1. XDM / XDR Point-to-Point Transmission of Documents
ITI Planning Committee

2. Point-to-Point Transmission of Documents
XDS is the base
XDM = exchange of XDS metadata and documents on Media
XDR = exchange of XDS metadata and documents over reliable protocols 2

3. XDM XDM – Media Interchange (email, CD, etc.)
Documents and XDS Metadata shared via media
Options
USB
CD-R
ZIP over
Imposes File/Directory structure on the media
Transport Multiple XDS Submission Sets
Each Submission Set has Metadata describing documents
Documents
Protocol structure of XDS imposed on file/directory organization

4. XDM XDM – Media Interchange (email, CD, etc.) Uses Works with XDS
Release of documents to patient
Manual (in pocket or ) transfer of documents
Local display after receipt
Index.htm file required to support display
These are manual operations!
Works with XDS
XDS Query/Retrieve can feed XDM transmission
Point-to-point transfer via XDM can feed XDS submission 4

5. Health Information Exchange
XDM
Health Information Exchange
e.g. A
Hospital
e.g. Home
Read
Discharge summary + Lab report
Write
Interchange
Media
Discharge summary +Lab report
Read
e.g. Physician
Office
Generally more than two trading partners,

6. XDR XDR – Reliable Interchange Single Submission Set per transfer
Optionally identify intended recipients
More like XDS than XDM
Reliable asynchronous point-to-point transmission of XDS content (metadata and documents) over reliable communications
A new profile but really just documents how to use Provide and Register transaction [ITI-15] (same as XDS) to perform point-to-point transfers. 6

7. XDR XDR – Reliable Interchange
Reliable transfer comes from ebMS Messaging Services Specification v2.0
Online vs. Offline
Online = over direct TCP connection
Offline = over SMTP
Works with XDS
XDS Query/Retrieve can feed XDR transmission
Point-to-point transfer via XDR can feed XDS submission 7

8. Health Information Exchange
XDR
Health Information Exchange
e.g. A Specialist
Office
e.g. A
Clinic
Send to
Send to
Switch
A referral summary + lab report
A referral summary + lab report
Two specific trading partners,

9. Specialist, Radio or Lab Hospital Acute Care / ED
Combining XDM / XDR
Consulting to referring physicians
Specialist, Radio or Lab
GP / PCP Doctor A
Hospital-doctor
communication
Remote advice
Patient Transfer
Hospital Acute Care / ED
Personal Health Record (PHR) to ED/Primary Care EMR
Care Facility
Acute Care Discharge to Extended Care Facility (ECF)

10. Flexible Infrastructure
Health Information Exchange
XDS
Structured objects
Pull
Publish
Pull
Send to
Switch
XDR
Write
Read
Interchange
Media
XDM

11. Point-to-Point Transmission of Documents
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

12. Point-to-Point Transmission of Documents
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).