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

2. 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

3. IT Infrastructure Domain (ITI)
Supports profiles which supply necessary infrastructure for sharing healthcare information.
IT Infrastructure domain began in 2003 and now has 21 profiles that it supports.
Key ITI profiles demonstrated today:
Information Exchange: XDS (XDS.a & XDS.b), XDM, XDR, XDS-SD, RFD
Security: ATNA, CT, XUA, BPPC
Identity Management: PIX, PDQ (HL7 V2 & V3)

4. An Infrastructure Interoperability Component Is…
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

5. Document Exchange Integration Profiles XDR XDM
Document Content and Modes of Document Exchange
Doc Content Profiles
Pre Surgery
PPH P
Consent
BPPC
Emergency
EDR
Scanned Doc
XDS-SD
Laboratory
XD*-Lab
PHR Exchange
XPHR
Discharge & Referrals
XDS-MS
Imaging
XDS-I
Document Exchange Integration Profiles
Document
Sharing XDS.a
XDS.b
Reliable Interchange
XDR
Media Interchange
XDM
Cross-Community
Access XCA
XDS Stored
Query & Patient
Identity Merge

6. New/updated in 2007 Information Exchange Security/Privacy
Cross-Enterprise Document Sharing - b (XDS.b) ☼
Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼
XDS Stored Query Transaction (addition to XDS) ☼
XDS Patient Identity Merge (addition to XDS)
Cross Community Access (XCA) ☼
Retrieve Form for Data Capture (RFD) ☼
Cross-Enterprise Document Media Exchange (XDM) ☼
Cross-Enterprise Document Reliable Interchange (XDR)
HL7 V3 based PIX and PDQ transactions ☼
Security/Privacy
Cross-Enterprise User Assertion (XUA) ☼
Basic Patient Privacy Consents (BPPC) ☼
▀ colored text designates 2006 profiles which were updated this year
☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2007

7. 2003-2005 Information Exchange Security/Privacy
Retrieve Information for Display (RID)
Patient Identifier Cross-Referencing (PIX)☼
Patient Synchronized Applications (PSA)
Cross-Enterprise Document Sharing (XDS.a) ☼
Patient Demographics Query (PDQ) ☼
Notification of Document Availability (NAV)
Patient Administration Management (PAM)
Security/Privacy
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

8. Categories of Healthcare Communication Services
HIEs and RHIOs
Patient and Provider ID Mgt
Hospitals
e.g. access to last 6 months historical labs and encounter summaries
e.g. get a current list of allergies or med list from a source
e.g. order a lab test, track status and receive results
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

9. 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

10. Cross-Enterprise Document Sharing (XDS) Standards Used
Healthcare Content Standards
HL7 CDA, CEN EHRcom HL7, ASTM CCR DICOM …
Electronic Business Standards
ebXML Registry, SOAP,
Web Services …
Internet Standards
HTML, HTTP, ISO, PDF, JPEG …
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)

11. 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

12. XDS.a and XDS.b
XDS.a
Original XDS profile, pre 2007
Based on ebXML Reg/Rep 2.1
SOAP with attachments based Provide and Register
Retrieve is HTTP GET
XDS.b
Based on a use of the Web Services and ebXML Reg/Reg standards that is consistent with the current developments and best practices in the industry
Based on ebXML Reg/Rep 3.0
MTOM based Provide and Register
MTOM based retrieve
HL7 V3 Patient Identity Feed
Actors are the same in both XDS.a and XDS.b
Metadata is the same in both XDS.a and XDS.b

13. XDS.a Transactions Diagram

14. XDS.b Transactions Diagram

15. XDS Scenario + use of ATNA & CT
Physician Office
EHR System
Teaching Hospital
PACS
ED Application
EHR System
PMS
XDS Document Repository
Community Clinic
Lab Info. System
PACS
XDS Document Registry
Query Document
Register Document
Secured Messaging
Retrieve Document
Provide & Register Docs
Maintain Time
ATNA Audit record repository
CT Time server
Maintain
Time
Record Audit
Event
Maintain
Time
Record Audit
Event
Record Audit
Event

16. XDS Scenario + use of PIX & PDQ
PDQ Query to Acquire Affinity Domain Patient ID
Patient Identity Feed M
Patient Identity XRef Mgr
14355 M
L-716
A87631
Physician Office
EHR System
Patient Identity Feed M
A87631
L-716
Teaching Hospital
PACS
ED Application
EHR System
Affinity Domain Patient
Identity Source M
Patient Identity Feed
Patient Identity Feed
Community Clinic
Lab Info. System
PACS
XDS Document Repository
XDS
Document Repository
PIX
Query
A87631
L-716
Document Registry
PIX
Query
Query Document (using Pt Id)
Register (using Pt ID)
Provide & Register Docs
PACS
Retrieve Document
ATNA Audit record repository
CT Time server

17. Cross Community Access (XCA)
Sharing of documents across communities
Re-use of XDS.b transactions.
Document Consumer consistency
Requirements of Document Consumer are the same as for local document query and retrieval
Out of scope:
How to identify which communities to interact with
How to identify the patient id to use when interacting

18. XCA Transaction Diagram minimum required

19. XCA Transaction Diagram

20. XCA Transaction Diagram

21. XCA Transaction Diagram

22. Cross Community Access Actors and Transactions
Initiating Gateway
On behalf of internal actors, initiates all transactions leaving the community
Receives Registry Stored Query and Retrieve Document Set from Document Consumer
Propagates transaction to local Document Registry and Repository, if appropriate
Propagates transaction to other communities by contacting their Responding Gateway and sending: Cross Gateway Query and Cross Gateway Retrieve
Responding Gateway
Single contact point for all transactions coming in to the community.
Propagates incoming transactions to local actors
New Transactions:
Cross Gateway Query: from Initiating Gateway to Receiving Gateway, mimics Registry Stored Query
Cross Gateway Retrieve: from Initiating Gateway to Receiving Gateway, mimics Retrieve Document Set
Document Consumer
Supports Registry Stored query and Retrieve Document Set
New requirement: propagation of the homeCommunityId requirement
Applies to XDS.a, XDS.b and XCA profiles

23. XCA Process Flow Responding Gateway Initiating Gateway Responding
RSQ – Registry Stored Query
XGQ – Cross Gateway Query
RDS – Retrieve Document Set
XGR – Cross Gateway Query
Community B
Responding
Gateway
RSQ
XDS Registry
XGQ
Community A
Initiating
Gateway
RSQ
RDS
XDS Registry
XDS Repository
XDS Repository
RSQ
Community C
RDS
XGQ
Responding
Gateway
RSQ
XDS Registry
XGR
Document
Consumer
RDS
XDS Repository

24. IHE IT Infrastructure – Schedule for 2007
Development Schedule:
Planning Committee decision: December 2007
Issue Public Comment version: June 2008
Public Comment Due: July 2008
Issue Trial Implementation version: August 2008
IHE Connectathon: January 2009
HIMSS Demo: February 2009

25. IHE IT Infrastructure – Plan for 2008
New Supplements For 2008
Sharing of Value Sets
Referral Request
Emergency Contact Registry Query
Asynchronous XDS.b
Extended PDQ
Significant updates to previous years profiles
XDS-SD conformance to PCC TF
New White Papers for 2008
Publish/Subscribe Infrastructure for XDS

26. IHE IT Infrastructure Roadmap
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….

27. IHE IT Infrastructure Roadmap
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