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IHE IT Infrastructure Domain Update

IHE IT Infrastructure Domain Update. Karen Witting – IBM IT Infrastructure Technical Committee co-chair. IHE - Connecting standards to care. Care providers work with vendors to coordinate the implementation of standards to meet their needs

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IHE IT Infrastructure Domain Update

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

  2. IHE - Connecting standards to care • Care providers work with vendors to coordinate the implementation of standards to meet their needs • Care providers identify the key interoperability problems they face • Drive industry to develop and make available standards-based solutions • Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions

  3. IT Infrastructure Domain (ITI) • Supports profiles which supply necessary infrastructure for sharing healthcare information. • IT Infrastructure domain began in 2003 and now has 18 profiles that it supports. • Key ITI profiles demonstrated today: • Information Exchange: XDS, XDM, XDR, XDS-SD, RFD • Security: ATNA, CT • Identity Management: PIX, PDQ (HL7 V2 & V3)

  4. 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 RHIO or Health Information Exchange • Is a necessary ingredient, but is rarely visible to the end user

  5. Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Document Content and Modes of Document Exchange Doc Content Profiles PreSurgery PPH P Consent BPPC Emergency EDR Scanned Doc XDS-SD Document Exchange Integration Profiles Document SharingXDS ReliableInterchange XDR MediaInterchange XDM XDS Stored Query

  6. New in 2006 • Document Interchange and content profiles: • Cross-Enterprise Document Media Exchange (XDM) • Cross-Enterprise Document Reliable Interchange (XDR) • Cross-Enterprise Sharing of Scanned Documents (XDS-SD) • XDS Stored Query Transaction (addition to XDS) • Patient Identifier Cross-Reference and Patient Demographic Query HL7 V3 (PIX/PDQ V3) • HL7 V3 based PIX and PDQ transactions • Retrieve Form for Data Capture (RFD) • Gather data within a user’s current application to meet requirements of an external system. Supports form retrieval, form completion, form submission. • Applicable to usecases: drug trials, public health reporting, pharmaco-vigilance, cardiology research,

  7. 2003-2005 • Information Exchange • Retrieve Information for Display (RID) • Patient Identifier Cross-Referencing (PIX)☼ • Patient Synchronized Applications (PSA) • Cross-Enterprise Document Sharing (XDS) ☼ • Patient Demographics Query (PDQ) ☼ • Notification of Document Availability (NAV) • Patient Administration Management (PAM) • Security • Enterprise User Authentication (EUA) • Consistent Time (CT) ☼ • Audit Trail and Node Authentication (ATNA) ☼ • Personnel White Pages (PWP) • Document Digital Signature (DSG) ▀ colored text designates profiles still in Trial Implementation ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2007

  8. Categories of Healthcare Communication Services HIEs and RHIOs Hospitals Patient and Provider ID Mgt e.g. access to last 6 months historical labs and encounter summaries e.g. get a current list of allergies or med list from a source e.g. order a lab test, track status and receive results Security 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

  9. Health Information Exchanges Interoperability: Cross-enterprise Document Sharing • Cross-Enterprise Document Sharing simplifies clinical data management by defining interoperable infrastructure. Transparency = Ease of Evolution • Patients have guaranteed portability and providers may share information without concerns of aggregation errors.Digital Documents = Patients and providers empowerment • Supports both centralized and decentralized repository architectures. Ease of federation nationally. Flexible privacy, Flexibility of configurations • Addresses the need for a longitudinal healthcare data and its intend is for support of archival data. It does not address workflow or dynamic data access. • Workflows addressed in a second step in a much simpler manner.Point-to-Point messages best suited for workflows mgt

  10. Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … • Implemented world-wide by more than 30 vendors/open source. Final text published December 2006. • Adopted in several national & regional projects (Italy, France, Canada, Austria, USA, etc.) • IHE XDS: 42,300 “Google” references (Feb’ 07) Electronic BusinessStandards ebXML Registry, SOAP, Web Services … Internet Standards HTML, HTTP,ISO, PDF, JPEG …

  11. Why is IHE-XDS a breakthrough ? • It based on an International Standards; ebXML registry: OASIS and ISO standard, Web Service/Soap/XML. • Sharing of digital documents as “attested by the source”, meets the most urgent needs. A proven healthcare community data-sharing paradigm (Message feeding a central web server hinders use of EHRs). • Efficient to support all types of Health IT Systems (IDNs, Hospitals, Ambulatory, Pharmacy, Diagnostics Centers, etc.) and all types of information (summaries, meds, images, lab reports, ECGs, etc.), structured and unstructured. • Meets both the needs of point-to-point push communication and on-demand pull in a variety of centralized or distributed architectures. Offer a consistent, standards-based and functional record sharing for EHRs, PHRs & other IT Systems

  12. 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 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

  13. 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 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

  14. Hierarchical ExchangeFrom Cross Community Information Exchange White Paper Document Registry Document Registry Document Registry Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Long Term Care Long Term Care Long Term Care Regional Network A Regional Network B Acute Care (Inpatient) Acute Care (Inpatient) Acute Care (Inpatient) Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) DocumentRepository DocumentRepository DocumentRepository Which community holds records for a patient ? CommunityLocator service CrossCommunity Bridge IHE Transactions (future) CrossCommunity Bridge Cross Community Bridge • Each region notifies Community Location Service when new patient is registered or first data is stored. • Cross Community Bridges query Community Locator Service (future) • Cross-Community Bridges query and retrieve records (2007 & future) Regional Network C

  15. Lateral Exchange and non-IHE DomainsFrom Cross Community Information Exchange White Paper Document Registry Document Registry Document Registry Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Longitudinal Recordas usedacross-encounters Long Term Care Long Term Care Long Term Care National or Regional Network B Acute Care (Inpatient) Acute Care (Inpatient) Acute Care (Inpatient) Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services Other Specialized Careor Diagnostics Services PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) PCPs and Clinics (Ambulatory) DocumentRepository DocumentRepository DocumentRepository National Network C XDS Affinity Domain (NHIN sub-network) What communities have specific attributres? Community Search Service National Network A Non-IHE National EHR CrossCommunity Bridge IHE Transactions (future) CrossCommunity Bridge Cross Community Bridge • National or Regional Networks not required to be IHE-based • Mapping to & from IHE Transactions performed by X-Community bridges • Mapping practical as most European projects use variants of structured document sharing CommunityLocator service IHE based Sub-Networks Non-IHE Sub-Net Integrated Delivery Network

  16. IHE IT Infrastructure – Schedule for 2007 • Development Schedule: • Planning Committee decision: January 2007 • Issue Public Comment version: June 2007 • Public Comment Due: July 2007 • Issue Trial Implementation version: August 2007 • IHE Connectathon: January 2008 • HIMSS Demo: February 2008

  17. IHE IT Infrastructure – Plan for 2007 • New Supplements For 2007 • Web Services for XDS • Cross Enterprise User Authentication (XUA) • Cross Community Access (XCA) • Significant updates to existing last years profiles • PIX/PDQ HL7 V3 transactions updated to support latest V3 specification • RFD updated for latest level of XForms specification • White Papers for 2007 • Configuration Management • Security Risk Management • Web Services Roadmap • Aggregate Data • Meeting Privacy Principles using IHE Profiles • Come to the HIMSS ITI Planning meeting Wednesday 2/28 1-3 room 297 for more details about this years work items

  18. IHE IT Infrastructure Roadmap 2008-2009+ Profile Candidates • Continue Prior Profile Work • Web Services and SOA for Healthcare • Cross- Community Location • Cross-Enterprise User Authentication (Phase 2) • Advance White Papers to Profiles • Aggregate Data Monitoring • Configuration Management And then….

  19. IHE IT Infrastructure Roadmap 2008-2009+ Profile Candidates • Add New Work • Cross-Enterprise Ordering • Cross-Enterprise Workflow Scheduling • XDS Affinity Domain Configuration • XDS Templates • Composite Documents • Role-based Access Control • Anonymization and Pseudonymization • Mobile Security • Master File Maintenance • Service Discovery • SNMP MIBs

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