HIMSS IHE 2007 ITI Domain Update V3 by pengxuebo


									       IHE IT Infrastructure Domain

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
  – 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
                  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)
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
Document Content and Modes of Document Exchange

                           Doc Content Profiles
                   Pre         Consent      Emergency   Scanned Doc
                               BPPC           EDR       XDS-SD
                PPH P

  Imaging                  Laboratory           Discharge &             PHR
                                                 Referrals            Exchange
  XDS-I                    XD*-Lab              XDS-MS                XPHR

               Document                   Reliable               Media
                Sharing                 Interchange           Interchange
  XDS Stored
    QueryXDS         XDR          XDM
      Document Exchange Integration Profiles
                                          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,

• 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
Categories of Healthcare Communication Services

 HIEs and RHIOs                                            Hospitals
e.g. access to last 6   e.g. get a current list   e.g. order a lab test,
 months historical       of allergies or med        track status and
labs and encounter        list from a source         receive results
  Source persisted            Specific info         2 or more entities
 and attested health           snapshot                synchronize
      records             provided on demand              a task
   Document                                          Workflow
    Sharing                                         Management
                   Patient and Provider ID Mgt
 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
• 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
               Cross-Enterprise Document Sharing (XDS)
                                Standards Used

                           Content Standards
                          HL7 CDA, CEN EHRcom
                             HL7, ASTM CCR
                               DICOM …
          Electronic Business            Internet Standards
               Standards                     HTML, HTTP,
          ebXML Registry, SOAP,            ISO, PDF, JPEG …
             Web Services …
• 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)
                 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
                          XDS Scenario + use of ATNA & CT

              EHR System PMS

       Physician Office                                                                                            ED Application

                                    Document                              XDS
                                    Repository                            Document
                                                                          Registry                          PACS
                                          Query Document              Register Document

                                        Secured Messaging                                                                EHR System
                                                          Retrieve Document                                        Provide & Register Docs
                      Lab Info.                                                Maintain Time
                                                                                            Maintain         Teaching Hospital
                                  Record Audit
       Community Clinic                                           Maintain                   Time
                                                   ATNA Audit      Time
                                                 record repository         CT Time server
                              Record Audit                                                   Record Audit
                                 Event                                                          Event
                                               XDS Scenario + use of PIX & PDQ
PDQ Query to Acquire Affinity Domain
                                                                                          Patient Identity Feed
Patient ID                                            Patient Identity XRef Mgr
                                                                                                       Patient Identity Feed
                                                      M8354673993            14355

                                                    L-716           L-716       A87631

                                                            Affinity Domain Patient
               EHR System
                                                                     Identity Source
                                                 M8354673993                                                     ED Application
        Physician Office
                Patient Identity Feed                    Patient Identity Feed

                                       XDS                                    Document                    PACS
                                       Document                                        Query
                                                                              Registry                                            A87631
                                              Query                                      Document
                                                                                                                       EHR System
 PACS                                 Query Document (using Pt Id)             Register (using Pt ID)

 PACS                                                    Retrieve Document
                                                                                                            Provide & Register Docs
                          Lab Info.
                                                                                                           Teaching Hospital
        Community Clinic
                                                 ATNA Audit
                                               record repository             CT Time server
                                                                            Hierarchical Exchange
                                               From Cross Community Information Exchange White Paper
                                                Which community holds
                                                records for a patient ? Community
                                                                                                               Locator service
Regional Network B                                                                                                                                                   Regional Network A

                           Document Registry                                Cross                                 IHE Transactions                       Community                              Document Registry
                                                                                                                                                                         Longitudinal Record
    Longitudinal Record
    as used
    across-encounters                                                       Community                                  (future)                          Bridge
                                                                                                                                                                         as used
                                                           Long Term Care                                                                                                                                                       Long Term Care

                   Acute Care                                                                                                                                                           Acute Care
Document                                                                                                                                                             Document           (Inpatient)
                   (Inpatient)                                                                                                                                                                                 Other Specialized Care
Repository                                Other Specialized Care                                                                                                     Repository
                                          or Diagnostics Services                                                                                                                                              or Diagnostics Services

               PCPs and Clinics                                                                                                                                                     PCPs and Clinics
                                                                                                                                        Cross Community                             (Ambulatory)

                                                                                                                                                           Each region notifies Community
                                                                                                                                                            Location Service when new
                                                                             Regional Network C                                                             patient is registered or first data is
                                                                                 Longitudinal Record
                                                                                                        Document Registry
                                                                                                                                                           Cross Community Bridges query
                                                                                 as used
                                                                                                                                        Long Term Care
                                                                                                                                                            Community Locator Service
                                                                                                Acute Care
                                                                                                                                                           Cross-Community Bridges query
                                                                             Repository                                Other Specialized Care

                                                                                            PCPs and Clinics
                                                                                                                       or Diagnostics Services
                                                                                                                                                            and retrieve records (2007 &
                                      Lateral Exchange and non-IHE Domains
                                                       From Cross Community Information Exchange White Paper
                                                         What communities have
                                                         specific attributres?
                                                                                                                                               Search                                                  National Network A
 National or Regional                                                                                                                          Service
 Network B                                                                                                                                                                                                  Non-IHE
                                                                                                                                                                                           Cross            National
                                  Document Registry
                                                                                             Cross     IHE Transactions
       Longitudinal Record
       as used
                                                                    Long Term Care           Community      (future)
                                                                                                                                                                                           Bridge           EHR
                        Acute Care
  Document              (Inpatient)
  Repository                                       Other Specialized Care
                                                   or Diagnostics Services

                    PCPs and Clinics

                                                                                                                                                         Cross Community
                                                                                                                                                                                               National or Regional
                                                                                                                                                                                                Networks not required to be
National Network C                                                                                                                   Community
                                                                                                                                   Locator service
                                                                                                                                                                                               Mapping to & from IHE
       IHE based Sub-Networks                                                                                                                                                                   Transactions performed by
                                                                                                                                         Non-IHE Sub-Net
                    Document Registry
   Longitudinal Record
                                                                                                 Document Registry
                                                                                Longitudinal Record
                                                                                                                                                                                                X-Community bridges
   as used
                                                    Long Term Care
                                                                                as used
                                                                                                                            Long Term Care
                                                                                                                                               Integrated                                      Mapping practical as most
                                                                                                                                                                                                European projects use
                 Acute Care
                 (Inpatient)                                                 Document
                                                                                            Acute Care
                                                                                                                                                Delivery                                        variants of structured
                                       Other Specialized Care                                                  Other Specialized Care

               PCPs and Clinics
                                       or Diagnostics Services

                                                                                          PCPs and Clinics
                                                                                                               or Diagnostics Services
                                                                                                                                                  XDS Affinity Domain (NHIN sub-network)        document sharing
               (Ambulatory)                                                               (Ambulatory)
      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
        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
    •   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
                  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….
                   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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