencing for MPIValue Proposition

  • 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

  • Leverages standards and transactions already used within IHE


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B:X456C: ?

B:X456C: 2RT

Patient

Identity

Cross References

Patient Identifier Cross-referencing for MPI

Patient Identity Cross

-

reference

Patient

Identification

Manager

Cross

-

reference

Domain

B:

X456 =

C:

2RT

A:

123 =

B:

Y

921 =

C:

3TY

B

:D456

Id=123

A

:235 =

B:

DF45

Id=235

A:678

Patient

Identification

Domain A

Id=3TY

Id=2RT

Id=X456

Id=Y921

Id=D456

Id=DF45

Patient Identity

Patient Identification

Patient Identification

Consumer

Domain C

Domain B


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PIX Integration Profile & MPIThe typical view

Master Patient

Index

Patient Identity Cross-reference Manager

Master (A) PatientIdentity Source

Patient Identification Domain A

(Master Domain)

Patient Identification

Domain B

Patient Identification

Domain C


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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Patient Administration & Management (PAM)

Patient Identification, Admission, Movements & Encounters


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Patient Administration ManagementAbstract / Scope

  • Coordinates exchange of patient registrations, updates, and movements for all clinical areas

  • Information may be received and processed by consumer applications in any clinical domain

  • Optionally allows unambiguous updating of historic patient movement events

  • Demographic and encounter tracking works in both inpatient and ambulatory care settings


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Patient Administration Management Value Proposition

  • Optional support levels allow products to offer “light” or “rich” functionality

  • Aligns legacy IHE Radiology and IT Infrastructure transactions with the latest HL7 standard

    • Permits robust error reporting and automated exception processing

  • Standardizes on HL7 conformance structures

    • Reduces variance among vendor and implementor specification formats


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Patient Administration Management Transaction Diagram

Patient Demographics

Patient Identity Feed

Patient Demographics

Source

Consumer

Patient Encounter Management

Patient Encounter

Patient Encounter

Source

Consumer


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Patient Administration Management Actor Grouping Requirements


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Patient Administration Management Standards Used

HL7 Version 2.5

  • ADT Registration, Update, and Patient Movement Trigger Events

    • Admission/registration

    • Merge, update, link/unlink

    • Movement management


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Patient Administration Management Actors

Patient Demographics Source

  • Definition

    • Responsible for maintaining demographics (name, address, etc.) about patient and related persons

    • Supplies new and updated information to Patient Demographics Consumer

  • Transaction Supported - Required

    • Patient Identity Feed [ITI-30] (as sender)


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Patient Administration Management Actors

Patient Demographics Consumer

  • Definition

    • Uses demographic information provided by the Patient Demographics Source about a patient

  • Transaction Supported – Required

    • Patient Identity Feed [ITI-30] (as receiver)


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Patient Administration Management Actors

Patient Encounter Source

  • Definition

    • Responsible for maintaining encounter information about a patient

    • Supplies new and updated information to the Patient Encounter Consumer

    • Must be grouped with either Patient Demographics Source or Patient Demographics Consumer

  • Transaction Supported - Required

    • Patient Encounter Management [ITI-31] (as sender)


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Patient Administration Management Actors

Patient Encounter Consumer

  • Definition

    • Uses patient encounter information provided by Patient Encounter Source

  • Transaction Supported - Required

    • Patient Encounter Management [ITI-31] (as receiver)


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Patient Administration Management Patient ID Management Transactions

Patient Identity Feed [ITI-30]

  • Definition

    • Patient Demographics Source registers or updates patient

    • Forwards ID, address, NOK, guarantor, etc., to other systems implementing Patient Demographics Consumer

  • Options

    • Merge

    • Link/Unlink


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Patient Administration Management Patient Encounter Management Transactions

Patient Encounter Management [ITI-31]

  • Definition

    • Patient Encounter Source registers or updates an encounter

    • Forwards encounter information to other systems implementing Patient Encounter Consumer

      • Location

      • Providers

      • Dates, times, etc.

  • Options

    • Inpatient/Outpatient Encounter Management

    • Pending Event Management

    • Advanced Encounter Management

    • Temporary Patient Transfer Tracking

    • Historic Movement Management


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Patient Administration Management Encounter Management Options

Inpatient/Outpatient Encounter Management

  • HL7 Trigger Events

    • Admit inpatient (A01/A11)

    • Register outpatient (A04/A11)

    • Discharge patient (A03/A13)

    • Update patient information (A08)

    • Pre-admit patient (A05/A38)

    • Change outpatient to inpatient (A06)

    • Change inpatient to outpatient (A07)

    • Transfer patient (A02/A12)


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Patient Administration Management Encounter Management Options

Pending Event Management

  • Additional HL7 Trigger Events

    • Pending admit (A14/A27)

    • Pending transfer (A15/A26)

    • Pending discharge (A16/A25)


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Patient Administration Management Encounter Management Options

Advanced Encounter Management

  • Additional HL7 Trigger Events

    • Change attending doctor (A54/A55)

    • Leave of absence (A21/A52)

    • Return from leave of absence (A22/A53)

    • Move account information (A44)

    • Merge patient ID list (A40)


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Patient Administration Management Encounter Management Options

Temporary Patient Transfers Tracking

  • Additional HL7 Trigger Events

    • Patient departing – tracking (A09/A33)

    • Patient arriving – tracking (A10/A32)


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Patient Administration Management Encounter Management Options

Historic Movement Management

  • Uses trigger events of any of the above options that have been adopted

  • Adds ZBE segment to contain a unique identifier for the movement

    • Standard segment pending adoption by HL7

  • Adds Z99 trigger event to allow update of any movement information, based on unique ID in ZBE segment

    • Standard trigger event pending adoption by HL7


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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Enterprise User Authentication (EUA)

Single user name & centralized authentication


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Enterprise User AuthenticationScope

  • Support a single enterprise governed by a single set of security policies and having a common network domain.

  • Establish one name per user to be used for all IT applications and devices.

  • Facilitate centralized user authentication management.

  • Provide users with single sign-on.


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Enterprise User AuthenticationValue Proposition

  • Meet a basic security requirement

    • User authentication is necessary for most applications and data access operations.

  • Achieve cost savings/containment

    • Centralize user authentication management

    • Simplify multi-vendor implementations

  • Provide workflow improvement for users

    • Increase user acceptance through simplicity

    • Decrease user task-switching time.

  • More effective security protection

    • Consistency and simplicity yields greater assurance.


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Enterprise User AuthenticationUse Case: Single Sign On

  • Motivation

    • Users need to frequently communicate with many non-integrated IT application services.

    • Managing multiple user identities and passwords is costly to users and system administration.

  • Solution

    • EUA supports a single common user identity for browser-based applications.

    • EUA allows multiple user authentication technologies.

    • EUA uses well-trusted standardized user identity mechanisms: Kerberos and CCOW user context.


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Enterprise User AuthenticationTransaction Diagram


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Enterprise User AuthenticationTransaction Diagram: CCOW Option


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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Personnel White Pages (PWP)

Access to workforce contact information


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Personnel White Pages (PWP) Abstract/Scope

  • Provide access to basic information about the human workforce members

    • Does not include Patients

  • Defines method for finding the PWP

  • Defines query/access method

  • Defines attributes of interest


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Personnel White Pages (PWP)Value Proposition

  • Single Authoritative Knowledge Base

    • Reduce duplicate and unconnected user info database

    • Single place to update

      • Name Changes

      • New Phone Number

      • Additional Addresses

  • Enhance Workflow and Communications

    • Providing information necessary to make connections

      • Phone Number

      • Email Address

      • Postal Address


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Personnel White Pages (PWP)Value Proposition

  • Enhance User Interactions

    • Provide user friendly identities and lists

      • List of members

      • Displayable name of a user

      • Initials query

  • Contributes to Identity Management

    • Additional methods of identity cross verification

      • Name, address, phone number, email

      • Cross reference with Enterprise User Authentication identity

    • Future expansion likely will contain certificates


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PWP - Transactions

DNS

Server

Find Personnel

White Pages

Personnel

White

Pages

Consumer

Personnel

White

Pages

Directory

Query for

Healthcare

Workforce

Member Info

Provide access to healthcare staff information to systems in a standard manner.


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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Patient Synchronized Applications (PSA)

Tune multiple applications to same patient


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Patient Synchronized Applications

Abstract / Scope

  • Patient Synchronization of Multiple Disparate Applications

  • Single Patient Selection

  • When combined with PIX Profile, allows patient synchronization across patient identifier domains

  • When combined with EUA Profile, provides user Single Sign-on (SSO)


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Patient Synchronized Applications

Value Proposition

  • User Convenience:

    • Eliminates the repetitive task of selecting the patient in each application

    • Permits the user to select the patient in the application for which they are most familiar and / or appropriate to the clinical workflow

  • Patient Safety:

    • Ensures all data being viewed across applications is for the same patient

  • Leverage Single Development Effort:

    • Allows vendors to leverage single CCOW enablement effort to support multiple actors:

      • Patient Context Participant (PSA)

      • User Context Participant (EUA)


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Patient Synchronized ApplicationsActors

Context Manager Actor

  • The IHE Context Manager Actor may encompass more than a CCOW context manager function. It may include a number of other components such as the context management registry and patient mapping agent.

    Patient Context Participant Actor

  • The Patient Context Participant Actor shall respond to all patient context changes. This actor shall set the patient context provided the application has patient selection capability.


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Patient Synchronized Applications

Transactions Diagram

These transactions are required by both Actors to claim compliance



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IT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)

2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG) –

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Retrieve Information for Display (RID)

Access patient clinical summaries in presentation format


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Retrieve Information for DisplayAbstract / Scope

  • Simple and rapid access to patient information

  • Access to existing persistent documents in well-known presentation formats: CDA, PDF, JPEG.

  • Access to specific key patient-centric information for presentation to a clinician : allergies, current medications, summary of reports, etc..

  • Links with other IHE profiles - Enterprise User Authentication, Patient Identifier Cross-referencing and Cross Enterprise Document Sharing


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Retrieve Information for DisplayValue Proposition

  • User Convenience:

    • Healthcare providers can "see" the information. A significant integration step.

    • Workflows from within the users’ on-screen workspace or application.

    • Complements multiple simultaneous apps workflow of Patient Synchronized Apps

  • Broad Enterprise-Wide access to information:

    • Web technology for simple clients

    • Clinical data handling fully assumed by the information source that holds clinical data.


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Retrieve Information for DisplayKey Technical Properties

  • Standards Used:

    • Web Services (WSDL for HTTP Get).

    • General purpose IT Presentation Formats: XHTML, PDF, JPEG, CDA L1 (HL7)

    • Client may be off-the-shelf browser or display application.

  • Two services :

    • Retrieve of Specific Information:

      • Patient centric: patient ID

      • Type of Request (see next slide)

      • Date, Time, nMostRecent

    • Retrieve a Document

      • Object Unique Instance Identifier (OID)

      • Type of Request

      • Content Type Expected


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Retrieve Specific Info for Display [11]

Summary of Laboratory Reports

Retrieve Document for Display [12]

Summary of Radiology Reports

Summary of Cardiology Reports

Summary of Surgery Reports

Summary of Intensive Care Reports

Summary of Emergency Reports

Summary of Discharge Reports

List of Allergies

Persistent Document

List of Medications

Retrieve Information for Display

Transaction Diagram

Display

Information

Source

Summary of All Reports

Summary of Prescriptions

Types ofRequests


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Retrieve Information for Display

  • Retrieved Data Presentation and Format

    - Non Persistent Data Content and Presentation is left to the Information Source Actor.

    - Persistent Data Documents are provided by the Information Source Actor in one of the Display Actor proposed formats: JPEG, PDF, CDA L1


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More information….

  • IHE Web sites: www.ihe.net

  • Technical Frameworks, Supplements

    • ITI V2.0, RAD V7.0, LAB V1.2

  • Non-Technical Brochures :

    • Calls for Participation

    • IHE Fact Sheet and FAQ

    • IHE Integration Profiles: Guidelines for Buyers

    • IHE Connect-a-thon Results

    • Vendor Products Integration Statements


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