1. Cross Community (XC) Profiles Karen Witting

2. Outline Vision – as described in 2006 IHE White Paper on Cross Community Exchange Existing – what has been implemented today First steps – plan for 2007 and 2008

3. 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)

4. 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

5. Common PIX Server XDS Registry Cross Community Bridge Document Consumer Meta-Community using existing IHE Profiles XDS Registry XDS Repository Patient Identity Source Patient Identity Source Patient Identity Source (1) (3) (2) XDS Registry (4) (5) XDS Repository (6) Meta-Community Community A Community B Community C

6. Cross Community White Paper Cross Community Access – 2007 profile Cross Community Location Service – 2008 profile

7. Cross Community Access Sharing of documents beyond the XDS Affinity Domain (community) boundary. Scoped to document sharing between XDS Affinity Domains. Future goal to define sharing with other types of communities. Two purposes: –Encapsulate cross community interactions in one actor – Cross Community Bridge (XC Bridge) –Define a query which returns data from external communities – Cross Community Query (XC Query) The XC query is the first instance of an interaction that the XC Bridge mediates

8. Meta-community XDS community C XDS community A XDS community B XDS Registry XC Bridge XC Locator Service or Any other service or configuration XDS Registry XC Bridge XDS Repository XC Consumer XC Bridge Use of the Cross Community Access profile in a Meta-community (1) XC Query (3) XC Query (2) internal (4) XC Query Response XDS Repository (5) XC Retrieve XDS Registry XDS Repository (6) XC Retrieve (3) XC Query (3) (5) Retrieve (6) XC Retrieve

9. XC Bridge (local)XC Consumer XC QueryXB Query XB Retrieve XC Bridge (remote) XC Retrieve Draft Transaction Diagram

10. Cross Community Access Technical Solution Cross Community Bridge –A new actor which supports all inter-community communications. Encapsulates in one actor all activities required to communicate outside the community. –Every community would have one cross community bridge which would interact with actors within the community and remote cross community bridges. Cross Community Consumer –Initiator of a request for information beyond the community. Technical Issues: –Need for asynchronous transactions in the cross community environment –Interaction with existing XDS actors –Reliable identification of the patient

11. Cross Community (XC) Location Service Service to save, update, remove, query patient record references –Record references might me: To documents (internal and external) To XDS registry (internal and external) To “XC Bridge” definition TBD To “Fine grained data repository” definition TBD i.e. MUST BE EXTENSIBLE –Record references indexed by patient demographics Patient ids could be one element of demographics but service must talk using demographics as a common patient id cannot be assumed.

12. Draft Transaction Diagram XC Location Consumer XC Location Service (PIX+/RLS/RLUS) Add Update Merge Remove Query XC Location Feed