september, 2005what ihe delivers 1 xds document source and consumer implementation strategies ihe...
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1September, 2005 What IHE Delivers
XDS Document Source XDS Document Source and Consumer and Consumer Implementation Implementation
StrategiesStrategies
IHE Vendors Workshop 2006IHE Vendors Workshop 2006
IHE IT Infrastructure EducationIHE IT Infrastructure Education
George Cole (Allscripts)George Cole (Allscripts)
with thanks to Charles Parisot for many slideswith thanks to Charles Parisot for many slides
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OverviewOverview
Review XDSReview XDS
Related ProfilesRelated Profiles
Implementation StrategiesImplementation Strategies
ResourcesResources
QuizQuiz
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Cross-Enterprise Document SharingCross-Enterprise Document Sharing
A baseline profileA baseline profile
Focused on managing the sharing of Focused on managing the sharing of patient healthcare documentspatient healthcare documents
Provides for Distributed RepositoriesProvides for Distributed Repositories
Content NeutralContent Neutral
Referenced and reused by other profilesReferenced and reused by other profiles
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XDS for DummiesXDS for Dummies
Document Source submits to RepositoryDocument Source submits to Repository
Document Consumer queries RegistryDocument Consumer queries Registry
Document Consumer retrieves from Document Consumer retrieves from RepositoryRepository
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Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide&Register Document Set
Register Document Set
XDS Actors and TransactionsXDS Actors and Transactions
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Clinical EncounterClinical Encounter ClinicalClinicalIT SystemIT System 1-Expression of a 1-Expression of a
need for additional need for additional informationinformation
Index of patients records(Document-level)
Temporary Aggregate Patient History
3-Documents3-DocumentsReturnedReturned
DocumentRepositories
4-Patient data 4-Patient data presented to presented to
PhysicianPhysician
3-Reference3-Referenceto Docs from to Docs from
InquiryInquiry2- Inquiry 2- Inquiry for Docs for Docs
XDS in ActionXDS in Action
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Related ProfilesRelated Profiles
Patient Identifier Cross-referencing (PIX) Patient Identifier Cross-referencing (PIX) or Patient Demographics Query (PDQ)or Patient Demographics Query (PDQ)
Consistent Time (CT)Consistent Time (CT)
Audit Trail and Node Authentication Audit Trail and Node Authentication (ATNA)(ATNA)
Document Digital Signature (DSG)Document Digital Signature (DSG)
Notification of Document Availability Notification of Document Availability (NAV)(NAV)
8XDS Affinity Domain (NHIN sub-network)
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of ATNA & CTXDS Scenario + use of ATNA & CT
PMS
Retrieve DocumentRetrieve Document
Register DocumentRegister DocumentQuery DocumentQuery Document
XDS Document Registry
ATNA Audit ATNA Audit record repositoryrecord repository CT Time serverCT Time server
Record AuditRecord AuditEventEvent
MaintainMaintainTimeTime
MaintainMaintainTimeTimeRecord AuditRecord Audit
EventEvent
Maintain TimeMaintain TimeProvide & Register Docs
Record AuditRecord AuditEventEvent
XDS Document Repository
XDSDocumen
t Reposito
rySecured MessagingSecured Messaging
9XDS Affinity Domain (NHIN sub-network)
Community Clinic
Lab Info. System
PACS
Teaching Hospital
PACS
ED Application
EHR System
Physician Office
EHR System
XDS Scenario + use of PIX & PDQXDS Scenario + use of PIX & PDQ
A87631L-716
Affinity Domain Patient Identity Source
M8354673993
Retrieve DocumentRetrieve Document Provide & Register Docs
Register (using Pt ID)Register (using Pt ID)Query Document (using Pt Id)Query Document (using Pt Id)
Patient Identity Feed
Document Registry
14355M8354673993
L-716
A87631
Patient Identity Feed
PIX Query
PIX Query
Patient Identity Feed
Patient Identity XRef MgrPatient Identity FeedPDQ Query to Acquire Affinity Domain Patient ID
M8354673993
A87631L-716
M8354673993
XDS Document Repository
XDSDocument
Repository
ATNA Audit ATNA Audit record repositoryrecord repository CT Time serverCT Time server
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IHE Integration Profiles for Health Info NetsIHE Integration Profiles for Health Info NetsWhat What is availableis available and and has been addedhas been added in 2005 and in 2005 and is for 2006is for 2006
Consistent TimeCoordinate time across
networked systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication
to create a secured domain.
Patient Demographics Query
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient electronic health record
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Emergency Referrals
Format of the Document Content and associated coded vocabulary
PHR Extract
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents
Format of the Document Content
Consent Management
Patient consents
Cross-enterpriseDocument InterchangeMedia-CD/USB & e-mail push
Notification of Document Availability
Notification of a remote provider/ health enterprise
Imaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Document Digital Signature
Attesting “true-copy and origin
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Document Consumer
Retrieve Document
Query Documents
Patient Identity Source
Patient Identity Feed
Document Source
Document Registry
Document Repository
Provide&Register Document Set
Register Document Set
XDS Actors and TransactionsXDS Actors and Transactions
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Document Availability ManagementDocument Availability Management
Availability Status Visible to a Document Source
ApprovedAvailable for Patient Care
Availability Status Change under the Control ofOriginal Document Source and Patient (if allowed in Affinity
Domain)
DeprecatedObsolete
SubmittedRegistration in progress
Availability Status Visible to a Document Consumer
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Document Life Cycle ManagementDocument Life Cycle Management
A two-way relationship between Original and Addendum
Document
Addendum
Document 1(Approved)
Addendum
ReplacementDocument
Replacement
Document 1(Deprecated)
Document 2(transform)
Transform
Document 1(Approved)
A two-way relationship between Original and Replacement Document.
A two-way relationship between Original and Transform (alternative format with same scope).
Time
Addendum to a registered document
Replacing a registered document by a new document
Registering an alternate form of a registered document
Time
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Provide and Register Document SetProvide and Register Document Set
Document Source to Document Document Source to Document RepositoryRepository
Metadata describing zero or more new Metadata describing zero or more new documentsdocuments
Submission Set defining linkage to new Submission Set defining linkage to new and references to existing documentsand references to existing documents
Zero or more Folder definitionsZero or more Folder definitions
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• Created by a single Document Source.
• Issued by a single Provide & Register Document Set or Register Document Set transaction.
• Related to care event(s) of a uniquely identified patient.
• Records new documents.
• References prior documents.
• Associated with a “content code” (e.g. clinical meaning) by the Document Source.
• Accessible via the Query Registry transaction.
XDS Submission SetXDS Submission Set
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Example:Example:Document Source prepares a submission request :Document Source prepares a submission request :
One One Submission SetSubmission Setassociated with two Documents and a Folderassociated with two Documents and a Folder
Document
Document
DocumentEntry
DocumentEntry
SubmissionSet1 Objects to be
Registered
Objects to be stored in the Repository
Folder A
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• A means to group one or more documents for any reason.
• Groups documents related to a single patient.
• May include contributions from one or more Document Sources.
• Can have new or existing documents inserted at anytime by a Document Source.
• Will be permanently known by the registry.
• Accessible via the Query Registry transaction.
• Associated with a code (e.g. clinical meaning) by Document Sources.
XDS FolderXDS Folder
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Details and ExamplesDetails and Examples
National Institute of Standards and Technology (NIST) Notes on XDS http://hcxw2k1.nist.gov/wiki/index.php/Notes_on_X
DS_Profile SOAP with Attachments How to Construct XDS Metadata
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Implementation StrategiesImplementation Strategies
Project ManagementProject Management Corporate commitmentCorporate commitment Applications, Fees, Deadlines, … (this costs $$’s)Applications, Fees, Deadlines, … (this costs $$’s) Signage, Marketing, Spin Doctors…Signage, Marketing, Spin Doctors…
Software Development & TestingSoftware Development & Testing This is YOURS; is it yours alone ?This is YOURS; is it yours alone ? Success depends on many different skillsSuccess depends on many different skills Teams !Teams !
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Strategy: Divide and ConquerStrategy: Divide and Conquer
Before MESA TestingBefore MESA Testing
MESA TestingMESA Testing
ConnectathonConnectathon
HIMSSHIMSS
Incorporation – IHE is not just for DemosIncorporation – IHE is not just for Demos
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Phase ActivitiesPhase Activities
Before MESA TestingBefore MESA Testing Read, Read, Read the ProfilesRead, Read, Read the Profiles Write Test HarnessesWrite Test Harnesses Develop / Improve code baseDevelop / Improve code base
MESA TestingMESA Testing Do the tests, in orderDo the tests, in order
ConnectathonConnectathon Read the Test PlansRead the Test Plans Plan the weekPlan the week
HIMSSHIMSS
IncorporationIncorporation Write and publish IHE Integration StatementsWrite and publish IHE Integration Statements
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Deliverables by PhaseDeliverables by Phase
Initial Development & Project Setup 09/05 – 11/01/05Initial Development & Project Setup 09/05 – 11/01/05Valid CDA/CRS; Valid multi-part mime XDS MessageValid CDA/CRS; Valid multi-part mime XDS Message
Pre-Connectathon Tests 11/01/05 – 12/01/05Pre-Connectathon Tests 11/01/05 – 12/01/05Completion of all Required Tests (and several Optionals)Completion of all Required Tests (and several Optionals)
““Product” Integration 12/01/05 – 01/11/06Product” Integration 12/01/05 – 01/11/06A version of TouchWorks that incorporates Phases 1,2A version of TouchWorks that incorporates Phases 1,2
Connectathon 01/16/06 – 01/20/06Connectathon 01/16/06 – 01/20/06Completion of IHE Profile Tests: XDS-MS, ATNA, CTCompletion of IHE Profile Tests: XDS-MS, ATNA, CT
Polish for HIMSS 01/23/06 – 02/08/06Polish for HIMSS 01/23/06 – 02/08/06Showcase ready laptopsShowcase ready laptops
HIMSS 02/11/06 – 02/16/06HIMSS 02/11/06 – 02/16/06Successful ShowSuccessful Show
Planning for 07 HIMSS 02/20/06 – 03/01/06Planning for 07 HIMSS 02/20/06 – 03/01/06Rough Needs Analysis for 07 RequirementsRough Needs Analysis for 07 Requirements
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Progress (from the Scorecard)Progress (from the Scorecard)
Project Completion
0%
20%
40%
60%
80%
100%
9/12
/200
5
9/19
/200
5
9/26
/200
5
10/3
/200
5
10/1
0/200
5
10/1
7/200
5
10/2
4/200
5
10/3
1/200
5
11/7
/200
5
11/1
4/200
5
11/2
1/200
5
11/2
8/200
5
12/5
/200
5
12/1
2/200
5
12/1
9/200
5
12/2
6/200
5
1/2/
2006
1/9/
2006
1/16
/200
6
1/23
/200
6
1/30
/200
6
2/6/
2006
2/13
/200
6
2/20
/200
6
% C
om
ple
te
Actual Complete Estimated Complete
Project Milestones & Due Dates
Project Approval 9/13/05Application & Payment 9/15/05Budget Plan Submitted to Joe 9/16/05Profile Reviews 9/16/05Preliminary Designs 9/23/05Hardware Acquisition & Setup 9/30/05Mesa Tools Installed 9/30/05Participants Workshop 10/7/05Final UI Design 12/11/05Final Architecture Design 12/13/05Development Environments Working 10/18/05Pre-Connectathon Tests Complete 12/1/05Ship Hardware to Connectathon 1/11/05Connectathon Begins 1/16/05Connectathon Ends 1/20/05Ship Hardware to HIMSS 2/1/05Final Changes for HIMSS Showcase 2/10/05HIMSS Setup 2/11/05HIMSS Ends 2/16/05
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Component ExamplesComponent Examples
Document SourceDocument Source Document ProductionDocument Production Document MetadataDocument Metadata Submission SetSubmission Set Web Post (http://… and https://…)Web Post (http://… and https://…)
Document ConsumerDocument Consumer AdHocQuery GeneratorAdHocQuery Generator Document ListDocument List Single Document RetrieveSingle Document Retrieve Document PresentationDocument Presentation Document ParserDocument Parser Document StorageDocument Storage Document FormatterDocument Formatter Web Retrieval (http://… and https://…)Web Retrieval (http://… and https://…)
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Components – Don’t forgetComponents – Don’t forget
PIX or PDQPIX or PDQ
ATNA – it is not a simple add-on or plug-inATNA – it is not a simple add-on or plug-in
Certificate ManagementCertificate Management
Logging – test documentation and Logging – test documentation and verificationverification
Configurability – everything, yes, Configurability – everything, yes, Everything that can be Configurable Everything that can be Configurable should be Configurableshould be Configurable
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XDS-MS Document SourceXDS-MS Document Source
Create CDA/CRS documentsCreate CDA/CRS documents
Validate to CDA schemaValidate to CDA schema
Use PCC-supplied SchematronUse PCC-supplied Schematron
Create Submission SetCreate Submission Set
Review and check using NIST ToolsReview and check using NIST Tools
Follow Tests in orderFollow Tests in order
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XDS-MS ConsumerXDS-MS Consumer
Retrieve from file system and consumeRetrieve from file system and consume
Test Consumer options:Test Consumer options: DisplayDisplay ImportImport Import and parse structured itemsImport and parse structured items
Query RegistryQuery Registry
Retrieve DocumentRetrieve Document
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XDS ResourcesXDS Resources
IHE IT Infrastructure Technical Framework, Volumes 1 and 2
National Institute of Standards and Technology (NIST) XDS Wikihttp://hcxw2k1.nist.gov/wiki/index.php/XDS_-_Cross-Enterprise_Document_Sharing
The people sitting next to you
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Content ResourcesContent Resources
IHE Profiles
CDA/CRS Quick Start Guide
EHRVA Validatorhttp://www.xmeta.com:8080/ehrva/
CDA/CRS Schematron
IBM Deployment Guide
The people sitting next to you
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QuizQuiz
What should you never do while getting What should you never do while getting ready for HIMSS ?ready for HIMSS ?
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Never Give UpNever Give Up
Whatever it is you do forWhatever it is you do for
Stress ReliefStress Relief
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I RideI Ride