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

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… 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 5

Point-to-point Deployment Models 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) Known partners, patient ID out-of-band, “blind” document ------------------------------------ Known partners, patient ID out-of-band, labelled document Known partners, linked patient, labelled document Direct moving to the next level IHE takes Direct to the next level 6

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 Sharing (XDS) (On-Demand Document Option and Document Subscription / Notification (DSUB)) IHE Patient ID Cross-reference (PIX) and Patient Demographics Query (PDQ) ------------------------------------------------- IHE Cross-Community Exchange (XCA) IHE Cross-community Patient Discovery (XCPD) IHE takes Direct to the next level 7

Direct Project, Nationwide/Exchange and IHE Profiles XDS Metadata Direct Project Option in Direct Pt-to-Pt Push IHE XDM (e-mail) Nationwide/Exchange IHE XDR (Web Service) Share & Pull IHE XCA (cross-HIE) IHE XDS (Intra-HIE)  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

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

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

XDS Scenario + Use of PIX & PDQ PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed M8354673993 Patient Identity XRef Mgr 14355 M8354673993 L-716 A87631 Physician Office EHR System Patient Identity Feed M8354673993 A87631 L-716 Teaching Hospital PACS ED Application EHR System Affinity Domain Patient Identity Source M8354673993 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

Cross-Community Demonstrating Sharing across regional boundaries NEW YORK Document Registry ILLINOIS Document Registry XCPD / XCA / XDR transactions Practice Practice Practice Hospitals Practice Hospitals Hospitals Gateway Practice Hospital Hospital Hospital Patient ID services Gateway Practice Clinic Practice Hospitals Clinic Practice Clinic Repository Practice Hospitals Hospitals Clinic Repository Patient ID services Clinic Clinic Repository Repository NORTH CAROLINA Document Registry Practice Clinic Hospitals Hospital Repository Patient ID services CALIFORNIA Gateway Document Registry Gateway Practice Practice Hospitals Practice Hospitals Hospitals Patient ID services Clinic Repository

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 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