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					 Integrating the Healthcare Enterprise
                                          XDS
       Cross-Enterprise Document Sharing
                            Integration Profile
Standards &Transactions & Implementation
                                  Bill Majurski – NIST
                   IHE IT Infrastructure Technical Committee
                    http://www.sanita.forumpa.it/documenti/0/100/150/150/IHE_XDS_1.ppt
   Sept 13-15, 2004                         1                         IHE Interoperability Worshop
                   Introduction

  Registry Standard
  Things XDS adds to the Registry Standard
  Structure of Actors and Transactions
  Implementation


  High-level focus – minimal XML



Sept 13-15, 2004        2          IHE Interoperability Worshop
                   Registry Standard
  ebXML Registry
  OASIS Standard
    OASIS (Organization for the Advancement of Structured
     Information Standards) is a not-for-profit, international
     consortium that drives the development, convergence, and
     adoption of e-business standards
    http://www.oasis-open.org
  Adopted by ISO
  Specifically a Document Registry
  Focus on business documents




Sept 13-15, 2004             3                  IHE Interoperability Worshop
 ebXML Registry Component
        Standards
  ebRIM – Registry Information Model
    Metadata
         •   Data about documents
         •   Defines basis for searches
  ebRS – Registry Services
    Interfaces
    Protocols
    Actions/verbs
    Query language



Sept 13-15, 2004                 4        IHE Interoperability Worshop
        ebXML Registry defines
Integrated Registry & Repository


  Registry holds Metadata


  Repository holds Documents




Sept 13-15, 2004    5              IHE Interoperability Worshop
      Metadata Building Blocks
Large collection of small objects
  Document (ExtrinsicObject)
  Association – Link between two objects
  External Link – URI – link to web resource
  Classification Scheme – Taxonomies
  Classification – Link to term in taxonomy
  RegistryPackage – Bundle of objects



Sept 13-15, 2004      6             IHE Interoperability Worshop
      Common Registry Object
           Attributes
  Id – object identifier (UUID)
  Name – label only – not used in identification
  Description – free text
  objectType
  Status – submitted/approved/deprecated…
  Slots – name/value pairs
  External Identifiers – primary search indexes



Sept 13-15, 2004         7            IHE Interoperability Worshop
      Common Registry Object
      Attribute Size Limitations
  Name – 128 chars
  Description – 256 chars
  Slots
    name – 128 chars
    value – 128 chars
  External Identifiers – 64 chars
  External Link (URI) – 256 chars



Sept 13-15, 2004         8          IHE Interoperability Worshop
  General Document Registry
          Operations
  Submit metadata and documents
  Update metadata and documents
  Query metadata
  Retrieve Documents




Sept 13-15, 2004   9         IHE Interoperability Worshop
        How does XDS relate to
          ebXML Registry?

  Applies
  Constrains
  Extends
  Reconfigures
  Integrates




Sept 13-15, 2004   10     IHE Interoperability Worshop
        ebXML Registry -> XDS
  Reconfigures:
    Registry and repository as separate actors
  Benefits:
    Repository may already be part of another
     product/system.
    Common registry for many repositories




Sept 13-15, 2004         11              IHE Interoperability Worshop
        ebXML Registry -> XDS
  Constrains:
    Metadata design
  Benefits:
    Establishes mandatory metadata
    Relevant to medical documents
    Restriction on how documents may relate
    Defines reasonable space for queries




Sept 13-15, 2004        12              IHE Interoperability Worshop
        ebXML Registry -> XDS
  Extends:
    Metadata submission to registry guaranteed
       atomic
  Benefits:
    Simpler registry client
    Well defined responsibilities




Sept 13-15, 2004          13            IHE Interoperability Worshop
        ebXML Registry -> XDS
  Integrates:
    With other IHE profiles
  Benefits:
    Integrate once – at specification level




Sept 13-15, 2004          14               IHE Interoperability Worshop
        ebXML Registry -> XDS
  Extends:
    By introducing the Submission Set (record of what
       was submitted together)
  Benefits:
    Related by medical event, parameters of the
       submission, support for transactions




Sept 13-15, 2004           15                 IHE Interoperability Worshop
        ebXML Registry -> XDS
  Extends:
    By introducing the Folder with constraints on its
       contents
  Benefits:
    Restricted content, standard parameters




Sept 13-15, 2004          16               IHE Interoperability Worshop
        ebXML Registry -> XDS
  Extends:
    By introducing new terminology
  Benefits:
    Terms now exist to describe subtle issues in
     standard
    New terms to describe how XDS deploys and
     integrates ebXML Registry




Sept 13-15, 2004         17              IHE Interoperability Worshop
                   New Terms
  XDS Document
  XDS Repository Submission Request
  XDS Registry Submission Request
  XDS Submission Set
  XDS Folder
  XDS Registry Adaptor Function




Sept 13-15, 2004      18          IHE Interoperability Worshop
What does XDS Not Change?
  Messages – all messages conform to
  standard
  Protocols - unchanged
  Information Model – restricted but
  unaltered




Sept 13-15, 2004    19           IHE Interoperability Worshop
                       XDS Actors

                         Patient Identity
                             Source




                           Document                  Document
                            Registry                 Consumer




Document                   Document
 Source                    Repository

    Sept 13-15, 2004          20            IHE Interoperability Worshop
         XDS Actors and Transactions

                               Patient Identity
                                   Source

                       Patient Identity
                       Feed
                                                  Query
                                 Document         Registry         Document
                                  Registry                         Consumer

                                          Register
                                          Document Set
               Provide &
               Register                                  Retrieve
Document       Document Set      Document                Document
 Source                          Repository

    Sept 13-15, 2004                 21                   IHE Interoperability Worshop
        Document Source Actor

Transactions
    Provide & Register Document Set




Sept 13-15, 2004       22              IHE Interoperability Worshop
Provide & Register Document
      Set Transaction

  Document Source has responsibility for
  generating metadata
  Send Repository Submission Request
  containing metadata and documents to
  repository
  Status returned




Sept 13-15, 2004    23          IHE Interoperability Worshop
          Repository Submission
                 Request
                   Repository Submission Request
                           Submission Set
                             Metadata



                           Document 1



                           Document 2


Sept 13-15, 2004                24                 IHE Interoperability Worshop
            Document Repository Actor
                               Patient Identity
                                   Source

                       Patient Identity
                       Feed
                                                  Query
                                 Document         Registry         Document
                                  Registry                         Consumer

                                          Register
                                          Document Set
               Provide &
               Register                                  Retrieve
Document       Document Set      Document                Document
 Source                          Repository

    Sept 13-15, 2004                 25                   IHE Interoperability Worshop
  Document Repository Actor

Transactions
    Provide & Register Document Set
    Register Document Set
    Retrieve Document




Sept 13-15, 2004         26            IHE Interoperability Worshop
Provide & Register Document
      Set Transaction
  Documents stored in repository
  Knows location of the cross-enterprise registry
  Invoke Register Document Set Transaction
  Success means documents accepted by
  repository and metadata accepted by registry




Sept 13-15, 2004       27             IHE Interoperability Worshop
         Register Document Set
              Transaction
  Compute
    Document address (URI) within repository
    Document size
    Document hash
  Metadata amended to include URI, size, hash
  Reject submission if document ID already present
  in repository with different size/hash (optional)
  Passes metadata to registry



Sept 13-15, 2004            28                  IHE Interoperability Worshop
                   Retrieve Document
                      Transaction

  Documents retrievable via HTTP GET
  request
  Uses URI generated by Document
  Repository in Register Document Set
  Transaction
  Exact byte stream is returned




Sept 13-15, 2004          29      IHE Interoperability Worshop
             Document Consumer Actor
                               Patient Identity
                                   Source

                       Patient Identity
                       Feed
                                                  Query
                                 Document         Registry         Document
                                  Registry                         Consumer

                                          Register
                                          Document Set
               Provide &
               Register                                  Retrieve
Document       Document Set      Document                Document
 Source                          Repository

    Sept 13-15, 2004                 30                   IHE Interoperability Worshop
   Document Consumer Actor

Transactions
    Query Registry
    Retrieve Document




Sept 13-15, 2004         31   IHE Interoperability Worshop
   Query Registry Transaction
  SQL query language
  ebRIM defines information model for
  queries
  ebRIM defines subset of SQL that applies
  Return is by reference or by value




Sept 13-15, 2004    32           IHE Interoperability Worshop
                    Simple SQL Query
Select all documents for patient ID 12345.34.259373


SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID
WHERE
   doc.objectType=XDSDocumentEntry AND
  patID.identificationScheme=XDSPatientID AND
  patID.registryObject=doc.id AND
  patID.value=‘12345.34.259373’ AND
  doc.status=‘Approved’


XDSDocumentEntry and XDSPatientID are coded as UUIDs



 Sept 13-15, 2004           33                IHE Interoperability Worshop
XDS                XDSDocumentEntry Attribute        EbRIM Attribute Type


Query              AuthorDepartment

                   AuthorInstitution
                                                     Slot

                                                     Slot

Keys               AuthorPerson
                   AvailabilityStatus
                                                     Slot
                                                     ebRIM Status attribute
Doc-level          ClassCode                         External Classification
                   CreationTime                      Slot
                   EventCodeList                     External Classification

                   FormatCode                        External Classification
                   HealthcareFacilityTypeCode        External Classification
                   legalAuthenticator                Slot
                   PatientId                         External Id
                   PracticeSettingCode               External Classification
                   ServiceStartTime                  Slot
                   ServiceStopTime                   Slot
                   TypeCode                          External Classification
                   UniqueId                          External Id




    Sept 13-15, 2004                            34                             IHE Interoperability Worshop
                   Retrieve Document
                      Transaction

  Query Registry Transaction
    Can return metadata including document URI
  Retrieve Document via HTTP GET
    Returns exact byte stream that was delivered to
     Repository in Provide & Register Document Set
     Transaction
    Not related to IHE RID Profile




Sept 13-15, 2004          35             IHE Interoperability Worshop
               Document Registry Actor
                               Patient Identity
                                   Source

                       Patient Identity
                       Feed
                                                  Query
                                 Document         Registry         Document
                                  Registry                         Consumer

                                          Register
                                          Document Set
               Provide &
               Register                                  Retrieve
Document       Document Set      Document                Document
 Source                          Repository

    Sept 13-15, 2004                 36                   IHE Interoperability Worshop
XDS Registry Actor Structure

Document Registry Actor
       Registry        ebXML
       Adaptor        Registry
       Function       Function


                               ebXML
                               Registry

                      Document
                      Repository
                        Actor

Sept 13-15, 2004          37              IHE Interoperability Worshop
       Document Registry Actor

Transactions
    Register Document Set
    Query Registry
    Patient Identity Feed




Sept 13-15, 2004         38   IHE Interoperability Worshop
             Register Document Set
                  Transaction

  Receives metadata from Repository Actor
  Validates metadata
  Stores metadata in registry as atomic
  operation




Sept 13-15, 2004      39         IHE Interoperability Worshop
Registry Submission Request

                   Registry Submission Request
                          Submission Set
                            Metadata




Sept 13-15, 2004               40                IHE Interoperability Worshop
     Document Availability Management

                              Submitted
                         Registration in progress


                              Approved
Availability            Available for Patient Care
                                                          Availability
Status Visible                                            Status Visible
to a Document                                             to a Document
Source                       Deprecated                   Consumer
                                Obsolete


                               Deleted


       Registry Status attribute: Life Cycle Status indicator

    Sept 13-15, 2004             41                  IHE Interoperability Worshop
     Registry Adaptor Function
Validate Metadata
  Valid patient ID
  Required attributes
  Valid coded values




Sept 13-15, 2004     42   IHE Interoperability Worshop
      Registry Adaptor Function
                (Cont)
Validate Metadata (Cont)
   Submission Set semantics
     Example – all new documents for same patient
   Folder semantics
     Example – all documents for same patient



Document Resubmission
   Implement resubmission semantics




 Sept 13-15, 2004            43                  IHE Interoperability Worshop
     Registry Adaptor Function
               (Cont)

XDS Submission is atomic
  ebXML Registry submission is not
  Use Status Attribute as control
    Submitted – submission in progress
    Approved – submission complete - available to
       query




Sept 13-15, 2004        44                IHE Interoperability Worshop
     Registry Adaptor Function
               (Cont)

Use two registry operations to store
 metadata
  Submit – store data, set status to
  submitted
  Approve – change status to Approved




Sept 13-15, 2004     45           IHE Interoperability Worshop
   Query Registry Transaction
  Process SQL query against registry
  contents
  Return list of
    Objects formatted in XML
    Object references
  Remember to search for Approved objects




Sept 13-15, 2004         46     IHE Interoperability Worshop
                    Simple SQL Query
Select all documents for patient ID 12345.34.259373


SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID
WHERE
   doc.objectType=XDSDocumentEntry AND
  patID.identificationScheme=XDSPatientID AND
  patID.registryObject=doc.id AND
  patID.value=‘12345.34.259373’ AND
  doc.status=‘Approved’


XDSDocumentEntry and XDSPatientID are coded as UUIDs



 Sept 13-15, 2004           47                IHE Interoperability Worshop
              Patient Identity Feed
                  Transaction
  Notification on
    Patient registration
    Updated Patient Information
  From Patient Identity Source (ADT)
  Registry Adaptor Function maintains list
  of valid patient IDs




Sept 13-15, 2004            48     IHE Interoperability Worshop
          Primary XDS Concepts
  Submission Request
  Submission Set
  Document
  Folder
  Document Life Cycle Management




Sept 13-15, 2004   49        IHE Interoperability Worshop
                       Submission Requests
                                Patient Identity
                                    Source




                                  Document                      Document
                                   Registry                     Consumer

                                          Registry
                                          Submission
                                          Request
                   Repository
                   Submission
Document           Request        Document
 Source                           Repository

    Sept 13-15, 2004                 50                IHE Interoperability Worshop
                   Document
  Real document vs. metadata
  Attributes
  Relationships between documents
    Replace
    Append
    Transform




Sept 13-15, 2004      51       IHE Interoperability Worshop
            Document in Registry
  ExtrinsicObject object
    With objectType of XDSDocumentEntry




Sept 13-15, 2004       52            IHE Interoperability Worshop
                     Folder
  ‘Directory’ metaphor
    But, a document can reside in multiple Folders
  Single patient
  Attributes




Sept 13-15, 2004         53              IHE Interoperability Worshop
                   Folder in Registry
  RegistryPackage object
  Classified as XDSFolder
  Contains document objects




Sept 13-15, 2004          54       IHE Interoperability Worshop
                   Submission Set
  Collection of documents & Folders
  Permanent label of what was submitted
  together
  Attributes
  Documents included by
    Value (same patient)
    Reference (any patient)




Sept 13-15, 2004        55      IHE Interoperability Worshop
   Submission Set in Registry
  RegistryPackage object
  Classified as XDSSubmissionSet
  RegistryPackage ‘contains’
    Documents (XDSDocumentEntry object)
    Folders (XDSFolder object)




Sept 13-15, 2004        56          IHE Interoperability Worshop
XDS            XDSSubmissionSet Attribute        Query
                                                 Key
                                                         EbRIM Attribute Type



Query          AuthorDepartment

               AuthorInstitution
                                                     O

                                                     R
                                                         Slot

                                                         Slot

Keys           AuthorPerson

               Comments
                                                     R

                                                     R
                                                         Slot

                                                         ebRIM Description attribute
Submis-        ContentTypeCode                       R   External Classification
               SourceId                              R   External Id
sion           SubmissionTime                        R   Slot
Set            UniqueId                              R   External Id

And            XDSFolder Attribute               Query   EbRIM Attribute Type
Folder                                           Key

               CodeList                              R   External Classification(s)
               Comments                              R   ebRIM Description attribute
               lastUpdateTime                        R   Slot
               PatientId                             R   External Id
               UniqueId                              R   External Id




   Sept 13-15, 2004                         57                         IHE Interoperability Worshop
      Document Resubmission
  Given multiple:
    Providers involved with a patient (Document
     Sources)
    Repositories
  Single Registry


  Document resubmission will happen!




Sept 13-15, 2004        58              IHE Interoperability Worshop
    Document Resubmission
Key Attributes:
                (Cont)
  XDSDocumentEntry.uniqueID
    Unique document ID
    Assigned by Document Source
  XDSDocumentEntry.hash
    Hash code of contents of document
    Computed by Document Repository
  ebXML Registry document id (UUID)
    Assigned by Document Source
    Internal to Registry




Sept 13-15, 2004           59            IHE Interoperability Worshop
      Document Resubmission
             (Cont)
Document submitted twice…
  Document altered slightly
    Different hash code
  Submitted by different office
    Assigned different document id


Detection of duplicate is beyond XDS!



Sept 13-15, 2004           60         IHE Interoperability Worshop
      Document Resubmission
             (Cont)
Document submitted twice…
  Document altered slightly
    Different hash code
  Document Id already present in
  Repository/Registry


  Submission is rejected!



Sept 13-15, 2004           61      IHE Interoperability Worshop
      Document Resubmission
             (Cont)
Document submitted twice…
  Document is identical
    Same hash code
  Document Id already present in
  Repository
  New UUID (internal registry ID)


  Submission is accepted!


Sept 13-15, 2004      62            IHE Interoperability Worshop
     Online/Offline & Protocols




Sept 13-15, 2004   63    IHE Interoperability Worshop
                   Online
  Direct network connection between all
  actors
  All Transactions
  Online ‘mode’ required in profile




Sept 13-15, 2004     64           IHE Interoperability Worshop
                    Offline
  Document Source connects to Document
  Repository via SMTP
  Remote, asynchronous submission via
  email
  Single transaction available
    Provide & Register Document Set Transaction
  Offline ‘mode’ is optional in profile




Sept 13-15, 2004        65             IHE Interoperability Worshop
                   Online Protocols
  SOAP Messages with Attachments
    W3C Note 11 December 2000
  MIME – Multipurpose Internet Message
  Extensions
    RFC 2045 - Part One: Format of Internet Message Bodies
    RFC 2046 - Part Two: Media Types
    RFC 2047 - Part Three: Message Header Extensions for
     Non-ASCII Text
    RFC 2048 - Part Four: Registration Procedures
    RFC 2049 - Part Five: Conformance Criteria and
     Examples
    RFC 2387 - The MIME Multipart/Related Content-type




Sept 13-15, 2004          66                IHE Interoperability Worshop
                   Offline Protocol
  Uses ebXML Message Service
  Specification v2.0 (ebMS)




Sept 13-15, 2004         67       IHE Interoperability Worshop
Implementation Scenarios




Sept 13-15, 2004   68   IHE Interoperability Worshop
           Document Submission
  Document Source Actor
    Provide & Register Document Set
    Online/Offline




Sept 13-15, 2004       69              IHE Interoperability Worshop
               Document Retrieval
  Document Consumer Actor
    Query Registry Transaction
    Retrieve Document Transaction




Sept 13-15, 2004        70           IHE Interoperability Worshop
   Clinical Information System
Product already creates/stores documents
Implement together
  Document Source Actor
  Document Repository Actor
Required Transactions
  Register Document Set
  Retrieve Document


Sept 13-15, 2004     71        IHE Interoperability Worshop
              Replace Documents
Replacement, Addendum, Transformation
  Document Consumer Actor
    Query Registry Transaction
    Needed to discover details of existing documents
  Document Source Actor
    Provide & Register Document Set
    Submit new documents and metadata




Sept 13-15, 2004         72             IHE Interoperability Worshop
Place Existing Documents in a
            Folder
  Document Consumer Actor
    Query Registry Transaction
    Discover details of existing documents
  Document Source Actor
    Provide & Register Document Set
    Submit new Folder metadata




Sept 13-15, 2004         73              IHE Interoperability Worshop
            Provide XDS Registry
Document Registry Actor
  Register Document Set Transaction
  Query Registry Transaction
  Patient Identity Feed Transaction
Including
  ebXML Registry functionality
  Registry Adaptor functionality



Sept 13-15, 2004    74             IHE Interoperability Worshop
       Construct Registry given
          ebXML Registry
          Implementation

  Build Registry Adaptor Function as front
  end to ebXML Registry




Sept 13-15, 2004    75           IHE Interoperability Worshop
         Construct XDS Registry
         without ebXML Registry
             Implementation

  Build to two specifications:
    ebXML Registry Standard (subset)
    XDS Profile - Registry Adaptor Function




Sept 13-15, 2004         76              IHE Interoperability Worshop
    Implementation Resources
Implementation guide
      Clinical Coding
      Example software
      Example queries
      Metadata cookbook (how-to)
      Metadata Schema
      Sample metadata submissions
  FAQ: http://www.connect-a-thon.net/bb
  Live registry with test data
  Testing




Sept 13-15, 2004            77       IHE Interoperability Worshop
                   Questions?




Sept 13-15, 2004      78        IHE Interoperability Worshop
               More information….
IHE Web sites:
     http://www.himss.org/IHE
     http://www.rsna.org/IHE
     http://www.acc.org/quality/ihe.htm.
Technical Frameworks:
     •   ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
     •   May 2004: Radiology
     •   August 2004: Cardiology, IT Infrastructure
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
Sept 13-15, 2004                 79                   IHE Interoperability Worshop

				
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