Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

XDS Overview - FTP Directory Listing - IHE_1_

VIEWS: 9 PAGES: 34

									        Publication and Discovery
             XDS and DSUB



IT Infrastructure Planning Committee
Ilia Fortunov - Microsoft
            XDS
Cross-Enterprise Document Sharing
                                               What is XDS ?

The Cross-Enterprise Document Sharing (XDS)
IHE Integration Profile facilitates the registration, distribution
and access across health enterprises of patient electronic
health records

It provides a standards-based specification for managing the
sharing of documents between any healthcare enterprise




                                                                     3
                                       XDS Affinity Domains

Group of healthcare enterprises that have agreed to work together using a
common set of policies and XDS-based infrastructures for sharing patient
clinical documents. Some examples are:
• Regional community of care
• Nationwide EHR
• Specialized or disease-oriented (cardio, diabetes, oncology)
• Government-sponsored or federation of enterprises
• Insurance provider supported communities

XDS profile is designed to accommodate a wide range of policies on:
• Patient identification and consent
• Controlling access to information
• Format, content, structure, and representation of clinical information



                                                                           4
                                                   Use Cases


• Patient Care Summary (e.g. within a region)
   – Publishing of Care Summaries by providers
   – Access to patient’s Care Summary in an emergency
• eReferral between primary and secondary care providers
• Sharing of radiology reports and images between facilities
• Sharing of laboratory reports by clinical laboratories with
  ordering physicians and other care providers
• ePharmacy between community pharmacy and
  ambulatory physicians



                                                                5
                 Main Systems and Responsibilities

• A document Repository is responsible for storing documents in
  a transparent, secure, reliable and persistent manner and
  responding to document retrieval requests.
• A document Registry is responsible for storing information or
  metadata about those documents so that the documents of
  interest for the care of a patient may be easily found, selected
  and retrieved irrespective of the repository where they are
  actually stored.
• Any IT system (e.g. point of care) may act as a Document
  Sources or Document Consumers submitting documents for
  registration, or querying/retrieving relevant documents.
Notes:
•   Analogous to a library (book repository) and catalog/index
•   The Registry does not have access to the documents – an important
    separation from security and privacy perspective
•   Multiple Repositories can be linked to one Registry


                                                                        6
                                         XDS Flow and Interactions
XDS Document
(Metadata):                                 Registry   3. Consumers search         Consumer
  Class                                                for documents with
  Patient Id                                           specific information
  Author
  Facility
  Date of Service
  …
                      2. Repository registers
                      the documents
                      metadata and pointer
                      with the Registry
                                                          4. Consumers retrieve
                                                          selected documents
                                                          from Repository (-ies)
                    1. Sources post
                    document packages
 Source of          to the Repository
Documents                                 Repository




                                                                                              7
                                             XDS Transaction Diagram

                                            Patient Identity
                                                Source


             Patient Identity Feed [ITI-8]
             Patient Identity Feed HL7v3 [ITI-44]
                                                               Registry Stored Query [ITI-18]

                                              Document                                     Document
                                               Registry                                    Consumer


                                                     Register Document Set-b [ITI-42]


                                                                 Retrieve Document Set [ITI-43]
  Document                                    Document
   Source      Provide&Register               Repository
               Document Set-b [ITI-41]
Integrated Document Source/Repository


                                                                                                  8
                                                                     XDS Actors
•   Document Source – producer and publisher of documents, responsible for
    sending documents and their metadata to a Document Repository actor
•   Document Repository is responsible for both the persistent storage of these
    documents as well as for their registration with the appropriate Document
    Registry
•   Document Registry maintains metadata about each registered document and a
    link to the Document in the Repository where it is stored. Responds to queries
    from Document Consumer actors about documents meeting specific criteria.
•   Document Consumer queries a Document Registry for documents meeting
    certain criteria, and retrieves selected documents from one or more Document
    Repository actors
•   Patient Identity Source provides unique identifier for each patient and
    maintaining a collection of identity traits. This facilitates the validation of patient
    identifiers by the Registry Actor in its interactions with other actors
•   Integrated Document Source/Repository combines the functionality of the
    Document Source and Document Repository actors into a single actor that does
    not expose the Provide and Register Document Set transaction


                                                                                              9
                                XDS Transactions (1)

• Provide and Register Document Set – For each
  document in the submitted set, the Document Source Actor
  provides both the documents as an opaque octet stream
  and the corresponding metadata to the Document
  Repository. The Document Repository is responsible to
  persistently store these documents, and to register them in
  the Document Registry using the Register Documents
  transaction.
• Register Document Set allows a Document Repository
  Actor to register one or more documents with a Document
  Registry, by supplying metadata about each document to
  be registered. This document metadata will be used to
  create an XDS Document Entry in the registry.

                                                            10
                                    XDS Transactions (2)

• Patient Identity Feed conveys the patient identifier and
  corroborating demographic data, in order to populate the
  Document Registry with patient identifiers that have been
  registered for the XDS Affinity Domain. (At least one of the
  options [ITI-8] or [ITI-44] must be supported.)
• Registry Stored Query is issued by the Document Consumer
  Actor to a Document Registry. It will return registry metadata
  containing a list of document entries found to meet the specified
  criteria including the locations and identifier of each
  corresponding document in one or more Document
  Repositories.
• Retrieve Document Set – initiated by a Document Consumer.
  The Document Repository shall return the document set that
  was specified by the Document Consumer.


                                                                  11
                    XDS Document Content Types

XDS profile is content agnostic – it can be used with a variety
of document types, including:
• XDS-SD: Scanned document, plain text or PDF/A, in HL7
   CDA R2 format
• XDS-MS: Medical summary in HL7 CDA format
• XDS-I: Radiology report in plain text of PDF format, or
   reference to a collection of DICOM SOP Instances in a
   manifest document in the DICOM Key Object Selection
   format
Also supported are many other document content profiles
specified by the IHE Patient Care Coordination, Laboratory,
Cardiology, Pharmacy Technical Frameworks

                                                              12
                                   XDS – Actors and Options

        Actors                         Options                    Reference
                          Document Replacement                ITI TF-1: 10.2.1
                          Document Addendum                   ITI TF-1: 10.2.2
Document Source           Document Transformation             ITI TF-1: 10.2.3
                          Folder Management                   ITI TF-1: 10.2.4
                          Basic Patient Privacy Enforcement   ITI TF-2b:3.41.4.1.3.1
Document Repository
Document Registry         Patient Identity Feed               ITI TF-2a: 3.8
Patient Identity Source   Patient Identity Feed HL7v3         ITI TF-2b: 3.44
                                                              ITI TF-2a: 3.18.4.1.3.5
                          Basic Patient Privacy Enforcement
Document Consumer                                             ITI TF-2b: 3.43.4.1.3.1
                          Basic Patient Privacy Proof         ITI TF-2a: 3.18.4.1.3.6




                                                                                       13
                                          Standards Used

• ebRIM OASIS/ebXML Registry Information Model v3.0
• ebRS OASIS/ebXML Registry Services Specifications v3.0
• ITI TF-2x: Appendix V
   – WS-I Profiles BP 1.1, BSP 1.0
   – WS-* Specifications (SOAP 1.2, MTOM/XOP)




                                                       14
                 Security and Privacy Considerations

• All actors be grouped with a ATNA Secure Node Actor or
  Secure Application Actor resulting in each node (systems
  supporting XDS actors) of the XDS Affinity Domain should
  have audit and security mechanisms in place
• Transactions between different secure nodes that use
  ATNA are encrypted
• Each XDS Transaction will result in an audit event record
  sent to an ATNA Audit Record Repository Actor from each
  XDS actor
• Timestamp consistency is provided by Consistent Time
  (CT) profile


                                                              15
                                                                   XDS Workflow
                                            Health Information Exchange Network

                                   PIX or PDQ                                                   PIX or PDQ
                                     Query            Patient Demographics Supplier               Query
                                                      Patient Identity XRef Mgr

                                                                   A87631
                                                              M8354673993

                          PMS                       M8354673993                 14355

                                                   L-716             14355
                                                                      L-716       A87631
                                                                                                                             ED Application
       Physician Office

                                                                                Document
                           Document                                             Registry
                           Repository                                                                                 PACS

                                                                                                               Document
                                                                                                               Repository
                                                                                                                                   EHR System
                                        Query Document                        Register Document                                    Provide &
                                        (using Patient ID)                     (using Patient ID)                                   Register
PACS
                                                    Retrieve Document
                                                                                      Maintain
                      Lab Info.   Record Audit
                                                                                       Time
                      System         Event                                                          Maintain
                                                                                                     Time              Teaching Hospital
                                                                     Maintain
       Community Clinic
                                                                      Time
                                           Audit record repository                Time server
                                                  ATNA                                  CT       Record Audit Event
             XDS Affinity Domain

                                                                                                                                                16
      Health Document Exchange Options
                  Flexible Infrastructure
                        XDS
XDS               INFRASTRUCTURE
                       M8354673993

      Publish          L-716 A87631
                           14355      Query/Retrieve


XDR               Existing Reliable

       Send to   Messaging System       Send to

                 Interchange Media
XDM
                                           Read
      Write      Including Email

                         XCA
XCA                INFRASTRUCTURE
                  M8354673993
                  L-716 A87631
                      14355           Query/Retrieve


                                                       17
          IHE XDS adopted in National & Regional
be updated and refined         Projects (sample)
                                         Lower
further by Charles P.
       NETHERLANDS
     Friesland                           Austria                        Italy
                                                                   Conto Corrente
  Natn’l Mamography                                                Venetto - Friuli
                             France                      Suisse
                                                                                                                  VITL-Vermont
                                                                                          Quebec, Toronto,
  Wales                      DMP                      St Gallen                       Alberta, British Columbia
 Imaging                               Austria        Lausane
                                                                                         Canada Infoway
                    France
                   Imaging
                                                                                                                   Boston Medical
                     IDF
                                                                                                                     Center - MA




                      For more complete list see:                 tinyurl.com/wwXDS                               Philadelphia HIE


         Belgium
 Flemish-Leuven                                                                                                       KeyHIE
                                                                                                                    Pennsylvania



                                                                                                                      CareSpark
                                                                                                                      – TN & VA

                                                                                                SHARP
                                                                                                 CA
  South Africa                                                                                             THINC- New York
                                                                                        Providence         NCHICA – N. Carolina
       CHINA-Shanghai              CHINA-MoH                 JAPAN-Nagoya
                                                                                      Health System -
     Imaging Info Sharing       Lab results sharing      Imaging Info Sharing,
                                                                                            OR                              18
                                                        Nationwide PDI guideline
                                                                                                                             1
                                          Who Is Using XDS?
To be refined further

  • Stable specification since 2009 (See IHE ITI Technical
    Framework)
  • First implementation in clinical use in region of Genoa -
    Italy) since early 2006.
  • Several since: Lower Austria region, State of Vermont,
    Nagoya city, South Africa region, Dutch regions, etc.
  • Adopted by several national programs world-wide:
         France, Canada, Switzerland, USA, Slovenia, China, etc.
  • Numerous product implementations world-wide:
         Close to 100 EMR/Clinical Systems products shipping
         More than 20 Infrastructure products shipping



                                                                   19
                          Open Source Implementations
o be refined further

   Numerous open source implementations tested at
   Connectathon are available for XDS, ATNA and CT:
       – NIST under Source Forge http://sourceforge.net/projects/iheos/
       – HIE-OS under Source Forge http://sourceforge.net/projects/hieos/
       – Microsoft under codeplex http://ihe.codeplex.com/
       – OHT – IHE Profiles Charter
         https://iheprofiles.projects.openhealthtools.org
       – OHT – Open Exchange Forge
         https://openexchange.projects.openhealthtools.org
       – OHT – Model Driven Health Tools-Charter
         https://mdht.projects.openhealthtools.org




                                                                            2020
                                                          XDS References

• Primary
   – ITI TF-1 Section 10 Cross-Enterprise Document Sharing (XDS.b)
• Underlying Technical Framework Content
   – ITI TF-1
       • Appendix J Content and Format of XDS Documents
       • Appendix K XDS Concept Details
       • Appendix M Cross-Enterprise Document Sharing and IHE Roadmap
   – ITI TF-2a
       • Section 3.8 Patient Identity Feed
       • Section 3.18 Registry Stored query
   – ITI TF-2b
       • Section 3.41 Provide and Register Document Set-b
       • Section 3.42 Register Document Set-b
       • Section 3.43 Retrieve Document Set
   – ITI TF-2x
       • Appendix V “Web Services for IHE Transactions”
   – ITI TF-3
       • Section 4.1 XDS Metadata Model



                                                                        21
              DSUB
Document Metadata Subscription supplement
                                        DSUB Overview

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




                                                            23
                Publish/Subscribe Infrastructure

• Presents a framework for building event-driven information
  exchange patterns using a publish/subscribe data
  exchange model
• Defines the transport of publish, subscribe and notify
  messages.
• Supports IHE profiles which define the use case specific
  content to be carried in the publish, subscribe and notify
  messages
 Document Metadata Subscription (DSUB) first profile to
  use this framework.



                                                           24
               Publish/Subscribe Infrastructure
                       Actors and Transactions

 Publisher


        Publish 4.4.2.3



Notification              Subscribe 4.4.2.1
                                              Subscriber
  Broker

        Notify 4.4.2.2



Notification
 Recipient



                                                           25
                                    Possible Combined Actors

 Publisher                                              Publisher
Notification    Subscribe
                            Subscriber                       Publish
  Broker

       Notify                                          Notification    Subscribe

                                                         Broker
Notification
                            Publisher
 Recipient                                                    Notify

                        Notification      Subscribe

                          Broker                       Notification
                                                                       Subscriber
                                                        Recipient
                                 Notify


                        Notification
                                          Subscriber
                         Recipient


                                                                                   26
                        Document Metadata Subscription
                             (DSUB) Integration Profile

• Defines a subscription which allows for the matching of
  metadata during the publication of a new document for a
  given patient, and results in the delivery of a notification.
• Enabled within an XDS Affinity Domain or XCA
  environment
• Use Cases
   – Emergency Department: Notification of new document availability
     during treatment
   – Primary Care Management: PCP receives notification when new
     documents for patient are available




                                                                       27
              DSUB Actors and Transactions

Document Metadata                         Document Metadata
    Publisher                                 Subscriber


            Document Metadata
            Publish [ITI-54]

                                Document Metadata
Document Metadata               Subscribe [ITI-52]
 Notification Broker


            Document Metadata
            Notify [ITI-53]


Document Metadata
Notification Recipient




                                                              28
                                                Transactions

• Document Metadata Subscribe : start a subscription for a
  particular topic and filtering within that topic. Supports full
  and minimal notifications and where to send the
  notification.
• Document Metadata Notify : send a notification about the
  availability of a document or documents of interest, based
  on the subscribers' filters on selected topics
• Document Metadata Publish : notify that an event
  occurred for which there may be a subscription.




                                                                    29
                                                       DSUB Process Flow
                                                       Notification            Notification
             Publisher             Subscriber
                                                         Broker                 Recipient
   XDS Document                                                                         XDS Document
       Source                              Subscribe                                      Consumer
XDS Document
   Registry

                         Publish
                                                                      Notify


                         Publish
                                                                      Notify



                                         Unsubscribe


                         Publish




                                                                                                  30
   DSUB Subscription Topics and Standards

• DSUB Topic Tree
  – ihe:FullDocumentEntry : subscribes to Document Entry registration
    events; the notification shall contain the full metadata describing
    each matching Document Entry
  – ihe:MinimalDocumentEntry : subscribes to Document Entry
    registration events; the notification shall contain a minimal set of
    data (identifiers only) describing each matching Document Entry
• DSUB Standards
  – OASIS Web Services Notification Family of Standards
      •   WS-BaseNotification 1.3 OASIS Standard
      •   WS-BrokeredNotification 1.3 OASIS Standard
      •   WS-Topics 1.3 OASIS Standard
      •   ITI TF-2x: Appendix V
  – Filter expression
      • Registry Stored Query [ITI-18]


                                                                       31
                                          Security and Privacy

• The risk assessment spreadsheet for DSUB profile is available
  from http://wiki.ihe.net/images/4/46/DSUB_risk_assesment.xls
• For general IHE risks and threats see ITI TF-1: Appendix L
• Many risks cannot be mitigated by the IHE profile and instead
  the responsibility for mitigation is transferred to the implementer:
   – A policy decision can be made during the Subscribe transaction,
     whether the subscription is an authorized subscription and whether a
     notification/type of notification is authorized. (This could be based on
     the XUA identity, the consumer address value, etc.)
   – This profile does not include the solution to changes of policy between
     the subscribe time and notify time (which can be substantial). The
     recommendation is that the policy is enforced conservatively (i.e. the
     length of subscription can be determined by the Document Metadata
     Notification Broker).
• Specific security considerations are presented in the security
  section of each transaction in Volume 2b.
                                                                            32
                                             DSUB References

• Primary
   – DSUB Supplement Rev 1.4 2010-08-10
• Underlying Technical Framework Content
   – ITI TF-2a
      • Section 3.18 Registry Stored query
   – ITI TF-2b
      • Section 3.42.4.1 Register Document Set-b Request
      • Section 3.43.4.2.2 Message Semantics
   – ITI TF-2x
      • Appendix V “Web Services for IHE Transactions”




                                                           33
34

								
To top