Cross-enterprise Document Workflow(XDW)

First Tcon

Charles Parisot, Claudio Saccavini, Luca Zalunardo, Arianna CocchigliaDecember, 20th 2010

IT Infrastructure Technical Committee

Introduction

The Cross-Enterprise Document Workflow profile handles the difficult to manage the status of documents involved in a clinical workflow. The metadata “availabilityStatus”, in fact, allows to specify only two status (approved or deprecated) but this doesn’t allow to manage the different steps in a clinical workflow. This profile resolves the problem through the use of a specific document, the Workflow Document, where we track the different steps of all documents related to a same clinical event and all specific properties (who, when) connected to the change of a status by an healthcare professional; it defines also a set of rules to manage this particular document in an XDS scenario.

IT Infrastructure Technical Committee

Actors/Transactions diagram

XDSRegistry

Document REPOSITORY

Document SOURCE

[ITI – 41]Provide and Register

Document Set-b

[ITI – 42]Register Document Set-b

[ITI – 43]Retrieve

Document Set-b

[ITI – 18]Registry Stored

Query

[ITI – 41]Provide and Register

Document Set-b Document SOURCE

Document CONSUMER

Workflow Document Consumer

Workflow Document Consumer

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Actor/Transaction Table

Actors Transactions Optionality Section

Document Source [ITI-41] R ITI TF -2b: 3.41

Document Repository

[ITI-41][ITI-42][ITI-43]

RRR

ITI TF -2b: 3.41ITI TF -2b: 3.42ITI TF -2b: 3.43

Document Registry

[ITI-42][ITI-18]

RR

ITI TF -2b: 3.42ITI TF -2a: 3.18

Document Consumer

[ITI-18][ITI-43]

RR

ITI TF -2a: 3.18ITI TF -2b: 3.43

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Integration Profile Options

Actors Options Vol&Sections

Workflow Document Consumer

XDS Doc Source and Consumer embedded

XDS Doc Source Management Docs life cycle required (RPLC)

ITI TF-2b: 3.41

Grouped Actors

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Process Flow – Use cases

Possible Use Cases:•ePrescription•eReferral•Mobility/disability/healthcare aids•Healthcare professional monitoring•Neurosurgical Teleconselling•…•Oncological scenario

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Use CaseePrescription workflow

PlacedIn Progress

In ProgressCompleted

Ordered 2-Pharmacy partialy dispenses

drugs1-Visit and production of ePrescription

3-Publication of dispensed

document related to the dispensed

drug

4-Pharmacy dispenses all

drugs

5-Publication of dispensed

document related to the dispensed

drug

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Use CaseePrescription

Workflow Document ConsumerDocument

SourceDocument Consumer

Document Repository

Document Registry

[ITI – 41] Provide & Register Document Set-bPubblishing of ePrescription

Query and Retrieve ePrescription

Query and Retieve WD

[ITI – 18] Registry Stored Query

[ITI - 43] Retrieve Document Set

DocumentSource

[ITI – 18] Registry Stored Query

[ITI - 43] Retrieve Document Set

Pubblishing of WD

[ITI – 41] Provide & Register Document Set-b

Replace of WD

[ITI – 41] Provide & Register Document Set-b_RPLC

Create a folder [ITI – 41] Provide & Register Document Set-b[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 41] Provide & Register Document Set-bPubblishing of Dispensed Document [ITI – 42] Register

Document Set-b

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2-Booking the visit

Use Case eReferral workflow

Ordered Placed

PlacedIn Progress

In ProgressCompleted

Ordered

3-ADTAdmission of the patient

4- RX Exam5- Production of

the Clinical Report

6- Publication of RX report

7-Notification to the GP

1-Visit and production of

eReferral

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Use CaseeReferral

Workflow Document ConsumerDocument

SourceDocument Consumer

Document Repository

Document Registry

[ITI – 41] Provide & Register Document Set-bPubblishing of eRefeeral

Query and Retrieve eRefeeral

Query and Retieve WD

[ITI – 18] Registry Stored Query

[ITI - 43] Retrieve Document Set

DocumentSource

[ITI – 18] Registry Stored Query

[ITI - 43] Retrieve Document Set

Pubblishing of WD

[ITI – 41] Provide & Register Document Set-b

Replace of WD

[ITI – 41] Provide & Register Document Set-b_RPLC

Create a folder [ITI – 41] Provide & Register Document Set-b[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

IT Infrastructure Technical Committee

Use CaseMobility/Disability/Healthcare Aids

2-The hospital decide if autorize the

prescription and produce an advise

documentOrdered Authorized

Ordered

1-Visit and production of Request for

healthcare aids

3-The hospital dispenses the health

aid and produce a document of dispensationAuthorized Dispensed

4-The doctor tests the health aid dispensed

and produces a report of the test

Dispensed Tested and Dispensed

6-The patient returns the ait to the hospital

Tested and Dispensed Returned

5 – Notification to

the GP

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Use Case Healthcare professional Monitoring

•Tracking of the follow up•Follow up of the conselling requests•Grouping of all reports related at the same workflow•Notification to the GP of the proceeding of the follow uo with the reports of the visits•Follow up at patient’s home or in structures dedicated (elderly home, health districts, etc.)

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Use Case: Neurosurgical Teleconselling

Workflow Step view Workflow Document view

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Use Case 2:Workflow Document Content

Document Status

Teleconselling Request Document In progress - Requested - Completed

CT Image KOS (1) In progress - Completed

… …

CT Image KOS (n) In progress - Completed

CT Report (1) Preliminary – Completed - Signed

… …

CT Report (n) Preliminary - Signed

Teleconselling Response Document In progress - Completed

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Use Case - Neurosurgical Teleconselling

Workflow Document ConsumerDocument

SourceDocument Consumer

Document Repository

Document Registry

[ITI – 41] Provide & Register Document Set-b

Pubblishing of Teleconselling

request Document

Query and Retrieve Teleconselling

request Document

Query and Retieve WD

[ITI – 18] Registry Stored Query

[ITI - 43] Retrieve Document Set

DocumentSource

[ITI – 18] Registry Stored Query

[ITI - 43] Retrieve Document Set

Pubblishing of WD

[ITI – 41] Provide & Register Document Set-b

Replace of WD

[ITI – 41] Provide & Register Document Set-b_RPLC

Create a folder [ITI – 41] Provide & Register Document Set-b[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 42] Register Document Set-b

[ITI – 41] Provide & Register Document Set-b [ITI – 42] Register Document Set-b

Pubblishing of Neurosurgeon

Response Document

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Security Considerations

• No new security problems are introduced by XDW

• Security XDS ATNA and CT Time Client actor, EUA, PWP

• Time window = Retrieve modify and replace • XDS rules of replacement• Use steps to have a time window as close as possible

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Proposed Standards & Systems

• ITI Afferent IHE Profiles: – XDS.b, DSUB, NAV, XCA, BPPC, ATNA, XDR

• Afferent IHE Profiles: – Pharmacy - CMPD, PCC - PCCP, XDS-MS, RAD, LABs,

Cardiology, Ophthalmology, Mammo CAD, etc.

• Other standards items: – HL7 CDA

• Stability and robustness: – No new transaction are introduced– The only new actor introduced is Workflow Document Consumer

but it is an XDS Doc Consumer and Source grouped together– No XDS Metadata extension expected, but specific rules about

Metadata content for the workflow Document

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OPEN ISSUES AND QUESTIONS

• CDA2 structure/Flux Schema• Document oriented or step oriented

• Pharmacy profile and use cases (In Appendice or as an use case?)

• Level of the use cases: technical or like a scenario discussion?

• Integration with XCA profile: • Provide and register document set-b cross-community• Management of Workflow Document(RPLC and Life cycle)• Folder cross community?

IT Infrastructure Technical Committee

The structure of the Workflow Document

Section 1

General and common data (patient data, author data, institution data, etc)

Section 2…n

One section for any performed Workflow Step (e.g. ePrescription, eReferral) which contains:• Internal management properties about workflow step (status,

author, date/time of the change, relationship with previous workflow step, expected upcoming workflow steps..)

• Reference to the shared documents that were used as input to the workflow step (if any)

• Reference to the documents that were shared as a result of the workflow step

Section 1

General and common data (patient data, author data, institution data, etc)

Section 2…n

One section for any performed Workflow Step (e.g. ePrescription, eReferral) which contains:• Internal management properties about workflow step (status,

author, date/time of the change, relationship with previous workflow step, expected upcoming workflow steps..)

• Reference to the shared documents that were used as input to the workflow step (if any)

• Reference to the documents that were shared as a result of the workflow step

IT Infrastructure Technical Committee

The structure of the Workflow Document

Header

Body

Workflow Step Level Section- General data about the document- Link at the document- orderStatus and related data

Second Level Section- general data about the item- status of the item and related data- the link to possible documents generated by this item

Workflow Step Level Section- General data about the document- Link at the document- orderStatus and related data

Second Level Section- general data about the item- status of the item and related data- the link to possible documents generated by this item

IT Infrastructure Technical Committee

Discussion

The value statement of this proposal is:• The standardization of the workflows’ management

transactions and the associated workflow tracking structure linked with clinical events

• The creation of a document structure able to respond at the present and possibly to extend to future requirements

• This profile proposal benefits many domains. So it increases the consistency of workflow interoperability and the skill to solve the requests of the various care areas. It will avoid that different competing solutions are developed in the different domains. It is necessary to create an IT Infrastructure Profile in this field.

IT Infrastructure Technical Committee

Next Steps

• Teleconference: January 14th ? US connectathon

may be the 21th or 25th could be better

• F2F meeting:February 7th – 10th

May 2nd – 6th

July 18th – 22nd • Publish Trial Implementation August 2011