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 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)

4. 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

5. Document Content and Modes of Document Exchange Document Exchange Integration Profiles Document Sharing XDS Sharing XDS Media Interchange XDM Reliable Interchange XDR Doc Content Profiles ConsentBPPCEmergencyEDR Pre Surgery PPH P Scanned Doc XDS-SDLaboratoryXD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MSImagingXDS-I XDS Stored Query

6. 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 user’s 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,

7. 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

8. Categories of Healthcare Communication Services Security Document Sharing Patient and Provider ID Mgt Dynamic Information Access Workflow Management Source persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task 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 Hospitals HIEs and RHIOs

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 … Internet Standards HTML, HTTP, ISO, PDF, JPEG … Electronic Business Standards 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)

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. 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.

13. 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 Document Query Document XDS Document Registry ATNA Audit record repository CT Time server Record Audit Event MaintainTime MaintainTime Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

14. 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) Patient Identity Feed Document Registry 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query PIX Query Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed PDQ Query to Acquire Affinity Domain Patient ID M8354673993 A87631 L-716 M8354673993 XDS Document Repository XDS Document Repository ATNA Audit record repository CT Time server

15. Regional Network B Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Regional Network C Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Regional Network A Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Hierarchical Exchange From Cross Community Information Exchange White Paper Cross Community Bridge Which community holds records for a patient ? Cross Community Bridge Bridge Community Locator service  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) IHE Transactions (future)

16. National Network A Non-IHE National EHR Cross Community Bridge Cross Community Bridge Bridge CommunitySearchService  National or Regional Networks not required to be IHE-based  Mapping to & from IHE Transactions performed by X-Community bridges  Mapping practical as most European projects use variants of structured document sharing National Network C IHE based Sub-Networks XDS Affinity Domain (NHIN sub-network) IntegratedDeliveryNetwork Community Locator service Non-IHE Sub-Net IHE Transactions (future) What communities have specific attributres? National or Regional Network B Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Lateral Exchange and non-IHE Domains From Cross Community Information Exchange White Paper Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters Acute Care (Inpatient) PCPs and Clinics (Ambulatory) Long Term Care Other Specialized Care or Diagnostics Services Document Registry Document Repository Longitudinal Record as used across-encounters

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

18. IHE IT Infrastructure – Plan for 2007 New Supplements For 2007New Supplements For 2007 Web Services for XDSWeb Services for XDS Cross Enterprise User Authentication (XUA)Cross Enterprise User Authentication (XUA) Cross Community Access (XCA)Cross Community Access (XCA) Significant updates to existing last years profilesSignificant updates to existing last years profiles PIX/PDQ HL7 V3 transactions updated to support latest V3 specificationPIX/PDQ HL7 V3 transactions updated to support latest V3 specification RFD updated for latest level of XForms specificationRFD updated for latest level of XForms specification White Papers for 2007White Papers for 2007 Configuration ManagementConfiguration Management Security Risk ManagementSecurity Risk Management Web Services RoadmapWeb Services Roadmap Aggregate DataAggregate Data Meeting Privacy Principles using IHE ProfilesMeeting 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 itemsCome to the HIMSS ITI Planning meeting Wednesday 2/28 1-3 room 297 for more details about this years work items

19. 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….

20. 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

21. 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 vendor’s for their products “IHE Integration Statements”. Need more interoperability ? –Contribute to IHE Committees

22. As a Provider or Vendor Contributor Offer Clinical Use Case Input to Drive IHE Profile Development Become a member of relevant domain’s Planning or Technical Committees Become a member of relevant Regional/National Committees Help to shape IHE’s 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. How can I participate?