1. IHE IT Infrastructure Domain Update Karen Witting – IBM IT Infrastructure Technical Committee co-chair

2. IT Infrastructure Domain (ITI) Supports profiles which supply necessary infrastructure for sharing healthcare information. IT Infrastructure domain began in 2003 and now has 27 profiles that it supports. Key ITI profiles demonstrated today: – Information Exchange: XDS.b, XDM, XDS-SD, RFD – Security: ATNA, CT, XUA, BPPC – Identity Management: PIX, PDQ (HL7 V2 & V3)

3. An Infrastructure Interoperability Component Is… An infrastructure Interoperability component… – Represents a common IT function or service that is used as a building block for a variety of use cases – May be imbedded in an application, but is often deployed as a shared resource within a RHIO or Health Information Exchange – Is a necessary ingredient, but is rarely visible to the end user

4. Categories of Healthcare Communication Services Security/Privacy Document Sharing Patient and Provider Identity Management Dynamic Information Access Workflow Management Source persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task e.g. access last 6 mo. historical labs & encounter summaries e.g. order lab test, track status and receive results e.g. get current list of allergies or med list from source Hospitals HIEs and RHIOs

5. ITI Profiles Security/Privacy – Cross-Enterprise User Assertion (XUA) ☼ – Basic Patient Privacy Consents (BPPC) ☼ – Enterprise User Authentication (EUA) – Consistent Time (CT) ☼ – Audit Trail and Node Authentication (ATNA) ☼ – Document Digital Signature (DSG) Identify Management – Personnel White Pages (PWP) – Patient Identifier Cross-Referencing (PIX) ☼ – Patient Demographics Query (PDQ) ☼ – Patient Identifier Cross-Referencing HL7 V3 (PIX V3) ☼ – Patient Demographics Query HL7 V3 (PDQ V3) ☼ – Patient Administration Management (PAM) – Pediatric Demographics Option – Cross-Community Patient Discovery (XCPD) ☼ ▀ colored text designates 2009 new profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

6. ITI Profiles (continued) Information Exchange – Cross-Enterprise Document Sharing - b (XDS.b) ☼ – Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼ – Cross Community Access (XCA) ☼ – Document Metadata Subscription (DSUB) ☼ – Multi-Patient Queries ☼ – Cross-Enterprise Document Media Exchange (XDM) ☼ – Cross-Enterprise Document Reliable Interchange (XDR) – Notification of Document Availability (NAV) – Retrieve Form for Data Capture (RFD) ☼ – Retrieve Information for Display (RID) – Patient Synchronized Applications (PSA) Terminology – Sharing Value Sets ▀ colored text designates 2009 new profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

7. Document Content & Modes of Exchange Document Exchange Integration Profiles Document Sharing XDS Media Interchange XDM Reliable Interchange XDR Document Content Profiles Consent BPPC Emergency EDR Pre Surgery PPH P Scanned Doc XDS-SD Laboratory XD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MS Imaging XDS-I Cross-Community Access XCA

8. Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + Use of ATNA & CT PMS Retrieve Document Register Document Query Document XDS Document Registry ATNA Audit record repository CT Time server Record Audit Event Maintain Time Maintain Time Record Audit Event Maintain Time Provide & Register Docs Record Audit Event XDS Document Repository Secured Messaging

9. Community Clinic Lab Info. System PACS Teaching Hospital PACS ED Application EHR System Physician Office EHR System XDS Scenario + Use of PIX & PDQ A87631 PACS L-716 Affinity Domain Patient Identity Source M8354673993 Retrieve Document Provide & Register Docs Register (using Pt ID)Query Document (using Pt Id) Patient Identity Feed Document Registry 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query PIX Query Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed PDQ Query to Acquire Affinity Domain Patient ID M8354673993 A87631 L-716 M8354673993 XDS Document Repository XDS Document Repository ATNA Audit record repository CT Time server

10. Document Registry Practice Clinic Hospitals Repository Practice Gateway Repository Patient ID services ILLINOIS HIMSS 10 Cross-Community Demonstrating Sharing across regional boundaries IHE transactions Document Registry Practice Clinic Hospitals Hospital Repository Practice Hospital Gateway Repository Patient ID services NEW YORK Document Registry Practice Clinic Hospitals Repository Gateway Patient ID services NORTH CAROLINA Document Registry Practice Clinic Hospitals Hospital Repository Practice Hospital Repository Patient ID services CALIFORNIA Gateway

11. 2009 New Work Cross-Community Patient Discovery (XCPD) Document Metadata Subscriptions (DSUB) Multi-Patient Query

12. XCPD Actors and Transactions

13. XCPD Illustration of Use (Informative) Steps 1 - 10

14. XCPD Illustration of Use (Informative) Steps 11-13

15. DSUB Overview The Document Metadata Subscription (DSUB) supplement contains two related parts 1)Publish/Subscribe Infrastructure: General framework for defining web-services based publish/subscribe interactions 2)Document Metadata Subscription (DSUB) Integration Profile: Use of subscriptions within an XDS Affinity Domain or across communities

16. Publish/Subscribe Infrastructure Actors and Transactions

17. DSUB Actors and Transactions

18. DSUB Illustration of Use

19. Multi-Patient Query Actors and Transactions

20. Multi-Patient Queries - New Stored Queries FindDocumentsForMultiple Patients – Equivalent to FindDocuments but $XDSDocumentEntryPatientId parameter: is optional (zero values)‏ may have multiple values specified – At least one of the following parameters is required: ClassCode, EventCodeList, HealthcareFacilityTypeCode – More of a medical event based query than a patient based query FindFoldersForMultiplePatients – Equivalent to FindFolders but $XDSFolderPatientId parameter: is optional (zero values)‏ may have multiple values specified – At least one of the following parameters is required: folderCodeList – More of a medical event based query than a patient based query

21. IHE IT Infrastructure Schedule for 2010 Development Schedule: Planning Committee decision ……… December 2009 Issue Public Comment version …….. May 2010 Public Comment Due ……………….. June 2010 Issue Trial Implementation version … August 2010 IHE Connectathon …………………… January 2011 HIMSS Demo ………………………… February 2011

22. IHE IT Infrastructure Plan for 2010 New Supplements For 2010 Enhanced Sharing Value Set (Enhanced SVS) Add supports for registering and updating value sets Healthcare Provider Directory (HPD) Supports healthcare provider search and feed System Directory for Document Sharing (SDDS) Supports directory of services used in document sharing environments XDS Metadata Update Service Supports update of metadata registered in a XDS Document Registry Dynamic/Deferred Document Sharing (D3S) Supports registration, query and retrieve of document content that is created at time of retrieval. XUA Extension for Access Control Extend XUA SAML assertion with authorization attributes