IHE IT Infrastructure Domain Update

1. IHE IT Infrastructure Domain Update Karen Witting – IBM IT Infrastructure Planning Committee co-chair

2. IT Infrastructure Domain (ITI) • Supports profiles which supply necessary infrastructure for sharing healthcare information. • IT Infrastructure domain began in 2003 and now has 27 profiles that it supports. • Key ITI profiles demonstrated today: • Information Exchange: XDS, XDM, XDS-SD, RFD • Security: ATNA, CT, XUA, BPPC • Identity Management: PIX, PDQ (HL7 V2 & V3)

3. An Infrastructure Interoperability Component Is… • An infrastructure Interoperability component… • Represents a common IT function or service that is used as a building block for a variety of use cases • May be imbedded in an application, but is often deployed as a shared resource within a Health Information Exchange • Is a necessary ingredient, but is rarely visible to the end user

4. ITI Strategic Focus Categories • Patient and Provider Identity • support the management of patient, provider and healthcare organization identity including their localization. This includes the ability to look up, cross-reference, update, remove, merge, link and general management of identities. • PIX, PDQ, PAM, PWP, XCPD, HPD, PIX/PDQ HL7 v3 • Health Record Sharing • support the ability to share patient specific healthcare information within and across Enterprises. This includes the ability to submit, locate/list, push, pull and retrieve patient specific healthcare information. • XCA, XDM, XDR, XDS, XDS-SD, MPQ, RID • Security and Privacy • support the ability to ensure that healthcare information is managed consistent with a reasonable set of security and privacy policies . • ATNA, BPPC, XUA, DSG, EUA • Workflow Enablers • support standard sequences for performing workflow activities. • DRR, DSUB, NAV, PSA, RFD • Support Management • support the ability to share information needed for interoperable healthcare management such as clinical coding, technical or IT management information • CT, SVS

5. Categories of Healthcare Communication Services Patient and Provider Identity Management Exchange of Health Information Hospitals Security/Privacy e.g. order lab test, track status and receive results e.g. access last 6 mo. historical labs & encounter summaries e.g. get current list of allergies or med list from source Document Sharing Dynamic Information Access Workflow Management Source persisted and attested health records Specific info snapshot provided on demand 2 or more entities synchronize a task

6. ITI Profiles • Security/Privacy • Cross-Enterprise User Assertion (XUA) ☼ • Basic Patient Privacy Consents (BPPC) ☼ • Enterprise User Authentication (EUA) • Consistent Time (CT) ☼ • Audit Trail and Node Authentication (ATNA) ☼ • Document Digital Signature (DSG) • Identify Management • Personnel White Pages (PWP) • Patient Identifier Cross-Referencing (PIX)☼ • Patient Demographics Query (PDQ) ☼ • Patient Identifier Cross-Referencing HL7 V3 (PIX V3)☼ • Patient Demographics Query HL7 V3 (PDQ V3) ☼ • Patient Administration Management (PAM) • Pediatric Demographics Option • Cross-Community Patient Discovery (XCPD) ☼ • Healthcare Provider Directory (HPD) ☼ ▀ colored text designates 2010 new and updated profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2011

7. ITI Profiles (continued) • Information Exchange • Cross-Enterprise Document Sharing - b (XDS.b) ☼ • Cross-Enterprise Sharing of Scanned Documents (XDS-SD)☼ • Cross Community Access (XCA)☼ • Document Metadata Subscription (DSUB) ☼ • Multi-Patient Queries ☼ • Cross-Enterprise Document Media Exchange (XDM) ☼ • Cross-Enterprise Document Reliable Interchange (XDR) • Notification of Document Availability (NAV) • Retrieve Form for Data Capture (RFD) ☼ • Retrieve Information for Display (RID) • Patient Synchronized Applications (PSA) • XDS Metadata Update • On-Demand Documents • Delayed Document Assembly • Terminology • Sharing Value Sets ▀ colored text designates 2010 new and updated profiles ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2011

8. EHR System ED Application Physician Office XDS Document Repository PACS XDSDocument Repository EHR System PACS Lab Info. System Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Scenario + Use of ATNA & CT PMS XDS Document Registry Query Document Register Document Secured Messaging Retrieve Document Provide & Register Docs Maintain Time Maintain Time Record Audit Event Maintain Time Record Audit Event Record Audit Event

9. Document Content & Modes of Exchange Document Content Profiles PreSurgery PPH P Consent BPPC Emergency EDR Scanned Doc XDS-SD Laboratory XD*-Lab Discharge &Referrals XDS-MS PHR Exchange XPHR Imaging XDS-I Document Exchange Integration Profiles Document SharingXDS ReliableInterchange XDR MediaInterchange XDM Cross-Community AccessXCA

10. A87631 A87631 A87631 14355 M8354673993 M8354673993 M8354673993 M8354673993 EHR System ED Application Physician Office XDS Document Repository PACS XDS Document Repository EHR System PACS Lab Info. System L-716 L-716 L-716 Teaching Hospital Community Clinic ATNA Audit record repository CT Time server XDS Scenario + Use of PIX & PDQ PDQ Query to Acquire Affinity Domain Patient ID Patient Identity Feed Patient Identity XRef Mgr Patient Identity Feed Affinity Domain Patient Identity Source Patient Identity Feed Patient Identity Feed PIX Query Document Registry PIX Query Query Document (using Pt Id) Register (using Pt ID) Provide & Register Docs Retrieve Document PACS

11. Gateway CALIFORNIA Document Registry Practice Practice Hospitals Practice Hospitals Practice Hospitals Hospital Practice Hospital Hospital Patient ID services Clinic Clinic Clinic Repository Clinic Repository Cross-CommunityDemonstrating Sharing across regional boundaries NEW YORK Document Registry ILLINOIS Document Registry XCPD / XCA / XDR transactions Practice Practice Hospitals Practice Hospitals Practice Hospitals Gateway Hospital Practice Hospital Hospital Patient ID services Practice Gateway Practice Hospitals Clinic Practice Hospitals Clinic Practice Hospitals Clinic Repository Clinic Repository Patient ID services Clinic Clinic Repository Repository NORTH CAROLINA Document Registry Gateway Practice Practice Hospitals Practice Hospitals Hospitals Patient ID services Clinic Repository

12. 2010 Committee Activities • ITI Technical committee 2010 • Delivered 2010 versions of Technical Framework and Supplements • Processing of numerous Change Proposals (CPs) • Integration of CPs into 2010 versions of documentation • Delivered new supplements • Healthcare Provider Directory (HPD) • Cross-Enterprise User Assertion - Attribute Extension (XUA++) • XDS Metadata Update • SVS Extension • On-Demand Documents • Delayed Document Assembly • ITI Planning Committee 2010 • ITI Strategic Planning • Definition of ITI Categories • Development of Liaisons and Outreach plan • Selection of new work for 2011 • review proposals and identify new work for each development cycle

13. IHE ITI Completed Work for 2010 • Healthcare Provider Directory (HPD) • Supports interoperable feed and query transactions for healthcare provider information • Supports individual and organizational providers • Transactions are based on LDAP and DSML • Cross-Enterprise User Assertion - Attribute Extension (XUA++) • Extends XUA based on feedback on attributes • Adds attributes supporting Role-Based-Access Control , Consent/Authorization, Purpose of Use and general descriptive attributes • XDS Metadata Update • Enables update and deletion of metadata in the XDS/XCA/XDR profiles • SVS Extension • Update integrated directly into SVS supplement • adds value set metadata and search capability in support of publication and distribution of value sets. • On-Demand Documents • Supports sources of healthcare data which prefer to build most up-to-date document content at the time of retrieve, on-demand • Delayed Document Assembly • Allows source systems to register the existence of stable document content but defer actually assembling the document content only if and when it is retrieved. This approach is adopted for efficiency reasons.

14. ITI Technical Committee New Supplements/Handbook For 2011 (next chart) Change Proposal processing Delivery of 2011 updated version of Technical Framework and prior year Supplements ITI Planning Committee Preparation of Educational Material – development of reusable PPT decks on key ITI topics Strategic Planning and Liaison Activity – build liaisons with other IHE committees Selection of Trial Implementation Supplements to become Final Text Profiles Selection of new work for 2012 2011 Committee Activities

15. IHE ITI New Work for 2011 • XDS Affinity Domain Patient Identifier Change Management (XPID) • Communication of link, unlink and merge events to XDS Document Registry • Cross-Enterprise Document Workflow (XDW) • Tracking the steps of workflows to support care coordination and clinical pathways • XCA Query and Retrieve • Combining XCA Query and XCA Retrieve transactions • Direct Project use of XDS Metadata • Adjustment of XDS metadata requirements when used in XDR and XDM environments with minimal metadata knowledge • Document Encryption • Standard mechanism for encrypting health documents • Pseudonymisation and De-Identification in IHE Profiles (Handbook) • Providing guidelines to industry on the application of pseudonymisation

16. IHE IT Infrastructure Schedule for 2011 • Development Schedule: • Planning Committee decision ……… December 2010 • Issue Public Comment version …….. May 2011 • Public Comment Due ……………….. June 2011 • Issue Trial Implementation version … August 2011 • IHE Connectathon …………………… January 2012 • HIMSS Demo ………………………… February 2012

17. Learn More and Start to Participate • Join the ITI Planning Committee at our HIMSS 11 Recruitment Meeting • Meet key IT Infrastructure Committee participants • Q&A on any ITI related topic • Tuesday 10:30 – 11:30 Room 305 A&B • Q&A