1. September, 2005What IHE Delivers 1 Cross-Enterprise Document Point-to-point Interchange (XDP) IHE Vendors Workshop 2006 IHE IT Infrastructure Education David HEANEY (McKesson), Emmanuel CORDONNIER (ETIAM)

2. 2 XDP Uses Cases Specialist, Radio or Lab GP / PCP Doctor ACare Facility Hospital Acute Care / ED Patient Transfer Personal Health Record (PHR) to ED/Primary Care EMR Acute Care Discharge to Extended Care Facility (ECF) Remote advice Consulting to referring physicians Hospital-doctor communication communication

3. 3 XDP Value proposition Complementary to sharing documents (XDS), point-to-point communication of documents Both transports: secured mail & media (CD…) As XDS, “document content agnostic” Maximal re-use of XDS objects & meta-data Compatible with exchange of images (PDI…) All XDS “content profiles” apply

4. 4 XDP Scope Interchange of patient centered documents Transmission of results, discharge letters or patient referrals (not the "workflow" itself but all the medical information associated with - e.g. reports, results, images, signals…) Personal Health Record medical information (history, etc), snapshots of clinical information (medication list, immunization records, etc), current observations from home care medical devices (e.g. blood pressure, blood sugar level, etc).

5. 5 XDP Key Technical Properties Re-uses XDS approach for documents  SubmissionSet, DocumentEntry  ebRS based XML meta-data w. limited extensions Secure e-mail (ebMS over SMTP, S/MIME) Optional on-line protocol (similar to XDS) PDI like media profile with XDS meta-data Potential association of XDS and PDI at the actor level (Document Source…) Further evolution possible for direct interchange over web services (MTOM…)

6. 6 XDP Actor Diagram Send Document Set [ITI-32]  Document Source Portable Media Importer Document Recipient Portable Media Creator Distribute Document Set on Media [ITI-33] 

7. 7 XDP in conjunction with XDS Document Source Document ConsumerDocument Repository Document Registry Document Recipient XDP Document Recipient Document Source XDP XDS

8. 8 XDP Actors and Transactions ActorsTransactionsOptionalitySection in Vol 2 Document Source Send Document SetRITI TF-2: 3.32 Document Recipient Send Document SetRITI TF-2: 3.32 Portable Media Creator Distribute Document Set on Media RITI TF-2: 3.33 Portable Media Importer Distribute Document Set on Media RITI TF-2: 3.33

9. 9 XDP off-line message Protocol encapsulation in SMTP/ESMTP SOAP with MIME attachments (multipart/related) text/xml SOAP:Envelope SOAP:Header, with Service=LifeCycleManager and Action=submitObjects SOAP:Body, with Manifest=list of attachments (e.g. ebXML Reg. Msg + Documents) Part 1 (start) text/xml SubmitObjectRequest (ebXML Registry Message) Part 2 Document 1 Part 3 Document n....... Part n+2

10. 10 XDP Actors and Options ActorOptionsVol & Section Document SourceMultiple Document Submission ITI TF-1:15.2.1 On-Line ModeITI TF-1:15.2.2 Document RecipientOn-Line ModeITI TF-1:15.2.2 Portable Media CreatorUSB (Note 1)ITI TF-1:15.2.3 CD-R (Note 1)ITI TF-1:15.2.4 Portable Media ImporterUSB (Note 1)ITI TF-1:15.2.3 CD-R (Note 1)ITI TF-1:15.2.4 Note 1: At least one of these options is required for each Actor.

11. 11 XDP Integration Profile Options Multiple Documents Submission Option  Offers the ability to include multiple documents in a single Submission Request On-Line Mode Option  Offers the ability to send the set of documents to one unique recipient, using a HTTP web-service based on-line transmission mode. USB Option  Portable Media Creator writes a set of documents on USB media CD-R Option  Portable Media Creator writes a set of documents on CD-R media.

12. 12 Structure of the XDP media

13. 13 XDP in conjunction with PDI XDP content: In complement, PDI content:

14. 14 Security considerations (1) Use of S/MIME encryption and signature for off- line network transfer (integrity, privacy) Encryption, with TLS authentication of both hosts, for on-line transfers across secure domains Actors need to protect themselves against confidentiality and integrity related risks XDP grouped with ATNA (access control/audit) Import operations need to be further protected (hash and size to detect corruption with metadata assurance) Media must be securely managed (respect of privacy, proper identification, and corruption checking)

15. 15 Security considerations (2) Additionally, parties are recommended to have a mutual agreement:  Management of Patient identification in order to avoid/limit identification errors. The metadata includes a patient id shared by both the Document Source and the Document Recipient as well as id and associated patient info as known by the Document Source.  Measures taken to avoid/limit loss of email by using acknowledgements.  Management of personnel and the organizations identification and access control mechanisms.  Codes set and vocabulary used enabling a consistent management of the metadata on both side.  In addition both organizations shall have mutually acceptable audit trail mechanisms.

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