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IT Infrastructure for the Enterprise

IT Infrastructure for the Enterprise Mike Henderson Principal Consultant, Eastern Informatics Past co-Chair, IT Infrastructure Technical Committee Integration Profiles PDQ PIX PAM EUA PWP PSA RID CT + ATNA (Already Addressed) IT Infrastructure Profiles 2004

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IT Infrastructure for the Enterprise

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  1. IT Infrastructure for the Enterprise Mike Henderson Principal Consultant, Eastern Informatics Past co-Chair, IT Infrastructure Technical Committee

  2. Integration Profiles • PDQ • PIX • PAM • EUA • PWP • PSA • RID • CT + ATNA (Already Addressed)

  3. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Patient Demographic Query (PDQ) Patient name, Patient ID

  4. Patient Demographics QueryAbstract / Scope • Allow quick retrieval of a patient list including common patient names, identifiers, contacts, and visit information • Enable selection of correct patient when full identification data may not be available • Limits access to only a subset of demographic and visit information

  5. Patient Demographics QueryValue Proposition • Enables access on demand to diverse systems and devices • Participants that do not need continual synchronization of patient registration information • Devices that cannot participate in monitoring of ADT feeds, e.g.: • Small-footprint devices • Low-memory devices • Allow search on full or partial data

  6. Patient Demographics QueryTransaction Diagram A departmental system that is connected on demand to the registration system. HL7 Version 2.5, Chapter 5 Diverse systems including bedside monitors, physician office systems, lab applications, mobile blood bank registries; might be any system at the point of contact.

  7. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Patient Identifier Cross-referencing for MPI (PIX) (Map patient identifiers across independent identification domains)

  8. Patient Identifier Cross-referencing for MPIAbstract / Scope • Allow all enterprise participants to register the identifiers they use for patients in their domain • Participants retain control over their own domain’s patient index(es) • Support domain systems’ queries for other systems’ identifiers for their patients • Optionally, notify domain systems when other systems update identifiers for their patients

  9. Patient Identifier Cross-referencing for MPIValue Proposition • Maintain all systems’ identifiers for a patient in a single location • Use any algorithms (encapsulated) to find matching patients across disparate identifier domains • Lower cost for synchronizing data across systems • No need to force identifier and format changes onto existing systems • Leverages standards and transactions already used within IHE

  10. B:X456C: ? B:X456C: 2RT Patient Identity Cross References Patient Identifier Cross-referencing for MPI Patient Identity Cross - reference Patient Identification Manager Cross - reference Domain B: X456 = C: 2RT A: 123 = B: Y 921 = C: 3TY B :D456 Id=123 A :235 = B: DF45 Id=235 A:678 Patient Identification Domain A Id=3TY Id=2RT Id=X456 Id=Y921 Id=D456 Id=DF45 Patient Identity Patient Identification Patient Identification Consumer Domain C Domain B

  11. PIX Integration Profile & MPIThe typical view Master Patient Index Patient Identity Cross-reference Manager Master (A) PatientIdentity Source Patient Identification Domain A (Master Domain) Patient Identification Domain B Patient Identification Domain C

  12. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Patient Administration & Management (PAM) Patient Identification, Admission, Movements & Encounters

  13. Patient Administration ManagementAbstract / Scope • Coordinates exchange of patient registrations, updates, and movements for all clinical areas • Information may be received and processed by consumer applications in any clinical domain • Optionally allows unambiguous updating of historic patient movement events • Demographic and encounter tracking works in both inpatient and ambulatory care settings

  14. Patient Administration Management Value Proposition • Optional support levels allow products to offer “light” or “rich” functionality • Aligns legacy IHE Radiology and IT Infrastructure transactions with the latest HL7 standard • Permits robust error reporting and automated exception processing • Standardizes on HL7 conformance structures • Reduces variance among vendor and implementor specification formats

  15. Patient Administration Management Transaction Diagram Patient Demographics Patient Identity Feed Patient Demographics Source Consumer Patient Encounter Management Patient Encounter Patient Encounter Source Consumer

  16. Patient Administration Management Actor Grouping Requirements

  17. Patient Administration Management Standards Used HL7 Version 2.5 • ADT Registration, Update, and Patient Movement Trigger Events • Admission/registration • Merge, update, link/unlink • Movement management

  18. Patient Administration Management Actors Patient Demographics Source • Definition • Responsible for maintaining demographics (name, address, etc.) about patient and related persons • Supplies new and updated information to Patient Demographics Consumer • Transaction Supported - Required • Patient Identity Feed [ITI-30] (as sender)

  19. Patient Administration Management Actors Patient Demographics Consumer • Definition • Uses demographic information provided by the Patient Demographics Source about a patient • Transaction Supported – Required • Patient Identity Feed [ITI-30] (as receiver)

  20. Patient Administration Management Actors Patient Encounter Source • Definition • Responsible for maintaining encounter information about a patient • Supplies new and updated information to the Patient Encounter Consumer • Must be grouped with either Patient Demographics Source or Patient Demographics Consumer • Transaction Supported - Required • Patient Encounter Management [ITI-31] (as sender)

  21. Patient Administration Management Actors Patient Encounter Consumer • Definition • Uses patient encounter information provided by Patient Encounter Source • Transaction Supported - Required • Patient Encounter Management [ITI-31] (as receiver)

  22. Patient Administration Management Patient ID Management Transactions Patient Identity Feed [ITI-30] • Definition • Patient Demographics Source registers or updates patient • Forwards ID, address, NOK, guarantor, etc., to other systems implementing Patient Demographics Consumer • Options • Merge • Link/Unlink

  23. Patient Administration Management Patient Encounter Management Transactions Patient Encounter Management [ITI-31] • Definition • Patient Encounter Source registers or updates an encounter • Forwards encounter information to other systems implementing Patient Encounter Consumer • Location • Providers • Dates, times, etc. • Options • Inpatient/Outpatient Encounter Management • Pending Event Management • Advanced Encounter Management • Temporary Patient Transfer Tracking • Historic Movement Management

  24. Patient Administration Management Encounter Management Options Inpatient/Outpatient Encounter Management • HL7 Trigger Events • Admit inpatient (A01/A11) • Register outpatient (A04/A11) • Discharge patient (A03/A13) • Update patient information (A08) • Pre-admit patient (A05/A38) • Change outpatient to inpatient (A06) • Change inpatient to outpatient (A07) • Transfer patient (A02/A12)

  25. Patient Administration Management Encounter Management Options Pending Event Management • Additional HL7 Trigger Events • Pending admit (A14/A27) • Pending transfer (A15/A26) • Pending discharge (A16/A25)

  26. Patient Administration Management Encounter Management Options Advanced Encounter Management • Additional HL7 Trigger Events • Change attending doctor (A54/A55) • Leave of absence (A21/A52) • Return from leave of absence (A22/A53) • Move account information (A44) • Merge patient ID list (A40)

  27. Patient Administration Management Encounter Management Options Temporary Patient Transfers Tracking • Additional HL7 Trigger Events • Patient departing – tracking (A09/A33) • Patient arriving – tracking (A10/A32)

  28. Patient Administration Management Encounter Management Options Historic Movement Management • Uses trigger events of any of the above options that have been adopted • Adds ZBE segment to contain a unique identifier for the movement • Standard segment pending adoption by HL7 • Adds Z99 trigger event to allow update of any movement information, based on unique ID in ZBE segment • Standard trigger event pending adoption by HL7

  29. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Enterprise User Authentication (EUA) Single user name & centralized authentication

  30. Enterprise User AuthenticationScope • Support a single enterprise governed by a single set of security policies and having a common network domain. • Establish one name per user to be used for all IT applications and devices. • Facilitate centralized user authentication management. • Provide users with single sign-on.

  31. Enterprise User AuthenticationValue Proposition • Meet a basic security requirement • User authentication is necessary for most applications and data access operations. • Achieve cost savings/containment • Centralize user authentication management • Simplify multi-vendor implementations • Provide workflow improvement for users • Increase user acceptance through simplicity • Decrease user task-switching time. • More effective security protection • Consistency and simplicity yields greater assurance.

  32. Enterprise User AuthenticationUse Case: Single Sign On • Motivation • Users need to frequently communicate with many non-integrated IT application services. • Managing multiple user identities and passwords is costly to users and system administration. • Solution • EUA supports a single common user identity for browser-based applications. • EUA allows multiple user authentication technologies. • EUA uses well-trusted standardized user identity mechanisms: Kerberos and CCOW user context.

  33. Enterprise User AuthenticationTransaction Diagram

  34. Enterprise User AuthenticationTransaction Diagram: CCOW Option

  35. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Personnel White Pages (PWP) Access to workforce contact information

  36. Personnel White Pages (PWP) Abstract/Scope • Provide access to basic information about the human workforce members • Does not include Patients • Defines method for finding the PWP • Defines query/access method • Defines attributes of interest

  37. Personnel White Pages (PWP)Value Proposition • Single Authoritative Knowledge Base • Reduce duplicate and unconnected user info database • Single place to update • Name Changes • New Phone Number • Additional Addresses • Enhance Workflow and Communications • Providing information necessary to make connections • Phone Number • Email Address • Postal Address

  38. Personnel White Pages (PWP)Value Proposition • Enhance User Interactions • Provide user friendly identities and lists • List of members • Displayable name of a user • Initials query • Contributes to Identity Management • Additional methods of identity cross verification • Name, address, phone number, email • Cross reference with Enterprise User Authentication identity • Future expansion likely will contain certificates

  39. PWP - Transactions DNS Server Find Personnel White Pages Personnel White Pages Consumer Personnel White Pages Directory Query for Healthcare Workforce Member Info Provide access to healthcare staff information to systems in a standard manner.

  40. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Patient Synchronized Applications (PSA) Tune multiple applications to same patient

  41. Patient Synchronized Applications Abstract / Scope • Patient Synchronization of Multiple Disparate Applications • Single Patient Selection • When combined with PIX Profile, allows patient synchronization across patient identifier domains • When combined with EUA Profile, provides user Single Sign-on (SSO)

  42. Patient Synchronized Applications Value Proposition • User Convenience: • Eliminates the repetitive task of selecting the patient in each application • Permits the user to select the patient in the application for which they are most familiar and / or appropriate to the clinical workflow • Patient Safety: • Ensures all data being viewed across applications is for the same patient • Leverage Single Development Effort: • Allows vendors to leverage single CCOW enablement effort to support multiple actors: • Patient Context Participant (PSA) • User Context Participant (EUA)

  43. Patient Synchronized ApplicationsActors Context Manager Actor • The IHE Context Manager Actor may encompass more than a CCOW context manager function. It may include a number of other components such as the context management registry and patient mapping agent. Patient Context Participant Actor • The Patient Context Participant Actor shall respond to all patient context changes. This actor shall set the patient context provided the application has patient selection capability.

  44. Patient Synchronized Applications Transactions Diagram These transactions are required by both Actors to claim compliance

  45. Simple Patient Switching Process

  46. IT Infrastructure Profiles 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) Retrieve Information for Display (RID) Access patient clinical summaries in presentation format

  47. Retrieve Information for DisplayAbstract / Scope • Simple and rapid access to patient information • Access to existing persistent documents in well-known presentation formats: CDA, PDF, JPEG. • Access to specific key patient-centric information for presentation to a clinician : allergies, current medications, summary of reports, etc.. • Links with other IHE profiles - Enterprise User Authentication, Patient Identifier Cross-referencing and Cross Enterprise Document Sharing

  48. Retrieve Information for DisplayValue Proposition • User Convenience: • Healthcare providers can "see" the information. A significant integration step. • Workflows from within the users’ on-screen workspace or application. • Complements multiple simultaneous apps workflow of Patient Synchronized Apps • Broad Enterprise-Wide access to information: • Web technology for simple clients • Clinical data handling fully assumed by the information source that holds clinical data.

  49. Retrieve Information for DisplayKey Technical Properties • Standards Used: • Web Services (WSDL for HTTP Get). • General purpose IT Presentation Formats: XHTML, PDF, JPEG, CDA L1 (HL7) • Client may be off-the-shelf browser or display application. • Two services : • Retrieve of Specific Information: • Patient centric: patient ID • Type of Request (see next slide) • Date, Time, nMostRecent • Retrieve a Document • Object Unique Instance Identifier (OID) • Type of Request • Content Type Expected

  50. Retrieve Specific Info for Display [11] Summary of Laboratory Reports Retrieve Document for Display [12] Summary of Radiology Reports Summary of Cardiology Reports Summary of Surgery Reports Summary of Intensive Care Reports Summary of Emergency Reports Summary of Discharge Reports List of Allergies Persistent Document List of Medications Retrieve Information for Display Transaction Diagram Display Information Source Summary of All Reports Summary of Prescriptions Types ofRequests

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