1. Sept 13-15, 2004IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise HIMSS Demonstration XDS Document Content Specifications Keith W. Boone – Dictaphone Corporation IHE IT Infrastructure Technical Committee

2. Sept 13-15, 2004IHE Interoperability Workshop 2 1. Why do we need Document Content Profiles? 2. HIMSS Demo Document Content Prototypes 3. CCR Details 4. Demonstration Scenario Agenda

3. Sept 13-15, 2004IHE Interoperability Workshop 3 Clinical Encounter Clinical IT System 1-Expression of a need for patient information Index of patients records (Document-level) Temporary Aggregate Patient History 3-DocumentsReturned Document Repositories 4-Patient data presented to Physician 3-Reference to Docs from Inquiry 2- Inquiry for Docs Clinicians access XDS Services

4. Sept 13-15, 2004IHE Interoperability Workshop 4 Querying for Documents The four main axes for Document Queries: 1. Which Patient ? 2. What Type of Document ? 3 interrelated sub-dimensions: Facility Type Document Class Event Type 3. By Groups of Documents 4. By time of Services 10 additional attributes to query. Patient Id Time of Services Document ClassFacility Type XDS core Meta-Data derived from HL7 CDA and CEN EHRcom Folder Submission Set Practice Setting

5. Sept 13-15, 2004IHE Interoperability Workshop 5 Why Document Content Profiles Define Standards and/or Versions of Format used Content Constraints  Define Mandatory and Required Components Mandatory – Must be present Required – Must be present when known  Reduce Variations – eliminate choices Map data-types between standards Define Vocabularies used in Registry Fields  Simplifies query Define Process Flows for use of the Content  May Introduce New Actors and Transactions to define process flows

6. Sept 13-15, 2004IHE Interoperability Workshop 6 XDS is a foundation building block for cross-enterprise EHR: Document Content Integration Profiles, e.g., CDA, PDF, HL7 or JPEG used to transfer medical records, labs, images, et cetera. Process Flow Profiles, e.g. Define process flows using XDS and a collection of Document Content Profiles XDS Cross-Enterprise Document Sharing. CCR, CDA, PDF, HL7, JPEG, etc. eReferral IHE Roadmap - Building upon XDS

7. Sept 13-15, 2004IHE Interoperability Workshop 7 Demonstration Prototype Document Content 1.CDA – Clinical Document Architecture  Release 1  ANSI/HL7 Standard 2.PDF – Portable Document Format 3.HL7 – V2.5 Lab Reports 4.CCR – Continuity of Care Record  ASTM Work in Progress

8. Sept 13-15, 2004IHE Interoperability Workshop 8 CDA Content Standards and Profiles CDA Release 1.0  Balloted Standard by ANSI/HL7 Claims Attachments LOINC  Logical Observation and Identifier Codes  Supporting Vocabularies

9. Sept 13-15, 2004IHE Interoperability Workshop 9 CDA Content Profile Overview Document Content Integration Profile  Defines content and mapping Required CDA Elements  service_tmr, originator, originatating_organization, organization.nm, person_name Mapping CDA Schema to Registry Fields  MIME Type: text/xml  Type Conversions Identifiers Dates and Times Patient Demographics Vocabulary Patient Identifiers in XDS Domain  Based on LOINC Document Type Vocabularies

10. Sept 13-15, 2004IHE Interoperability Workshop 10 PDF Content Profile Overview Document Content Profile  Defines Content only, no Mapping – registry content supplied by Document Source Standards and Profiles  Portable Document Format V4  Archivable Document Subset  MIME Type application/pdf Vocabulary  Use XDS Affinity Domain Defined Vocabularies

11. Sept 13-15, 2004IHE Interoperability Workshop 11 HL7 - Lab Report Content Overview Document Content Profile  Defines Content and Mapping  HL7 V2.5 to Registry  Some Registry Content provided by Document Source HL7 V2.5  Balloted Standard by ANSI/HL7  Constrained to a V2.5 subset supported by most Lab/EHR systems  Consistent with IHE Transaction: LAB-Order Results Management Vocabulary: LOINC  Logical Observation and Identifier Codes  Supporting Vocabulary for test Codes  Lab test results available as if received through an HL7 V2 feed.

12. Sept 13-15, 2004IHE Interoperability Workshop 12 Continuity of Care Record Provides a mechanism for exchange of relevant patient information between providers and the patient to ensure continuity of care. Standard defined by ASTM Initiated by MMS Data elements of CCR are identified XML schema for exchange is a work in progress

13. Sept 13-15, 2004IHE Interoperability Workshop 13 Continuity of Care Record Document Content Profile  Defines Content and Mapping October 8 th Draft  MIME Type: text/xml  Document Class: Referral  Document Type: X-CCR  Constrained to certain Data Elements Vocabulary  To be determined Mapping from Content to Registry  Patient Identifier in XDS Patient Identity Domain  Type Conversions Identities Dates and Times Patient and Provider Names Patient Demographics

14. Sept 13-15, 2004IHE Interoperability Workshop 14 CCR Demo Data Element Categories Identifiers Problem and Reason for Referral Past Medical History Medications and Allergies Patient Health Status  Vital Signs  Recent lab and x-ray tests  New stat tests ordered Advance Directives Plan of Care

15. Sept 13-15, 2004IHE Interoperability Workshop 15 Sample Scenario This is a sample similar to what will be used in the HIMSS Demonstration. Patient arrives at PCP office complaining of coughing up blood  Chest x-ray from nearby radiology imaging center demonstrates a lung mass.  PCP communicates with nearby Specialist Thoracic Surgeon  PCP discusses patient specific data and shares documents securely with specialist on same day of patient visit  PCP completes referral CCR to specialist Includes documentation of recent and past studies and history Signed document is part of patient record and protected for proper access  Specialist returns a CCR to PCP for follow-up care

16. Sept 13-15, 2004IHE Interoperability Workshop 16 Use Case Goal in context  Consultation between primary care providers and specialists  Collaboration with the right people to treat efficiently and eliminate error Scope  Cross Enterprise Document Sharing Pre-Condition  Participants are linked to leverage collaborative technologies

17. Sept 13-15, 2004IHE Interoperability Workshop 17 Stakeholders and Interests Primary Care Provider  Provides appropriate patient care using available medical records.  Active participation in patient care for continuity and follow-up Specialist Physician  Immediate access to patient data  Availability of input from PCP and other specialists  Ability to provide high quality patient care Patient  Quick and proper care  Minimal inconvenience  Independence from place of care Other participants in patient care  Easy workflow  Minimum delay  Access to right information at the right time

18. Sept 13-15, 2004IHE Interoperability Workshop 18 Success Verification Patient arrives at PCP office with problem, obtains chest film & results on same day of visit Specialist is notified by PCP of the problem on the same day PCP discusses patient specific data and shares documents securely PCP completes referral CCR to specialist with appropriate and relevant documentation and sends patient for admission to specialist’s inpatient service Specialist responds with CCR to PCP to provide for appropriate follow-up care The signed and completed documents become part of patient record and are protected for proper access

19. Sept 13-15, 2004IHE Interoperability Workshop 19 CCR Demo Plan Sample Scenario  This presentation CCR Content Profile  To be Finalized by October 8 th Vendor Applications  Due October 15 th  Indicate ASTM-CCR on Demo Application Draft Schema and Implementation Guide  To be Finalized by October 8 th  Need Reviewers

20. Sept 13-15, 2004IHE Interoperability Workshop 20 CCR Demonstration Development Schedule DateActivity September 15Presentation of CCR September 17Draft 1 Issued September 22Draft 1 Specification Review T-CON September 29Draft 2 Review Face to Face (ATL) October 6Draft 3 Review T-CON October 8Demo Specification Issue

21. Sept 13-15, 2004IHE Interoperability Workshop 21Questions?

22. Sept 13-15, 2004IHE Interoperability Workshop 22 More information…. IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm. Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure Non-Technical Brochures: Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements