1. IHE IT Infrastructure Outreach to Patient Care Coordination Domain Michael Nusbaum IT Infrastructure Planning Committee December 13 th, 2010

2. Objectives of this Presentation To build awareness of the IT Infrastructure (ITI) DomainTo build awareness of the IT Infrastructure (ITI) Domain To establish an ongoing liaison between ITI and your domain/deployment committeeTo establish an ongoing liaison between ITI and your domain/deployment committee To begin a conversation about your committees strategic planning, and how ITI can support your committee to achieve your objectivesTo begin a conversation about your committees strategic planning, and how ITI can support your committee to achieve your objectives

3. IT Infrastructure Domain (ITI) Supports profiles which supply necessary infrastructure for sharing healthcare information.Supports profiles which supply necessary infrastructure for sharing healthcare information. IT Infrastructure domain began in 2003 and now has 27 profiles that it supports.IT Infrastructure domain began in 2003 and now has 27 profiles that it supports. An infrastructure Interoperability component…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 –Is a necessary ingredient, but is rarely visible to the end user

4. Scope of the ITI Domain The ITI domain addresses the implementation of standards-based interoperability solutions to improve information sharing, workflow and patient care.The ITI domain addresses the implementation of standards-based interoperability solutions to improve information sharing, workflow and patient care. Efforts have been focused on the following categories:Efforts have been focused on the following categories: –Patient and Provider Identity –Health Record Sharing –Security and Privacy –Workflow Enablers –Support Management

5. Patient & Provider Identity Profiles in the Patient and Provider Identity category 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.Profiles in the Patient and Provider Identity category 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.

6. Health Record Sharing Profiles in the Health Record Sharing category 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.Profiles in the Health Record Sharing category 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.

7. Security & Privacy Profiles in the Security and Privacy category support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies.Profiles in the Security and Privacy category support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies.

8. Workflow Enablers Profiles in the Workflow Enablers category support standard sequences for performing workflow activities.Profiles in the Workflow Enablers category support standard sequences for performing workflow activities.

9. Support Management Profiles in the support management category support the ability to share information needed for interoperable healthcare management such as clinical coding, technical or IT management informationProfiles in the support management category support the ability to share information needed for interoperable healthcare management such as clinical coding, technical or IT management information

10. Categories of Healthcare Communication Services Security/Privacy Document Sharing Patient and Provider Identity Management Dynamic Information Access Workflow Management Source persisted and attested health records Specific health records snapshot provided on demand 2 or more entities synchronize a task e.g. access last 6 mo. historical labs & encounter summaries e.g. order lab test, track status and receive results e.g. get current list of allergies or med list from source Hospitals Regional Infrastructure Health Record SharingWorkflow Enablers Support Management

11. ITI Profiles Security/PrivacySecurity/Privacy –Cross-Enterprise User Assertion (XUA) –Cross-Enterprise User Assertion (XUA) –Basic Patient Privacy Consents (BPPC) –Basic Patient Privacy Consents (BPPC) –Enterprise User Authentication (EUA) –Audit Trail and Node Authentication (ATNA) –Audit Trail and Node Authentication (ATNA) –Document Digital Signature (DSG) Patient and Provider IdentityPatient and Provider Identity –Personnel White Pages (PWP) –Patient Identifier Cross-Referencing (PIX) –Patient Identifier Cross-Referencing (PIX) –Patient Demographics Query (PDQ) –Patient Demographics Query (PDQ) –Patient Identifier Cross-Referencing HL7 V3 (PIX V3) –Patient Identifier Cross-Referencing HL7 V3 (PIX V3) –Patient Demographics Query HL7 V3 (PDQ V3) –Patient Demographics Query HL7 V3 (PDQ V3) –Patient Administration Management (PAM) –Pediatric Demographics Option –Cross-Community Patient Discovery (XCPD) –Cross-Community Patient Discovery (XCPD) colored text designates 2009 new profiles colored text designates 2009 new profiles Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010 Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

12. ITI Profiles (continued) Health Record SharingHealth Record Sharing –Cross-Enterprise Document Sharing - b (XDS.b) –Cross-Enterprise Document Sharing - b (XDS.b) –Cross-Enterprise Sharing of Scanned Documents (XDS-SD) –Cross-Enterprise Sharing of Scanned Documents (XDS-SD) –Cross Community Access (XCA) –Cross Community Access (XCA) –Multi-Patient Queries (MPQ) –Multi-Patient Queries (MPQ) –Cross-Enterprise Document Media Exchange (XDM) –Cross-Enterprise Document Media Exchange (XDM) –Cross-Enterprise Document Reliable Interchange (XDR) –Retrieve Information for Display (RID) Workflow EnablerWorkflow Enabler –Patient Synchronized Applications (PSA) –Notification of Document Availability (NAV) –Retrieve Form for Data Capture (RFD) –Retrieve Form for Data Capture (RFD) –Document Metadata Subscription (DSUB) –Document Metadata Subscription (DSUB) Support ManagementSupport Management –Consistent Time (CT) –Sharing Value Sets (SVS) colored text designates 2009 new profiles Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

13. Health Record Sharing - Document Sharing Document Exchange Profiles Document Sharing XDS Media Interchange XDM Reliable Interchange XDR Document Content Profiles (examples) Consent BPPC Emergency EDR Pre Surgery PPHP Scanned Doc XDS-SD Laboratory XD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MS Imaging XDS-I Cross-Community Access XCA ITI Profiles are shown with a red border

14. IHE IT Infrastructure Supplements Published in 2010 Enhanced Sharing Value Set (Enhanced SVS) Add supports for registering and updating value sets Healthcare Provider Directory (HPD) Supports healthcare provider search and feed XDS Metadata Update Service Supports update of metadata registered in a XDS Document Registry Dynamic/Deferred Document Sharing (D3S) Supports registration, query and retrieve of document content that is created at time of retrieval. XUA Extension for Access Control Extend XUA SAML assertion with authorization attributes

15. IHE IT Infrastructure Work Plan (2011) New Supplements For 2011 XDS Link/Unlink Support Cross Enterprise Document Workflow (XDW) XCA Query and Retrieve XD* Minimal Metadata CDA Encryption Pseudonymisation and De-Identification in IHE Profiles (Handbook)

16. Analysis of ITI support efforts to date

17. Next Steps Validate the domain-specific column of analysis worksheet and provide feedback on categories and completeness of contentValidate the domain-specific column of analysis worksheet and provide feedback on categories and completeness of content Ascertain the extent of adoption of ITI profiles in your domain/regionAscertain the extent of adoption of ITI profiles in your domain/region Discuss how ITI liaison can be most effectively utilized to support your domain/regionDiscuss how ITI liaison can be most effectively utilized to support your domain/region Develop your domain/regions strategic approach for ITI supportDevelop your domain/regions strategic approach for ITI support Short-term: Establish domain priorities to be proposed to ITI (target: July), in support of the domains preparation of profile proposals for submission to ITIs 2011/2012 planning cycle (Sept)Short-term: Establish domain priorities to be proposed to ITI (target: July), in support of the domains preparation of profile proposals for submission to ITIs 2011/2012 planning cycle (Sept)