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IHE IT Infrastructure Domain Update. Karen Witting – IBM IT Infrastructure Planning Committee co-chair. IT Infrastructure Domain (ITI). Supports profiles which supply necessary infrastructure for sharing healthcare information.

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Ihe it infrastructure domain update

IHE IT Infrastructure Domain Update

Karen Witting – IBM IT Infrastructure Planning Committee co-chair


It infrastructure domain iti
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)


An infrastructure interoperability component is
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


Iti strategic focus categories
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


Categories of healthcare communication services
Categories of Healthcare Communication Services

Patient and Provider Identity Management

Exchange of Health Information

Hospitals

Security/Privacy

e.g. order lab test, track status and receive results

e.g. access last 6 mo. historical labs & encounter summaries

e.g. get current list of allergies or med list from source

Document

Sharing

Dynamic Information

Access

Workflow

Management

Source persisted and attested health records

Specific info snapshot

provided on demand

2 or more entities

synchronize

a task


Iti profiles
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


Iti profiles continued
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


Xds scenario use of atna ct

EHR System

ED Application

Physician Office

XDS Document Repository

PACS

XDSDocument Repository

EHR System

PACS

Lab Info. System

Teaching Hospital

Community Clinic

ATNA Audit record repository

CT Time server

XDS Scenario + Use of ATNA & CT

PMS

XDS Document Registry

Query Document

Register Document

Secured Messaging

Retrieve Document

Provide & Register Docs

Maintain Time

Maintain

Time

Record Audit

Event

Maintain

Time

Record Audit

Event

Record Audit

Event


Document Content & Modes of Exchange

Document Content Profiles

PreSurgery

PPH P

Consent

BPPC

Emergency

EDR

Scanned Doc

XDS-SD

Laboratory

XD*-Lab

Discharge &Referrals

XDS-MS

PHR Exchange

XPHR

Imaging

XDS-I

Document Exchange Integration Profiles

Document

SharingXDS

ReliableInterchange

XDR

MediaInterchange

XDM

Cross-Community

AccessXCA


Xds scenario use of pix pdq

A87631

A87631

A87631

14355

M8354673993

M8354673993

M8354673993

M8354673993

EHR System

ED Application

Physician Office

XDS Document Repository

PACS

XDS

Document Repository

EHR System

PACS

Lab Info. System

L-716

L-716

L-716

Teaching Hospital

Community Clinic

ATNA Audit record repository

CT Time server

XDS Scenario + Use of PIX & PDQ

PDQ Query to Acquire Affinity Domain Patient ID

Patient Identity Feed

Patient Identity XRef Mgr

Patient Identity Feed

Affinity Domain Patient

Identity Source

Patient Identity Feed

Patient Identity Feed

PIX

Query

Document Registry

PIX

Query

Query Document (using Pt Id)

Register (using Pt ID)

Provide & Register Docs

Retrieve Document

PACS


Cross community demonstrating sharing across regional boundaries

Gateway

CALIFORNIA

Document

Registry

Practice

Practice

Hospitals

Practice

Hospitals

Practice

Hospitals

Hospital

Practice

Hospital

Hospital

Patient ID

services

Clinic

Clinic

Clinic

Repository

Clinic

Repository

Cross-CommunityDemonstrating Sharing across regional boundaries

NEW YORK

Document

Registry

ILLINOIS

Document

Registry

XCPD / XCA / XDR transactions

Practice

Practice

Hospitals

Practice

Hospitals

Practice

Hospitals

Gateway

Hospital

Practice

Hospital

Hospital

Patient ID

services

Practice

Gateway

Practice

Hospitals

Clinic

Practice

Hospitals

Clinic

Practice

Hospitals

Clinic

Repository

Clinic

Repository

Patient ID

services

Clinic

Clinic

Repository

Repository

NORTH CAROLINA

Document

Registry

Gateway

Practice

Practice

Hospitals

Practice

Hospitals

Hospitals

Patient ID

services

Clinic

Repository


2010 committee activities
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


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.


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

2011 Committee Activities


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


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


Learn more and start to participate
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


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