IHE IT Infrastructure Domain Update

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IHE IT Infrastructure Domain Update
Karen Witting IBM IT Infrastructure Technical
Committee co-chair
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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

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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)

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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

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Document Content and Modes of Document Exchange
Doc Content Profiles
Consent BPPC
Emergency EDR
PreSurgery PPH P
Scanned Doc XDS-SD
Document Exchange Integration Profiles
Document SharingXDS
MediaInterchange XDM
ReliableInterchange XDR
XDS Stored Query
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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 users 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,

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2003-2005

• 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

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Categories of Healthcare Communication Services
HIEs and RHIOs
Hospitals
Patient and Provider ID Mgt
e.g. access to last 6 months historical labs and
encounter summaries
e.g. order a lab test, track status and receive
results
e.g. get a current list of allergies or med list
from a source
Security
Document Sharing
Dynamic Information Access
Workflow Management
Source persisted and attested health records
Specific info snapshot provided on demand
2 or more entities synchronize a task
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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
  configurations
• 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

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Cross-Enterprise Document Sharing (XDS)
Standards Used
HealthcareContent Standards HL7 CDA, CEN
EHRcomHL7, ASTM CCRDICOM
Internet Standards HTML, HTTP,ISO, PDF, JPEG
Electronic BusinessStandards ebXML Registry,
SOAP, 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)

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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
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IHE-XDS Infrastructure Components

• Audit Record Repository (ATNA) Receive audit
  records from other actors and securely store for
  audit purposes. ATNA also authenticates
  peer-nodes and encrypt communications.
• Time Server (CT) Provides consistent definition
  of date/time enabling time synchronization across
  multiple systems. Enables events associated with
  patients to be sorted reliably in chronological
  order.
• Document Registry (XDS) Queryable index of
  metadata and references to all documents shared
  within a connected community (XDS Affinity
  Domain)
• Document Repository (XDS) Supports storage and
  retrieval of clinical information (as documents).
  May be centralized or distributed.
• Patient Identifier Cross Reference Manager (PIX)
  Reconciles information on patients from
  multiple domains to a single, cross referenced
  set of IDs for each given patient.
• Patient Demographics Supplier (PDQ) Returns
  demographic information and identifiers for
  patients based on specified demographic criteria.

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XDS Scenario use of ATNA CT
PMS
XDS Document Registry
Register Document
Query Document
Secured Messaging
Retrieve Document
Provide Register Docs
Maintain Time
Maintain Time
Record Audit Event
Maintain Time
Record Audit Event
Record Audit Event
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XDS Scenario use of PIX PDQ
PDQ Query to Acquire Affinity Domain Patient ID
Patient Identity Feed
Patient Identity XRef Mgr
Patient Identity Feed
Affinity Domain Patient Identity Source
Patient Identity Feed
Patient Identity Feed
PIX Query
Document Registry
PIX Query
Register (using Pt ID)
Query Document (using Pt Id)
Provide Register Docs
Retrieve Document
PACS
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Hierarchical ExchangeFrom Cross Community
Information Exchange White Paper
Which community holds records for a patient ?
CommunityLocator service
CrossCommunity Bridge
IHE Transactions (future)
CrossCommunity Bridge
Cross Community Bridge

• Each region notifies Community Location Service
  when new patient is registered or first data is
  stored.
• Cross Community Bridges query Community Locator
  Service (future)
• Cross-Community Bridges query and retrieve
  records (2007 future)

Regional Network C
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Lateral Exchange and non-IHE DomainsFrom Cross
Community Information Exchange White Paper
What communities have specific attributres?
Community Search Service
National Network A
Non-IHE National EHR
CrossCommunity Bridge
IHE Transactions (future)
CrossCommunity Bridge
Cross Community Bridge

• National or Regional Networks not required to be
  IHE-based
• Mapping to from IHE Transactions performed by
  X-Community bridges
• Mapping practical as most projects use variants
  of structured document sharing

CommunityLocator service
IHE based Sub-Networks
Non-IHE Sub-Net
Integrated Delivery Network
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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

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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 specification
• 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

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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.

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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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What can you do?

• Learn about IHE
• Insist on IHE compliance in your RFPs and
  contract documents
• Select Integration Profiles, and Appropriate
  Actor(s)
• Ask vendors for their products IHE Integration
  Statements.
• Need more interoperability ?
• Contribute to IHE Committees

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How can I participate?

• As a Provider or Vendor Contributor
• Offer Clinical Use Case Input to Drive IHE
  Profile Development
• Become a member of relevant domains Planning or
  Technical Committees
• Become a member of relevant Regional/National
  Committees
• Help to shape IHEs future direction
• As a Vendor Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Participate in Connect-a-thons and Demonstrations
• As a Provider/Consultant Participant
• Respond to Public Comments of Domain Supplements
• Attend the June Educational Workshop
• Attend Demonstrations and include IHE Integration
  Profiles in your RFPs and Integration Projects.

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