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					                                                                    IT Infrastructure (ITI) Technical Framework Suppleme
Use the table below to submit comments on 2011 IT Infrastructure (ITI) Technical Framework and Supplements to the IHE IT
below. Comments on these documents submitted by July 3, 2011 will be considered in refining the Trial Implementation vers
invited at any time. You may use the form below to submit comments on ITI documents currently published in their trial impl
indicate the title of the relevant document in the Other Document Name column. Enter your comments using the table below

Instructions:
1. Download and review documents. The 2011 ITI Profile Supplements are: (list below)
   a. Cross Community Fetch (XCF)
   b. Cross-Enterprise Document Workflow (XDW)
   c. Document Encryption (DEN)
   d. Support for Metadata-Limited Document Sources
   e. XAD-PID Change Management (XPID)

   These documents are available for download at http://www.ihe.net/Technical_Framework/public_comment.cfm.
  (ITI Trial Implementation supplements and Final Text Technical Frameworks are available at http://www.ihe.net/Technical_
2. Designate Submitter Name, Supplement Name, Volume, Section and Line Number for each comment (or designate as "gen
3. Specify the Issue concisely and provide any new or replacement text in the Proposed Change section.
4. Designate the Priority of each comment as High (H), Medium (M), or Low (L)
    H: Important issue where there is major issue to be resolved. Requires discussion and debate.
    M: Medium issue or clarification. Requires discussion, but should not lead to long debate.
    L: Typo or other minor classification that an editor can manage. Requires no group discussion.
5. After completing form, save it and send as an email attachment to iticomments@googlegroups.com.
6 .Comments on Supplements for Public Comment are due by July 3, 2011.




Submitter   Supplement Name             Other Document   Vol Section #   Line #
Name        (click cell and select from Name
            list)

sippel      Cross-Enterprise                                1x                      0
            Document Workflow
            (XDW)


sippel      Cross-Enterprise                                1 overall               0
            Document Workflow
            (XDW)
sippel      Cross-Enterprise                                1x                    312
            Document Workflow
            (XDW)
sippel      Cross-Enterprise                                1 x.1                 317
            Document Workflow
            (XDW)
sippel      Cross-Enterprise                                1 x.1                 325
            Document Workflow
            (XDW)
sippel     Cross-Enterprise    1 x.2.1     334
           Document Workflow
           (XDW)
sippel     Cross-Enterprise    1 x.2.1     334
           Document Workflow
           (XDW)
sippel     Cross-Enterprise    1 x.2.2     343
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    1 X.2.2.1   346
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    1 X.2.2.1   347
           Document Workflow
           (XDW)

felhofer   Cross-Enterprise    1 X.2.2.2   349
           Document Workflow
           (XDW)
sippel     Cross-Enterprise    1 x.3       351
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    1 X.3       376
           Document Workflow
           (XDW)




felhofer   Cross-Enterprise    1 X.3       381
           Document Workflow
           (XDW)



felhofer   Cross-Enterprise    1 X.3       384
           Document Workflow
           (XDW)




sippel     Cross-Enterprise    1 x.4       395
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise      X.4       396
           Document Workflow
           (XDW)
sippel     Cross-Enterprise    1 x.4.1.4       434
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise                    460
           Document Workflow
           (XDW)
sippel     Cross-Enterprise    1 appendix aa   460
           Document Workflow
           (XDW)




felhofer   Cross-Enterprise      XX.1.1        515
           Document Workflow
           (XDW)



felhofer   Cross-Enterprise    1 Glossary      936
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    3 5.Y           942
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise                    943
           Document Workflow
           (XDW)




felhofer   Cross-Enterprise    3 5.Y.2         957
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    3 5.Y.2.1      978
           Document Workflow
           (XDW)



felhofer   Cross-Enterprise    3 5.Y.2.1.1    982
           Document Workflow
           (XDW)



felhofer   Cross-Enterprise    3 5.Y.2.2     1070
           Document
           Workflow (XDW)


felhofer   Cross-Enterprise    3 5.Y.3       1097
           Document Workflow
           (XDW)




felhofer   Cross-Enterprise    3 5.Y.3.3     1109
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    3 5.Y.4    1112
           Document Workflow
           (XDW)




felhofer   Cross-Enterprise     5.Y.4     1112
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise     5.Y.5     1138
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise     5.Y.5.1   1153
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise     5.Y.5.2             1158
           Document Workflow
           (XDW)




felhofer   Cross-Enterprise     5.Y.5.3             1169
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise     5.Y.5.4             1173
           Document Workflow
           (XDW)


felhofer   Cross-Enterprise     X.4.1.2
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    1 Intro and Sec 127 and
           Document Workflow     X             269
           (XDW)




felhofer   Cross-Enterprise    1 Intro and Sec 137 and
           Document Workflow     X             278
           (XDW)

felhofer   Cross-Enterprise     throughout
           Document Workflow
           (XDW)


felhofer   Cross-Enterprise     throughout
           Document Workflow
           (XDW)

felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)


felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)

felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)

felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)


felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document
           Workflow (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise    3 3.Y.2.1.2
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
felhofer   Cross-Enterprise
           Document Workflow
           (XDW)
 rastructure (ITI) Technical Framework Supplement Public Comment Form
ture (ITI) Technical Framework and Supplements to the IHE ITI Technical Committee. Documents currently in their specified public comm
 11 will be considered in refining the Trial Implementation versions of these supplements to be published in August 2011. Comments on ot
mments on ITI documents currently published in their trial implementation or final text versions. To do so select "Other" in the Supplemen
 ent Name column. Enter your comments using the table below and send by email to iticomments@googlegroups.com.


ements are: (list below)




ihe.net/Technical_Framework/public_comment.cfm.
al Frameworks are available at http://www.ihe.net/Technical_Framework/index.cfm.)
tion and Line Number for each comment (or designate as "general").
ent text in the Proposed Change section.
  (M), or Low (L)
d. Requires discussion and debate.
hould not lead to long debate.
age. Requires no group discussion.
ent to iticomments@googlegroups.com.
uly 3, 2011.




             Issue


             roadshow needed




             ALL figures, incl appendix, must have a Figure # and title


             what about outside of affinity domain?


             small title issues


             cloud diagram not applicable
section numbering issues


no grouping with ATNA or the like?


section numbering issues


Remove the reference to PCC TF-1:3.4.1.1. This is specific to the
XDS-MS profile.

PCC TF-2:3.1.1 to which you point for the definition of the View
option contains the requirement that the Content Consumer must be
able to print the document. Is it your intent to require this?

Remove the reference to PCC TF-1:3.4.1.2. This is specific to the
XDS-MS profile.

section headings


Because you speak of deprecated documents going in a folder, I
suggest this clarification-->




suggested clarification:




"It is up to each specification of the specific workflow to analyze
the need and frequency to search for the list of workflows…"
…this statement made me think about what the template for an
'content profile' would contain. Can that be concisely described in
this document? There are also other considerations (eg do
referenced documents get put in the Folder? back-linking
considerations, etc)
section numbering issues


Here (and elsewhere) you refer to the "XDW Content Profile", ie
the profile specified in **this** TI supplement. In line 136, you
refer to "XDS-Based Content Profiles" which are the future
specifications that will define different clinical workflows based on
XDW. I think this is a subtlety that some readers will not
understand.
section titles


go back and review Appendix XX


resolve conflicts in document updates?




Omit these sentences; you state the same thing at the end of Sec
XX




you can remove this "Glossary" section since you are not making
any changes to that section.

typo:


REPLACE: The main structure of the document and some
elements related to its metadata and the management of its lifecycle
need to be fixed and independent by the domain or the scenario in
which it is used. The different IHE domains and the different
scenarios, in which the Cross-Enterprise Document Workflow
Content profile is applied, have to define the specific rules of the
workflows. The structure of the Workflow Document and the
general rules defined by the ITI domain remain fixed; the different
domains and Affinity Domains can contestualize only the different
steps of the workflow and their content (e.g.: name and codes).

The use of a defined structure for the workflow document, of a
common set of metadata and of their values and a common
management for the workflow document is necessary to guarantee
the interoperability cross-enterprise.
suggested clarification:
typos:




I would like to see the contents of this section reformatted into a
table. Each row of the table would contain an attribute. The
columns would be attribute name, attribute description, and
optionality. Or, if that detail is just borrowed from CDA R2 or
somewhere in the PCC spec, just point there.

The specification for the contents of the Body needs to identify the
sections (Control Info, Input, Output), and then within each
section, identification of the entries within that section. . For each,
I want to know its name, description, optionality, ,data type,
cardinality, defined values (if any)... Look at how Sections &
Entries are specified in the PCC TF
Formatting option: Rather than specifying all XDS metadata
attributes and marking many with "No special rqmts…" you could
choose to follow the pattern used for XDS-SD (ITI TF-3:5.2.2)
which states "XDS-SD is a CDA R2 document and thus conforms
to the XDS Metadata requirements in the
PCC TF-2:4 unless otherwise specified below. "

 ..and then just the deltas are listed.

You refer here to ITI TF-3:4.1.5. I think the PCC TF reference is
more proper.
You say "At the level of the XDS Affinity Domain is necessary to
define some specific codes to identify the type of the Folder used. "
but then you specify the codeList attribute to be "XDW Workflow
Context Folder". It sounds like that code is mandated by IHE, not
the affinity domain.
S/T/L to discuss:

This is the first time in Vol 3 that folders are mentioned. It is also
the first time in Vol 3 where you need to go beyond the capabilities
of a traditional "Content Creator" (eg in XDS, Doc Sources create
folders, not Content Creators). Your profile needs to mandate
behaviors (create folders, replace documents). I cannot think of
another profile to use a a model for this text.

One option is to create a section at this level (5.Y.4) named
something like "XDW and XDS behaviors (bad name) with a stmt
that appears a bit further down "The Cross-Enterprise Document
Workflow profile specifies both the content of the Workflow
Document and also the lifecycle management of the Workflow
Document. The XDW Content Profile relies on XDS operations
for management of the Workflow Document. The XDW
Content Creator is grouped with an XDS Document Source
and an XDW Content Consumer is grouped with an XDS
Document Content Consumer. "

Then there would be subsections specifying rqmts for folders,
lifecycle, associations.
Section needs to be reworked. The behavior of the XDS Doc
Source needs to be detailed, with "shall" statements.

Section and its subsections need to be reworked. The behavior of
the XDS Doc Source needs to be detailed, with "shall" statements.

sample rework:
sample rework:




Move the contents of this section into the "Contents" section.
These are rules for creating the content of the workflow document.

The text in this section doesn't match the section heading. You do
need to talk abou "Getting clinical documents referenced by a
workflow" (the heading topic), and how various versions of a
workflow document are handled (the text topic)

grammar fix:


suggested rewording:




suggested rewording:



I suggest that whenever your refer to the "workflow document"
defined by this profile, you use upper case, perhaps even with the
double quotes, ie, "Workflow Document". This visually identifies
the entity you are specifying in this supplement.

At various points, you refer to XDW as a "Content Profile". I
think this is misleading and should be removed. This profile
mandates a workflow (little w) involving XDS operations.

open issues
As I read the text preceding Figure X.4.1.4-1 and looked at the
figure, I came to the conclusion that the numbered steps need a
numbered narrative, similar to what was done in Vol 1 of XCA
(sec 18.3.3). To ensure I understood how this work, I identified
these steps:
GP creates an eReferral document as a result of Patient P's visit


GP (XDW Content Creator) creates a new workflow document for
Patient P with one step. The eReferral document is included as an
Output document in the Step.
GP (XDS Doc Source) puts new workflow document in a folder
and P&R the XDW workflow document in the folder and the
eReferral document (not in the folder) to the Repository (ITI-41)

Repository registers the Workflow Doc (in the folder) and the
eReferral doc with the Registry (ITI-42)

Specialist (XDS Doc Consumer) queries for Workflow documents
for Patient P. (ITI-18)

Specialist (XDS Doc Consumer) retrieves the workflow doc (ITI-
43), then (XDW Content Consumer) examines the contents and
sees the reference to the eReferral doc as an output to the step.

Specialist (XDS Doc Consumer) retrieves the eReferral doc (ITI-
43)

After performing exam on Patient P, Specialist creates an XYZ
report, then (XDW Content Creator) creates an updated workflow
document, adding a second step. The eReferral doc is referenced
as a Input to step 2 and the XYZ report is referenced as an Output.

Specialist (XDS Doc Source) submits the updated workflow
document to the Repository as a Replacement for the previous (ITI-
41)
Specialist (XDS Doc Source) submits the XYZ report to the
Repository

The Repository updates the Registry with for the 2 new docs (ITI-
41)

Patient P return to his GP. GP (XDS Doc Consumer) queries for
Patient P's workflow document (ITI-18)

GP (XDS Doc Consumer) retrieves the updated workflow
document (ITI-43), and then (XDW Content Consumer) examines
the workflow document
GP (XDS Doc Consumer) retrieves the XYZ report referred as an
output to Step 2.
ent Public Comment Form
TI Technical Committee. Documents currently in their specified public comment phase are listed
 sions of these supplements to be published in August 2011. Comments on other ITI documents are
plementation or final text versions. To do so select "Other" in the Supplement Name column and
 w and send by email to iticomments@googlegroups.com.




_Framework/index.cfm.)
neral").




            Proposed Change                                                           Priority



            you should consider grabbing 10 min of time from the PCC, QRPH,
            and PCD committee meeting and do a roadshow on this profile if you
            want it to be adopted because there are a lot of complex use cases
            being defined out there right now that this would work for...

                                                                                      Medium


            do you want to explicitly state that all workflow must be within          Medium
            facilities which are part of affinity domain or do you just think it is
            obvious?
            add the acronym XDW in front of the titles in sections x.1, x.2           Medium
            (delete words/text), x.5 (XDS??!) for consistency and so that the
            TOC of is more readable (per Supplement Template)
            the cloud diagram goes into Volume 2, not Vol 1. vol 1 gets old           Medium
            fashioned arrows to show the interactions at the Profile level.
x.2.1 should be x.3 and named "XDW Actor Grouping and Profile          Medium
Interactions";

                                                                       Medium


x.2.2 should be x.2.1; x.2.2.1 be x.2.1.1; x.2.2.2 be x.2.1.2          Medium


                                                                       Low




                                                                       Low


x.3 should be "x.4 XDW Process Flow"                                   Medium


This new version of the workflow document is then published as a
replacement and the previous version is deprecated. The technical
description of the updating of the workflow document is specified in
ITI TF-3:5.y. All deprecated Workflow Documents, as well as the
          ‖
most recent (active) Workflow Document are placed in a
―Folder so that the folder uniqueId provides a stable reference to
an instance of a workflow, while the workflow document uniqueId is
different for each of the various past versions of the workflow.

There is no requirement that all referenced documents (clinical
documents referenced as Inputs or Outputs inside the Workflow
Document) be placed by reference within this same folder.




x.4 should be x.4.1 and make it "Use Cases" (get rid of dash)          Medium
All "Sequence Diagram" should be "Process Flow" - also true in             Medium
Appendix; current xx.1..2 "Process Flow" should be "Use Case"




it is entirely possible that I missed it, but I tried to step through all of High
the diagrams… what is the intent to either mitigate/eliminate/ or fix
the problem when two different locations/actors retrieve the WD
from the Document Repository, make changes independently/
simultaneously, and then re-submit to the Doc Repository? couldn't
a work step be lost when the next user replaces the existing
document?

This use cases described need to be regarded as possible
examples and not as an exhaustive solution to the real life
scenarios. The use case are not intended to constrain nor replace
future profile development that other IHE Domain would
perform.




This section describes the the content of the XDW...                       Low


 WITH:
The use of a defined structure for the Workflow Document, of a
common set of metadata and of their values and a common
management for the workflow document is necessary to guarantee
the interoperability of workflows cross-enterprise.

The structure of the Workflow Document and the general
requirements for managing Workflow Documents are specified by
the XDW profile. Different IHE domains or organizations will use
this XDW "infrastructure" and define workflows specific to their
domain by indentifying steps in their workflow, the inputs and
outputs of those steps (eg documents, codes) as well as specific rules
for managing those steps.



The XDW Content Profile is based on the rules specified on ― in Low
the Patient Care Coordination Technical Framework about how
organizes content modules are organized categorically by the base
standard. XDW uses one in the base standard, CDA Release 2.0.
So For CDA Release 2.0 where the modules are organized by
document, section, entry, and header elements.
The purpose of t The CDA header is to enables document exchange Low
across and within clinical institutions and facilitates document
management; the header of a Workflow Document contains all the
necessary informationins to identify the document it self, the
workflow type, the first author, and organizastion involved.

                                                              Medium




                                                              High




                                                              Medium
                                                                 High




                                                                 High


                                                                 High


When the first step of a new workflow is completed, the XDW      High
Content Creator shall:
- create the first version of the Workflow Document and t

Then the grouped XDS Document Source shall:
- submit it the Workflow Document to the XDS Document
Repository using ITI-41 Provide and Register Document set. The
Document Source
 puts the Workflow Document in a new Workflow Context Folder.
For each subsequent step in the Workflow, an XDW Content Creator High
shall

- obtain the most recent version of the Workflow document, (eg
using a grouped XDS Document Consumer)
- updates the content in the Workflow Document (e.g., by adding a
new step.. ) and t

Then the grouped Document Source shall replaces the Workflow
Document with its new version. This new version is automatically
added
to the correct Workflow Context Folder by normal XDS rules for
document replacement in the context of a folder.

The process for updating the document is:
• Open the existing workflow document
   o Add or update workflow steps
   o Re-register (update) the workflow document by performing a
document replace
                                                                      High


                                                                      High




The GP examines him and some of his the reports in relation with
related to his health problem.

Such shared workflow state information allows the various               Low
participating systems to be aware of the history (past steps) of any of
the workflows known for a patient, access the workflow's current
state and remain coordinated by updating this shared
document with the new steps they have performed.


Benefits many clinical and non-clinical domains by avoiding           Low
different competing approaches to workflow management.
interoperability.
Cross Community Fetch (XCF)
Cross-Enterprise Document Workflow (XDW)
Document Encryption (DEN)
Support for Metadata-Limited Document Sources
XAD-PID Change Management (XPID)
Other
High
Medium
Low

				
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