IHE IT Infrastructure Domain Update

Karen Witting IBM IT Infrastructure Technical Committee co-chair

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.b, 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
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

Categories of Healthcare Communication Services

HIEs and RHIOs e.g. access last 6 mo. historical labs & encounter summaries
Source persisted and attested health records

Hospitals e.g. get current list of allergies or med list from source
Specific info snapshot provided on demand

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

2 or more entities synchronize a task

Document Sharing

Dynamic Information Access

Workflow Management

Patient and Provider Identity Management Security/Privacy

ITI Profiles
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) Terminology Sharing Value Sets

colored text designates 2009 new profiles Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

ITI Profiles (continued)

Identify Management 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) 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) Personnel White Pages (PWP) Document Digital Signature (DSG)

colored text designates 2009 new profiles Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

Document Content & Modes of Exchange

Document Content Profiles
Consent
Emergency
Pre Surgery

Scanned Doc

PPH P
Laboratory

BPPC
Imaging

EDR
Discharge & Referrals

XDS-SD
PHR Exchange

XD*-Lab

XDS-I

XDS-MS

XPHR

Document Sharing

Reliable Interchange

Media Interchange

Cross-Community Access

XDS

XDR

XDM

XCA

Document Exchange Integration Profiles

XDS Scenario + Use of ATNA & CT

EHR System PMS

Physician Office XDS Document Repository XDS Document Registry XDS Document Repository
PACS Lab Info. System

ED Application

PACS

Secured Messaging
Retrieve Document

Query Document

Register Document EHR System Provide & Register Docs

Maintain Time Record Audit Event Maintain Time

Community Clinic

Maintain Time ATNA Audit CT Time server record repository

Teaching Hospital

Record Audit Event

Record Audit Event

XDS Scenario + Use of PIX & PDQ

PDQ Query to Acquire Affinity Domain Patient ID
Patient Identity XRef Mgr
A87631 M8354673993 M8354673993 M8354673993 L-716 L-716 14355 A87631

Patient Identity Feed Patient Identity Feed

EHR System

Affinity Domain Patient Identity Source

M8354673993

Physician Office Patient Identity Feed

ED Application

Patient Identity Feed PIX Document Query Registry

XDS Document Repository Register (using Pt ID)

L-716

XDS Document Repository

PACS
A87631

PIX Query
Query Document (using Pt Id) Lab Info. System

PACS PACS

EHR System Provide & Register Docs

Retrieve Document

Community Clinic
ATNA Audit record repository CT Time server

Teaching Hospital

HIMSS 10 Cross-Community
Demonstrating Sharing across regional boundaries
NEW YORK
Document Registry

ILLINOIS IHE transactions

Document Registry

Practice Practice Practice Practice Practice Clinic Clinic Clinic Clinic

Hospitals Hospitals Hospitals Hospital Hospital Hospital Patient ID services Repository Repository

Gateway Gateway
Practice Practice Practice Practice Hospitals Hospitals Hospitals Patient ID services Repository Repository

Clinic Clinic

NORTH CAROLINA
Gateway
Document Registry

Gateway

CALIFORNIA
Hospitals Hospitals Hospitals Document Registry

Practice Practice Practice

Clinic

Patient ID services Repository

Practice Practice Practice Practice Practice Clinic Clinic Clinic Clinic

Hospitals Hospitals Hospitals Hospital Hospital Hospital Patient ID services Repository Repository

XCPD Actors and Transactions

Initiating Community
Cross Gateway Patient Discovery [ITI-55]

Responding Community

Initiating Gateway

Patient Location Query [ITI-56]

Responding Gateway

XCPD Illustration of Use (Informative) Steps 1 10

Community A: Registration Community A: I&R Gateway Community B: Consumer 2.Cross Gateway Patient Discovery 3.Cross Gateway Patient Discovery 5. Patient Location Query 6. XDS Registry Stored Query Community B: I&R Gateway Community C: I&R Gateway 1. Patient Feed

2. Consult local MPI

4. Consult local MPI and save association

7. Consult local MPI

7.Cross Gateway Patient Discovery 10. XCA Cross Gateway Query

8.Cross Gateway Patient Discovery 10. XCA Cross Gateway Query

9. Consult local MPI and save association

Community A: Consumer

10. XDS Registry Stored Query response

XCPD Illustration of Use (Informative) Steps 11-13

7. Consult local MPI 7.Cross Gateway Patient Discovery 10. XCA Cross Gateway Query 10. XDS Registry Stored Query response 11. XDS Registry Stored Query 12. Patient Location Query 13. XCA Cross Gateway Query 13. XCA Cross Gateway Query 6. XDS Registry Stored Query 8.Cross Gateway Patient Discovery 10. XCA Cross Gateway Query 9. Consult local MPI and save association

Community A: Consumer

13. XDS Registry Stored Query response

DSUB Overview
The Document Metadata Subscription (DSUB) supplement contains two related parts
1) Publish/Subscribe Infrastructure: General framework for defining web-services based publish/subscribe interactions 2) Document Metadata Subscription (DSUB) Integration Profile: Use of subscriptions within an XDS Affinity Domain or across communities

Publish/Subscribe Infrastructure Actors and Transactions

Publish er

Publish 4.4.2 .3

Subscribe 4 .4.2.1 Notificatio n Broker Subscr iber

No tif y 4.4.2 .2

Notification Recipien t

DSUB Actors and Transactions

Document Metadata Publisher Document Meta data Subscriber Do cument M etad ata Publish [ITI-54]

Docume nt M etada ta Subscribe [ITI-52 ]

Docume nt Metadata Notifica tion B roker

D ocument Meta data Notify [ITI-53]

Docu ment M etadata No tification Re cipient

DSUB Illustration of Use

Document Metadata Publisher Document Metadata Subscriber Document Metadata Notification Broker Subscribe Document Metadata Notification Recipient

Publish Notify

Publish Notify

Unsubscribe

Publish

Multi-Patient Query Actors and Transactions

Document Consumer

Multi-Patient Stored Query [ITI-51]

Document Registry

Multi-Patient Queries - New Stored Queries

FindDocumentsForMultiple Patients
Equivalent to FindDocuments but $XDSDocumentEntryPatientId parameter:
is optional (zero values) may have multiple values specified

At least one of the following parameters is required:

ClassCode, EventCodeList, HealthcareFacilityTypeCode

More of a medical event based query than a patient based query

FindFoldersForMultiplePatients
Equivalent to FindFolders but $XDSFolderPatientId parameter:
is optional (zero values) may have multiple values specified

At least one of the following parameters is required:

folderCodeList

More of a medical event based query than a patient based query

IHE IT Infrastructure Schedule for 2010

Development Schedule:
Planning Committee decision December 2009 Issue Public Comment version .. May 2010 Public Comment Due .. June 2010 Issue Trial Implementation version August 2010 IHE Connectathon January 2011 HIMSS Demo February 2011

IHE IT Infrastructure Plan for 2010

New Supplements For 2010
Enhanced Sharing Value Set (Enhanced SVS)
Add supports for registering and updating value sets

Healthcare Provider Directory (HPD)

Supports healthcare provider search and feed

System Directory for Document Sharing (SDDS)

Supports directory of services used in document sharing environments

XDS Metadata Update Service

Supports update of metadata registered in a XDS Document Registry

Dynamic/Deferred Document Sharing (D3S)

Supports registration, query and retrieve of document content that is created at time of retrieval.

XUA Extension for Access Control

Extend XUA SAML assertion with authorization attributes