1. Publication and Discovery XDS IHE IT Infrastructure Webinar Series

2. IT Infrastructure Planning Committee What is XDS ? The Cross-Enterprise Document Sharing (XDS) IHE Integration Profile facilitates the registration, distribution and access across health enterprises of patient electronic health records. provides a standards-based specification for managing the sharing of documents between any healthcare enterpriseprovides a standards-based specification for managing the sharing of documents between any healthcare enterpriseHistory Originally based on ebXML and SOAP (now depreciated)Originally based on ebXML and SOAP (now depreciated) Web Services – XDS.b (currently the only XDS in TF v7)Web Services – XDS.b (currently the only XDS in TF v7)

3. IT Infrastructure Planning Committee XDS Affinity Domains Group of healthcare enterprises that have agreed to work together using a common set of policies and standards-based infrastructures for sharing patient clinical documents, e.g.: Regional community of careRegional community of care Nationwide HERNationwide HER Specialized or disease-oriented (cardio, diabetes, oncology)Specialized or disease-oriented (cardio, diabetes, oncology) Government-sponsored or federation of enterprisesGovernment-sponsored or federation of enterprises Insurance provider supported communitiesInsurance provider supported communities XDS profile is designed to accommodate a wide range of policies on: Patient identification and consentPatient identification and consent Controlling access to informationControlling access to information Format, content, structure, and representation of clinical informationFormat, content, structure, and representation of clinical information

4. IT Infrastructure Planning Committee Some Possible Scenarios ePharmacy between ward and pharmacy departments within a hospitalePharmacy between ward and pharmacy departments within a hospital eReferral between primary and secondary care providerseReferral between primary and secondary care providers Publishing of Emergency Care Summaries within a RegionPublishing of Emergency Care Summaries within a Region Radiology reports and images between facilitiesRadiology reports and images between facilities

5. IT Infrastructure Planning Committee Main Entities and Responsibilities A document repository is responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests.A document repository is responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests. A document registry is responsible for storing information about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored.A document registry is responsible for storing information about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored.

6. IT Infrastructure Planning Committee 1. Sources post document packages to the Repository 2. Repository registers the documents metadata and pointer with the Registry 3. Consumers search for documents with specific information 4. Consumers retrieve documents from Repository (-ies) XDS Document (Metadata): Type Patient Author Facility Authenticator … XDS Document (Metadata): Type Patient Author Facility Authenticator … Repository Origin of Documents Package Registry Flow and Interactions Consumer

7. IT Infrastructure Planning Committee XDS.b Formal Diagram Patient Identity Source Document Registry Document Repository Document Source Document Consumer Patient Identity Feed [ITI-8] Patient Identity Feed HL7v3 [ITI-44] Provide&Register Document Set-b [ITI-41] Retrieve Document Set [ITI-43] Registry Stored Query [ITI-18] Register Document Set-b [ITI-42] Integrated Document Source/Repository

8. IT Infrastructure Planning Committee XDS.b Actors Document Source – producer and publisher of documents, responsible for sending documents and their metadata to a Document Repository actorDocument Source – producer and publisher of documents, responsible for sending documents and their metadata to a Document Repository actor Document Consumer – queries a Document Registry actor for documents meeting certain criteria, and retrieves selected documents from one or more Document Repository actorsDocument Consumer – queries a Document Registry actor for documents meeting certain criteria, and retrieves selected documents from one or more Document Repository actors Document Registry – maintains metadata about each registered document and a link to the Document in the Repository where it is stored. Responds to queries from Document Consumer actors about documents meeting specific criteria.Document Registry – maintains metadata about each registered document and a link to the Document in the Repository where it is stored. Responds to queries from Document Consumer actors about documents meeting specific criteria. Patient Identity Source facilitates the validation of patient identifiers by the Registry Actor in its interactions with other actors by providing unique identifier for each patient and maintaining a collection of identity traitsPatient Identity Source facilitates the validation of patient identifiers by the Registry Actor in its interactions with other actors by providing unique identifier for each patient and maintaining a collection of identity traits Integrated Document Source/Repository combines the functionality of the Document Source and Document Repository actors into a single actor that does not initiate nor accept the Provide and Register Document Set transactionIntegrated Document Source/Repository combines the functionality of the Document Source and Document Repository actors into a single actor that does not initiate nor accept the Provide and Register Document Set transaction

9. IT Infrastructure Planning Committee XDS.b Transactions (1) Provide and Register Document Set – For each document in the submitted set, the Document Source Actor provides both the documents as an opaque octet stream and the corresponding metadata to the Document Repository. The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction.Provide and Register Document Set – For each document in the submitted set, the Document Source Actor provides both the documents as an opaque octet stream and the corresponding metadata to the Document Repository. The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction. Register Document Set – Allows a Document Repository Actor to register one or more documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry.Register Document Set – Allows a Document Repository Actor to register one or more documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry.

10. IT Infrastructure Planning Committee XDS.b Transactions (2) Registry Stored Query is issued by the Document Consumer Actor to a Document Registry. It will return registry metadata containing a list of document entries found to meet the specified criteria including the locations and identifier of each corresponding document in one or more Document Repositories.Registry Stored Query is issued by the Document Consumer Actor to a Document Registry. It will return registry metadata containing a list of document entries found to meet the specified criteria including the locations and identifier of each corresponding document in one or more Document Repositories. Patient Identity Feed conveys the patient identifier and corroborating demographic data, in order to populate the Document Registry with patient identifiers that have been registered for the XDS Affinity Domains. (At least one of the options [ITI-8] or [ITI-44] should be supported.)Patient Identity Feed conveys the patient identifier and corroborating demographic data, in order to populate the Document Registry with patient identifiers that have been registered for the XDS Affinity Domains. (At least one of the options [ITI-8] or [ITI-44] should be supported.) Retrieve Document Set – initiated by a Document Consumer. The Document Repository shall return the document set that was specified by the Document Consumer.Retrieve Document Set – initiated by a Document Consumer. The Document Repository shall return the document set that was specified by the Document Consumer.

11. IT Infrastructure Planning Committee XDS.b Actors and Transactions ActorsTransactionsOptionalitySection Document Consumer Registry Stored Query [ITI-18] Retrieve Document Set [ITI-43] RR ITI TF-2a: 3.18 ITI TF-2b: 3.43 Document Source Provide and Register Document Set-b [ITI-41] R ITI TF-2b: 3.41 Document Repository Provide and Register Document Set-b [ITI-41] Register Document Set-b [ITI-42] Retrieve Document Set [ITI-43] RRR ITI TF-2b: 3.41 ITI TF-2b: 3.42 ITI TF-2b: 3.43 Document Registry Register Document Set-b [ITI-42] R Registry Stored Query [ITI-18] R Patient Identity Feed [ITI-8] Patient Identity Feed HL7v3 [ITI-44] RR O (Note 2) ITI TF-2b: 3.42 ITI TF-2a: 3.18 ITI TF-2a: 3.8 ITI TF-2b: 3.44 Integrated Document Source/Repository Register Document Set-b [ITI-42] Retrieve Document Set [ITI-43] RR ITI TF-2b: 3.42 ITI TF-2b: 3.43 Patient Identity Source Patient Identity Feed [ITI-8] Patient Identity Feed HL7v3 [ITI-44] O (Note 1,2) ITI TF-2a: 3.8 ITI TF-2b :3.44

12. IT Infrastructure Planning Committee XDS Document Content Types XDS-SD: Scanned document, plain text or PDF/A, in HL7 CDA R2 formatXDS-SD: Scanned document, plain text or PDF/A, in HL7 CDA R2 format XDS-MS: Medical summary in HL7 CDA formatXDS-MS: Medical summary in HL7 CDA format XDS-I: Radiology report in plain text of PDF format, or reference to a collection of DICOM SOP Instances in a manifest document in the DICOM Key Object Selection formatXDS-I: Radiology report in plain text of PDF format, or reference to a collection of DICOM SOP Instances in a manifest document in the DICOM Key Object Selection format

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