ITI Infrastructure Update XDS

1
ITI Infrastructure UpdateXDS

• Adaptado por IHE España del Original de Emmanuel
  CORDONNIER (ETIAM)
• ITI Infrastructure Update - IHE-Europe
  Workshop, Berlin, Feb.2007

2
Document Sharing

• Before to address the EHR itself, the IHE
  community has decided to work on the
  cross-enterprise clinical document sharing
• This document sharing IHE XDS Integration Profile
  is referenced in numerous emerging projects
  around the World, at different levels (healthcare
  centers and local / specialized / regional /
  state health networks)

3
Implementing IHE XDS in regional national
projectsToday
FranceNational PHR
Canada Infoway
Austria
MA-Share MA IHIE IN Mendicino - CA
Denmark (Funen) Italy (Veneto) Spain (Aragon)
IHE Interoperability Showcase 06
Italy (Conto CorrenteSalute)
THINC- New York NCHICA N. Carolina
4
Building and accessing Documents
Documents Registry
EHR-LRLongitudinal Recordas usedacross-encount
ers
Long Term Care
Acute Care (Inpatient)
Other Specialized Careor Diagnostics Services
PCPs and Clinics (Ambulatory)
EHR-CR Care Record systemssupporting care
delivery
5
XDS Value Proposition

• Foundation for Health IT Infrastructures Shared
  Electronic Health Record, in a community, region,
  etc.
• Effective means to contribute and access clinical
  documents across health enterprises.
• Scalable sharing of documents between private
  physicians, clinics, long term care, pharmacy,
  acute care with different clinical IT systems.
• Easy access Care providers are offered means to
  query and retrieve clinical documents of interest.

6
XDS - Value Proposition

• Distributed Each Care delivery organization
  publishes clinical information for others.
  Actual documents may remain in the source EHR-CR.
• Cross-Enterprise A Registry provides an index
  for published information to authorized care
  delivery organizations belonging to the same
  clinical affinity domain (e.g. an LHII).
• Document Centric Published clinical data is
  organized into clinical documents. using
  agreed standard document types (HL7-CDA,
  ASTM-CCR, PDF, DICOM, etc.)
• Document Content Neutral Document content is
  processed only by source and consumer IT systems.
• Standardized Registry Attributes Queries based
  on meaningful attributes ensure deterministic
  document searches.

7
XDS Key Concepts

• XDS Document
• XDS Submission Set
• XDS Folder

8
XDS concepts
Submission
Folder
SubmissionSet
Folder
Folder
Document
Document
Document
Documents server (registry-repository)
9
XDS Key Concepts

• XDS Document
• A set of attested clinical information
  (structured or not) which form an element of a
  patient record to be shared. It may already
  exist within the source IT system.
• XDS Submission Set
• A set of documents related to a patient that a
  (team of) clinician(s) in the same source system
  have decided to make available to potential
  consumers.
• XDS Folder
• A means to group documents for a number of other
  reasons
• Team work across several physicians,
• Episode of care,
• Emergency information for a patient, etc.
• XDS leaves open the use of folders to affinity
  domain clinicians.

10
XDS Diagram
11
XDS standards used

• ebXML Registry Services
• SOAP with attachments and ebXML SOAP Messaging
  Services
• Meta-data based on HL7 CDA with HL7 v2.5 content
  for ids (patient, prof/org)
• On line (HTTP) or optional off-line (SMTP)
  submission of document
• On-line (HTTP) SQL query with recent stored
  queries on Web Services

12
XDS meta-data

• Patient Affinity domain id, demographics (id,
  name, birth date)  as viewed by the source 
• Origin author, institution, legal authenticator
• Identification ID index, repository URI, unique
  id, dates of creation and start /end of medical
  act, title, size, hash, status, parent document
• Classification class, type, format, MIME type,
  type and specialty of institution and author,
  medical codes, confidentiality level
• Required, If known, Generated by repository,
  Recommended