Dynamic Data Exchange Enhancement Proposal for Healthcare Information Sharing

1. Dynamic Data Brief Profile Proposal for 2009/10 presented to the IT Infrastructure Planning Committee Karen Witting September 30, 2009

2. The Problem • Sharing dynamically compiled health information across communities • Improves upon XCA to support dynamically compiled content in addition to source attested, static content. • U.S. NHIN • Has a crude mechanism to support the requirement • Currently reviewing the design to improve and expand the mechanism • Problem Scope discussed in detail in the “Cross-Community Dynamic Data” White Paper. • Technical Extension to existing profile

3. Use Case • The clinical use cases are the same as used for XCA. This proposal enables sharing amongst community architectural models that differ in terms of how and when they build documents to be shared outside the community. • Community Architectural Models identified: • Sharing of Stable, Source Attested Documents – XDS and similar models of sharing. Documents created as a by-product of patient care and shared when requested • Single Organization HIE – one or more tightly integrated databases and single EHR system which accesses data in the database as requested. • Distributed Source Databases – dynamic collection of data across distributed, independent databases. Collection of data happens in response to a specific request for content.

4. Single Organization EHR Stable Document Sharing Document Registry Gateway Conversion from DB results to Document based DB Repository Gateway Gateway Distributed Databases Repository Conversion from Web Display to Document based Web Portal DB DB DB DB

5. Solution outlined in White Paper Support for exchange of two new types of entries: • Deferred Creation Document Entry • Allows deferral of creation of documents until time of retrieval • Small extension to current use of Document Entry and its relationship to a document • Dynamic Entry • Allows access to a dynamically generated summary document that contains most up-to-date information • Provides a new model for accessing data – dynamic aggregation of healthcare content • XDS/XCA assumption is the aggregation and consolidation is done on the receiving side, Document Consumer. The “raw” data is set from the responder and receiver does any consolidation and aggregation needed. • This model supports aggregation at the responding side, Responding Gateway.

6. Current approach to XCA support in Database oriented HIE’s

7. Deferred Creation

8. Dynamic Entry

9. Proposed Standards & Systems • The Cross-Community Dynamic Data White Paper considers the following standards: • IHE Query for Existing Data (QED): underlying standard is HL7 V3 • Expansion of Cross Gateway Query (ITI-38): underlying standard is ebRS • The white paper recommends expansion of the XCA Cross Gateway Query (ITI-38) and explains the rationale for this approach.

10. Discussion • Scoping: this effort could be scoped in several different ways: • Deferred Creation applied only to XCA • Deferred Creation applied to XCA and XDS • Deferred Creation and Dynamic Entry applied only to XCA • Deferred Creation and Dynamic Entry applied to XCA and XDS • Level of effort depends on scoping chosen, from small to medium. • Proposed Editor: Karen Witting