IHE IT Infrastructure Domain Update

Karen Witting – IBM IT Infrastructure Planning Committee co-chair

IT Infrastructure Domain (ITI)• Supports profiles which supply common infrastructure for

sharing healthcare information.

• IT Infrastructure domain began in 2003 and now has 27 profiles that it supports.

• Key ITI profiles demonstrated today (and tested at Connectathon):– Information Exchange: XDS, XDM, XDR, XCA, XDS-SD, RFD, DSUB– Security: ATNA, CT, XUA, BPPC– Identity Management: PIX, PDQ (HL7 V2 & V3), HPD

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 Health Information Exchange

– Is a necessary ingredient, but is rarely visible to the end user

ITI Strategic Focus Categories• Patient and Provider Identity

– support the management of patient, provider and healthcare organization identity including their localization. This includes the ability to look up, cross-reference, update, remove, merge, link and general management of identities.

– PIX, PDQ, PAM, PWP, XCPD, HPD, PIX/PDQ HL7 v3 • Health Record Sharing

– support the ability to share patient specific healthcare information within and across enterprises. This includes the ability to submit, locate/list, push, pull and retrieve patient specific healthcare information.

– XCA, XDM, XDR, XDS, XDS-SD, MPQ, RID • Security and Privacy

– support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies .

– ATNA, BPPC, XUA, DSG, EUA • Workflow Enablers

– support standard sequences for performing workflow activities. – DRR, DSUB, NAV, PSA, RFD

• Support Management – support the ability to share information needed for interoperable healthcare

management such as clinical coding, technical or IT management information – CT, SVS

Different Information Exchange Approaches

• Point –to- Point

--------------------------------• Health Information

Sharing • One to Many, Pull

Known Partners Patient Association May Be

“Out-of-Band” Document Content: “Blind” or

Labelled

--------------------------------------- EMPI Document Registry / Record

Locator 1-n Document Repositories

Point-to-point Deployment ModelsKnown partners, patient ID

out-of-band, “blind” document

------------------------------------

Known partners, patient ID out-of-band, labelled document

------------------------------------

Known partners, linked patient, labelled document

Secure Email… Direct Project w/o Document Metadata Option

--------------------------------------------- IHE Cross-Enterprise

Document Exchange - Email Option (XDM-Email)

--------------------------------------------- IHE Cross-Enterprise Reliable

Exchange (XDR) w Patient ID Reconciliation (PIX/PDQ)

IHE takes Direct to the next level

Direct m

oving to the next level

Health Information Sharing Deployment Models

Many potential partners, linked patient, labelled documents

Centralized services (registry/EMPI)

---------------------------------

Nationwide Health Information Network Exchange / FHA CONNECT™

IHE Cross-Enterprise Document IHE Cross-Enterprise Document Sharing (XDS) Sharing (XDS) (On-Demand Document Option and Document Subscription / Notification (DSUB))

IHE Patient ID Cross-reference IHE Patient ID Cross-reference (PIX) and Patient Demographics (PIX) and Patient Demographics Query (PDQ)Query (PDQ)

-------------------------------------------------------------------------------------------------- IHE Cross-Community Exchange IHE Cross-Community Exchange

(XCA)(XCA) IHE Cross-community Patient IHE Cross-community Patient

Discovery (XCPD)Discovery (XCPD)

IHE takes Direct to the next level

XDS Metadata

Direct Project

Direct Project, Nationwide/Exchange and IHE Profiles

Direct is aligned with XDM: recommends but does not require metadata Nationwide/Exchange is aligned with XCA and XDR XDR may be bridged into Direct Project with metadata option

Nationwide/Exchange

IHE XDM (e-mail)

IHE XDR (Web Service)

IHE XCA (cross-HIE)

IHE XDS (Intra-HIE)

Pt-to-PtPush

Share& Pull

Option in Direct

Community Clinic

Lab Info. System

PACS

Teaching Hospital

PACS

ED Application

EHR System

Physician Office

EHR System

XDS Scenario + Use of ATNA & CT

PMS

Retrieve Document

Register DocumentQuery Document

XDS Document Registry

ATNA Audit record repository CT Time server

Record AuditEvent

MaintainTime

MaintainTimeRecord Audit

Event

Maintain TimeProvide & Register Docs

Record AuditEvent

XDS Document Repository

XDSDocumen

t Reposito

rySecured Messaging

Document Content & Modes of Exchange

Document Exchange Integration Profiles

Document Sharing

XDS

MediaInterchange

XDM

ReliableInterchange

XDR

Document Content ProfilesConsent

BPPCEmergency

EDRPre

Surgery

PPH P

Scanned Doc

XDS-SD

Laboratory

XD*-LabPHR

Exchange

XPHR

Discharge &Referrals

XDS-MS

Imaging

XDS-I

Cross-CommunityAccess

XCA

Community Clinic

Lab Info. System

PACS

Teaching Hospital

PACS

ED Application

EHR System

Physician Office

EHR System

XDS Scenario + Use of PIX & PDQ

A87631

PACS

L-716

Affinity Domain Patient Identity Source

M8354673993

Retrieve Document Provide & Register Docs

Register (using Pt ID)Query Document (using Pt Id)

Document Registry

14355M8354673993

L-716

A87631

Patient Identity Feed

PIX Query

PIX Query

Patient Identity Feed

Patient Identity XRef MgrPatient Identity FeedPDQ Query to Acquire Affinity Domain Patient ID

M8354673993

A87631L-716

M8354673993

XDS Document Repository

XDSDocument

Repository

ATNA Audit record repository CT Time server

Patient Identity Feed

Document Registry

PracticePracticePractice

ClinicClinic

HospitalsHospitalsHospitals

Repository

PracticeGateway

Repository

Patient IDservices

ILLINOIS

Cross-CommunityDemonstrating Sharing across regional boundaries

XCPD / XCA / XDR transactions

Document Registry

PracticePracticePractice

ClinicClinicClinicClinic

HospitalsHospitalsHospitalsHospital

Repository

PracticePractice HospitalHospital

Gateway

Repository

Patient IDservices

NEW YORK

Document Registry

PracticePracticePractice

Clinic

HospitalsHospitalsHospitals

Repository

Gateway

Patient IDservices

NORTH CAROLINA

Document Registry

PracticePracticePractice

ClinicClinicClinicClinic

HospitalsHospitalsHospitalsHospital

Repository

PracticePractice HospitalHospital

Repository

Patient IDservices

CALIFORNIA

Gateway

IT Planning Committee Activities• 2010 ITI Planning Committee

– ITI Strategic Planning• Definition of ITI Categories• Development of Liaisons and Outreach plan

– Selection of new work for 2011• review proposals and identify new work for each development

cycle

• 2011 ITI Planning Committee– Preparation of Educational Material – development of

reusable PPT decks on key ITI topics– Strategic Planning and Liaison Activity – build liaisons with

other IHE committees– Selection of Trial Implementation Supplements to become

Final Text Profiles– Selection of new work for 2012

ITI Technical Committee Activities• 2010 ITI Technical Committee

– Delivered new supplements for 2010 (next charts)– Delivered 2010 versions of Technical Framework and

Supplements• Processing of numerous Change Proposals (CPs)• Integration of CPs into 2010 versions of documentation

• 2011 ITI Technical Committee– New Supplements/Handbook For 2011 (next charts)– Change Proposal processing– Delivery of 2011 updated version of Technical Framework

and prior year Supplements

IHE ITI Completed Work for 2010 • Healthcare Provider Directory (HPD)

– Supports interoperable feed and query transactions for healthcare provider information

– Supports individual and organizational providers– Transactions are based on LDAP and DSML

• Cross-Enterprise User Assertion - Attribute Extension (XUA++)– Extends XUA based on feedback on attributes– Adds attributes supporting Role-Based-Access Control , Consent/Authorization, Purpose of Use

and general descriptive attributes• XDS Metadata Update

– Enables update and deletion of metadata in the XDS/XCA/XDR profiles• SVS Extension

– Update integrated directly into SVS supplement– Adds value set metadata and search capability in support of publication and distribution of value

sets.• On-Demand Documents

– Supports sources of healthcare data which prefer to build most up-to-date document content at the time of retrieve, on-demand

• Delayed Document Assembly– Allows source systems to register the existence of stable document content but defer actually

assembling the document content only if and when it is retrieved. This approach is adopted for efficiency reasons.

IHE ITI New Work for 2011

• XDS Affinity Domain Patient Identifier Change Management (XPID)– Communication of link, unlink and merge events to XDS Document

Registry• Cross-Enterprise Document Workflow (XDW)

– Tracking the steps of workflows to support care coordination and clinical pathways

• XCA Query and Retrieve– Combining XCA Query and XCA Retrieve transactions

• Direct Project Push use of XDS Metadata– Adjustment of XDS metadata requirements when used in XDR and

XDM environments with minimal metadata knowledge• Document Encryption

– Standard mechanism for encrypting health documents• Pseudonymisation and De-Identification in IHE Profiles

(Handbook)– Providing guidelines to industry on the application of pseudonymisation

ITI Profiles• Security/Privacy– Cross-Enterprise User Assertion (XUA) ☼– Basic Patient Privacy Consents (BPPC) ☼– Enterprise User Authentication (EUA)– Consistent Time (CT) ☼– Audit Trail and Node Authentication (ATNA) ☼– Document Digital Signature (DSG)

• Identify Management– Personnel White Pages (PWP)– Patient Identifier Cross-Referencing (PIX)☼– Patient Demographics Query (PDQ) ☼– Patient Identifier Cross-Referencing HL7 V3 (PIX V3)☼– Patient Demographics Query HL7 V3 (PDQ V3) ☼– Patient Administration Management (PAM)– Pediatric Demographics Option– Cross-Community Patient Discovery (XCPD) ☼– Healthcare Provider Directory (HPD) ☼

▀ colored text designates 2010 new and updated profiles☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2011

ITI Profiles (continued)• Information Exchange

– Cross-Enterprise Document Sharing - b (XDS) ☼– Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼– Cross Community Access (XCA) ☼– Document Metadata Subscription (DSUB) ☼– Multi-Patient Queries ☼ – Cross-Enterprise Document Media Exchange (XDM) ☼– Cross-Enterprise Document Reliable Interchange (XDR)– Notification of Document Availability (NAV)– Retrieve Form for Data Capture (RFD) ☼– Retrieve Information for Display (RID)– Patient Synchronized Applications (PSA) – XDS Metadata Update– On-Demand Documents– Delayed Document Assembly

• Terminology– Sharing Value Sets

▀ colored text designates 2010 new and updated profiles☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2011

IHE IT Infrastructure Schedule for 2011

• Development Schedule:• Planning Committee decision ……… December 2010• Issue Public Comment version …….. May 2011• Public Comment Due ……………….. June 2011• Issue Trial Implementation version … August 2011• IHE Connectathon …………………… January 2012• HIMSS Demo ………………………… February 2012

Learn More and Start to Participate

• Join the ITI Planning Committee at our HIMSS 11 Recruitment Meeting–Meet key IT Infrastructure Committee

participants–Q&A on any ITI related topic–Tuesday 10:30 – 11:30 Room 305 A&B

• Q&A