1. Federated Directory Service (FDS) IHE IT Profile Proposal Sören Bittins (eCR, Fraunhofer ISST) November, 18th 2008

2. IT Infrastructure Technical Committee Editors Olaf Rode, Ben Kraufmann (Fraunhofer ISST)Olaf Rode, Ben Kraufmann (Fraunhofer ISST) Gottfried Heider (eHealth Consultants)Gottfried Heider (eHealth Consultants)

3. IT Infrastructure Technical Committee Current Situation Distributed private hospital chains, state-owned hospitals and doctorsDistributed private hospital chains, state-owned hospitals and doctors HCP are not usually interconnected among each other = “offline”HCP are not usually interconnected among each other = “offline” Communication by mostly traditional means:Communication by mostly traditional means: –Telephone, Fax, Letter, Patient Localisation also by traditional means:Localisation also by traditional means: –Yellow Pages, Directory Assistance Only intra-enterprise digital communication:Only intra-enterprise digital communication: –Not secured by state-of-the-art methodologies –Usually not applicable for external communication –Triple-effort: localise, authenticate, and communicate (with) external partners

4. IT Infrastructure Technical Committee Basic Requirements Digital communication requires:Digital communication requires: –localisation –identification –addressing –authentication Those issues demand for adequate directory services that can be used across affinity domainsThose issues demand for adequate directory services that can be used across affinity domains

5. IT Infrastructure Technical Committee Objectives of FDS Federated, distributed and interconnected directory services greatly improve this process:Federated, distributed and interconnected directory services greatly improve this process: –Re-use of already existing but strongly isolated directories (e. g. PWP) –More secure and in full compliance to data-protection and –safety regulations –Enable cooperative and potentially cross-border / cross-organisational health-care applications –Lay the foundation for a secure and reliable exchange of digital documents –More efficient and much faster –Fully traceable and comprehensible

6. IT Infrastructure Technical Committee FDS Inter-connection

7. IT Infrastructure Technical Committee Federated Directory Service FDS enables the linkage of originally intra-enterprise/-domain directory servicesFDS enables the linkage of originally intra-enterprise/-domain directory services FDS manages and coordinates the data exchange of all participantsFDS manages and coordinates the data exchange of all participants FDS enables multiple deployment options, such as hierarchical organisational structures or lateral peer-to-peer networksFDS enables multiple deployment options, such as hierarchical organisational structures or lateral peer-to-peer networks FDS profiles the communication and requests for upmost compatibility and harmonisation between all participantsFDS profiles the communication and requests for upmost compatibility and harmonisation between all participants FDS aims at providing a foundation for further integration profiles that foster and ensure interoperability in healthcareFDS aims at providing a foundation for further integration profiles that foster and ensure interoperability in healthcare

8. IT Infrastructure Technical Committee Actors and Transactions

9. IT Infrastructure Technical Committee Proposed Standards & Systems The proposed profile should use existing directory standards (i. e. LDAP as profiled by DICOM Suppl. 67)The proposed profile should use existing directory standards (i. e. LDAP as profiled by DICOM Suppl. 67) The use of DSML is proposedThe use of DSML is proposed Federation and trust establishment/brokerage should be based on the respective WS* stack (e. g. using the recommendations of the HL7 v3 transport specification)Federation and trust establishment/brokerage should be based on the respective WS* stack (e. g. using the recommendations of the HL7 v3 transport specification) Entity Identification Service (Service Functional Model Specification, OMG Technical Spec.)Entity Identification Service (Service Functional Model Specification, OMG Technical Spec.)

10. IT Infrastructure Technical Committee IHE Profile Grouping XUA: for the authentication against FDS directory gatewaysXUA: for the authentication against FDS directory gateways XPP: for authorisation of directory access operationsXPP: for authorisation of directory access operations ATNA: for mutual node authenticationATNA: for mutual node authentication PWP: for potential instantiation of the FDS directory provider actorPWP: for potential instantiation of the FDS directory provider actor

11. IT Infrastructure Technical Committee Real-World Necessity Real-world experience while rolling-out health care networks in Germany:Real-world experience while rolling-out health care networks in Germany: –Missing or non-standardized directories are the #1 sore spot for every co-operative healthcare scenario in a federated environment –Inadequate identification means may cost efficiency –Inadequate localisation/addressing means cost valuable time –Inadequate authentication means may cost compliance FDS is a building-block of high significance :FDS is a building-block of high significance : –Physicians who refer a patient to a hospital needs: the correct address of the hospital (e. g. eMail)the correct address of the hospital (e. g. eMail) its current digital certificate (e. g. for encrypting the referral letter)its current digital certificate (e. g. for encrypting the referral letter) the intra-enterprise OID of the responsible department (e. g. for granting access authorization for a health record)the intra-enterprise OID of the responsible department (e. g. for granting access authorization for a health record)

12. IT Infrastructure Technical Committee Further Synergy Potential Cross-National solutions for co-operative health care:Cross-National solutions for co-operative health care: –Border-line winter sports regions: Germany and Austria –Cooperative health care in Benelux-States: France, Belgium, Luxembourg Pan-European Scope – epSOS ePrescription:Pan-European Scope – epSOS ePrescription: –A patient needs medicine that is already prescribed in the home country when in another country. In this case the pharmacist should be able to electronically access the prescription from the same eHealth interface used for prescriptions ordered in the local country. When medicine is dispatched, the system should notify the home country node of the foreign patient about the dispensed drugs. –A medical professional decides to prescribe medicine to a visiting patient from another country. To assist the medical professional to make the best decision on the pharmaceutical strategy to be used, the patient's medical and pharmaceutical history from her home country will be available through the patient summary. When the electronic prescription is finalized, a copy of the prescription will also be sent to the patient's national node for inclusion in the national medication summary.