1September, 2005 What IHE Delivers

Cross-Enterprise Document Cross-Enterprise Document Point-to-point Interchange Point-to-point Interchange

(XDP) (XDP)

IHE Vendors Workshop 2006IHE Vendors Workshop 2006

IHE IT Infrastructure EducationIHE IT Infrastructure Education

David HEANEY (McKesson), Emmanuel CORDONNIER (ETIAM)David HEANEY (McKesson), Emmanuel CORDONNIER (ETIAM)

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XDPXDP Uses CasesUses Cases

Specialist, Radio or LabGP / PCP Doctor A

Care Facility Hospital Acute

Care / ED

Patient TransferPatient Transfer

Personal Health Record (PHR)Personal Health Record (PHR)to ED/Primary Care EMRto ED/Primary Care EMR

Acute Care DischargeAcute Care Dischargeto Extended Care Facility (ECF)to Extended Care Facility (ECF)

Remote adviceRemote advice

Consulting to referring physicians Consulting to referring physicians

Hospital-doctorHospital-doctor communicationcommunication

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XDP Value propositionXDP Value proposition

Complementary to sharing documents (XDS), Complementary to sharing documents (XDS), point-to-point communication of documentspoint-to-point communication of documents

Both transports: secured mail & media (CD…)Both transports: secured mail & media (CD…)

As XDS, “document content agnostic”As XDS, “document content agnostic”

Maximal re-use of XDS objects & meta-dataMaximal re-use of XDS objects & meta-data

Compatible with exchange of images (PDI…)Compatible with exchange of images (PDI…)

All XDS “content profiles” applyAll XDS “content profiles” apply

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XDP ScopeXDP Scope

Interchange of patient centered documentsInterchange of patient centered documents

Transmission of results, discharge letters or Transmission of results, discharge letters or patient referrals (not the "workflow" itself but patient referrals (not the "workflow" itself but all the medical information associated with - all the medical information associated with - e.g. reports, results, images, signals…)e.g. reports, results, images, signals…)

Personal Health Record medical information Personal Health Record medical information (history, etc), snapshots of clinical information (history, etc), snapshots of clinical information (medication list, immunization records, etc), (medication list, immunization records, etc), current observations from home care medical current observations from home care medical devices (e.g. blood pressure, blood sugar devices (e.g. blood pressure, blood sugar level, etc). level, etc).

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XDP Key Technical PropertiesXDP Key Technical Properties

Re-uses XDS approach for documentsRe-uses XDS approach for documents SubmissionSet, DocumentEntrySubmissionSet, DocumentEntry ebRS based XML meta-data w. limited extensionsebRS based XML meta-data w. limited extensions

Secure e-mail (ebMS over SMTP, S/MIME)Secure e-mail (ebMS over SMTP, S/MIME)

Optional on-line protocol (similar to XDS)Optional on-line protocol (similar to XDS)

PDI like media profile with XDS meta-dataPDI like media profile with XDS meta-data

Potential association of XDS and PDI at the actor Potential association of XDS and PDI at the actor level (Document Source…)level (Document Source…)

Further evolution possible for direct interchange Further evolution possible for direct interchange over web services (MTOM…) over web services (MTOM…)

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XDP Actor DiagramXDP Actor Diagram

Send Document Set [ITI-32] Document Source

Portable Media Importer

Document Recipient

Portable Media Creator

Distribute Document Set on Media [ITI-33]

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XDP in conjunction with XDSXDP in conjunction with XDS

Document Source

Document ConsumerDocument Repository

Document Registry

Document Recipient

XDP

Document Recipient

Document Source

XDP

XDS

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XDP Actors and TransactionsXDP Actors and Transactions

Actors Transactions Optionality Section in Vol 2

DocumentSource

Send Document Set R ITI TF-2:3.32

DocumentRecipient

Send Document Set R ITI TF-2:3.32

Portable Media

Creator

Distribute Document Set on Media

R ITI TF-2:3.33

Portable Media

Importer

Distribute Document Set on Media

R ITI TF-2:3.33

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XDP off-line messageXDP off-line messageProtocol encapsulation in SMTP/ESMTP

SOAP with MIME attachments (multipart/related)

text/xml SOAP:Envelope

SOAP:Header, with Service=LifeCycleManager and Action=submitObjects

SOAP:Body, with Manifest=list of attachments (e.g. ebXML Reg. Msg + Documents)

Part 1 (start)Part 1 (start)

text/xml SubmitObjectRequest (ebXML Registry Message)Part 2Part 2

Document 1 Part 3Part 3

Document n

.

.

.

Part n+2Part n+2

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XDP Actors and OptionsXDP Actors and Options

Actor Options Vol &Section

Document Source Multiple Document Submission

ITI TF-1:15.2.1

On-Line Mode ITI TF-1:15.2.2

Document Recipient On-Line Mode ITI TF-1:15.2.2

Portable Media Creator USB (Note 1) ITI TF-1:15.2.3

CD-R (Note 1) ITI TF-1:15.2.4

Portable Media Importer

USB (Note 1) ITI TF-1:15.2.3

CD-R (Note 1) ITI TF-1:15.2.4

Note 1: At least one of these options is required for each Actor.Note 1: At least one of these options is required for each Actor.

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XDP Integration Profile OptionsXDP Integration Profile Options

Multiple Documents Submission Option Multiple Documents Submission Option Offers the ability to include multiple documents in a single Offers the ability to include multiple documents in a single

Submission RequestSubmission Request

On-Line Mode Option On-Line Mode Option Offers the ability to send the set of documents to one unique Offers the ability to send the set of documents to one unique

recipient, using a HTTP web-service based on-line recipient, using a HTTP web-service based on-line transmission mode. transmission mode.

USB Option USB Option Portable Media Creator writes a set of documents on USB Portable Media Creator writes a set of documents on USB

mediamedia

CD-R Option CD-R Option Portable Media Creator writes a set of documents on CD-R Portable Media Creator writes a set of documents on CD-R

media. media.

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Structure of the XDP mediaStructure of the XDP media

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XDP in conjunction with PDIXDP in conjunction with PDI

XDP content:XDP content:

In complement, PDI content:In complement, PDI content:

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Security considerationsSecurity considerations (1) (1)

Use of S/MIME encryption and signature for off-Use of S/MIME encryption and signature for off-line network transfer (integrity, privacy)line network transfer (integrity, privacy)

Encryption, with TLS authentication of both hosts, Encryption, with TLS authentication of both hosts, for on-line transfers across secure domainsfor on-line transfers across secure domains

Actors need to protect themselves against Actors need to protect themselves against confidentiality and integrity related risks confidentiality and integrity related risks

XDP grouped with ATNA (access control/audit)XDP grouped with ATNA (access control/audit)

Import operations need to be further protected Import operations need to be further protected (hash and size to detect corruption with metadata (hash and size to detect corruption with metadata assurance)assurance)

Media must be securely managed (respect of Media must be securely managed (respect of privacy, proper identification, and corruption privacy, proper identification, and corruption checking)checking)

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Security considerationsSecurity considerations (2) (2)

Additionally, parties are recommended to have a Additionally, parties are recommended to have a mutual agreement:mutual agreement: Management of Patient identification in order to avoid/limit Management of Patient identification in order to avoid/limit

identification errors. The metadata includes a patient id identification errors. The metadata includes a patient id shared by both the Document Source and the Document shared by both the Document Source and the Document Recipient as well as id and associated patient info as known Recipient as well as id and associated patient info as known by the Document Source.by the Document Source.

Measures taken to avoid/limit loss of email by using Measures taken to avoid/limit loss of email by using acknowledgements.acknowledgements.

Management of personnel and the organizations Management of personnel and the organizations identification and access control mechanisms.identification and access control mechanisms.

Codes set and vocabulary used enabling a consistent Codes set and vocabulary used enabling a consistent management of the metadata on both side.management of the metadata on both side.

In addition both organizations shall have mutually In addition both organizations shall have mutually acceptable audit trail mechanisms.acceptable audit trail mechanisms.

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