Transcript Patient Identifier Cross-referencing for MPI

Integrating the Healthcare Enterprise
IHE IT Infrastructure
Established Integration Profiles
Charles Parisot, GE Healthcare
IHE IT Infrastructure co-chair
February 7, 2005
IHE EU-Conference & Workshop
Providers and Vendors
Coming Together to Deliver
Interoperable Health Information Systems
Within and Between Enterprises and
Settings
www.IHE-europe.org
February 7, 2005
W W W . I H E . N E IHE
T EU-Conference & Workshop
IHE IT Infrastructure 2003-2004
IHE IT Infrastructure 2004-2005
New
Cross-Enterprise
Document Sharing
Registration, distribution and
access across health
enterprises of clinical
documents forming a patient
electronic health record
Retrieve Information
Information
Retrieve
for Display
Display
for
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information
and
documents
formata ready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
New
Audit Trail & Node
Authentication
Patient Identifier
Cross-referencing for
MPI
Map patient identifiers
across independent
identification domains
February 7, 2005
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Consistent Time
Coordinate time across
networked systems
New
Personnel White Page
Access to workforce
contact information
Patient Demographics
Query
New
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Enterprise User
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
Patient Identity
Patient Demographics
Query
New
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
Security
New
Personnel White Page
Access to workforce
contact information
New
Audit Trail & Node
Authentication
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Consistent Time
Coordinate time across
networked systems
February 7, 2005
Enterprise User
Enterprise
User
Authentication
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
Access to Patient Records
New
Cross-Enterprise
Document Sharing
Registration, distribution and
access across health
enterprises of clinical
documents forming a patient
electronic health record
February 7, 2005
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
IHE EU-Conference & Workshop
IHE IT Infrastructure
Established Integration Profiles
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
Enterprise User
Enterprise
User
Authentication
Authentication
Consistent Time
Coordinate time across
networked systems
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
IHE IT Infrastructure
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Cross-referencing for
MPI
Map patient identifiers
across independent
identification domains
February 7, 2005
Enterprise User
Enterprise
User
Authentication
Authentication
Consistent Time
Coordinate time across
networked systems
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPI
Abstract / 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
February 7, 2005
IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPI
Value 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
February 7, 2005
IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPI
Transaction Diagram
Patient Identity
Source
Patient Identity Feed
[ITI-8]
Patient Identity Crossreference Manager
 PIX Query [ITI-9]
 PIX Update Notification [ITI-10]
Patient Identity
Consumer
February 7, 2005
IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPI
Process Flow Showing ID Domains & Transactions
Patient Identity Feed
& Patient Identity
References
Patient
Identification
Domain A
Patient Identity
Cross-reference
Manager
Patient
Identity
Feed
Patient Identity
Source
Internal
Domain
transactions
Patient Identification
Cross-reference Domain
Patient
Identity
Cross
References
Patient Identity
Consumer
Other
IHE Actor
February 7, 2005
Patient Identification
Domain B
Patient
Identity
Feed
Patient Identity
Source
Internal
Domain
transactions
Patient
Identity
Cross References
Patient Identity
Consumer
Other
IHE Actor
Patient Identification
Domain C
IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPI
Patient Identity Cross-reference
Manager
B:X456 = C:2RT
A:123 = B:Y921 = C:3TY
B:D456
A:235 = B:DF45
A:678
Id=123
Id=235
Patient
Identification
Domain A
Id=X456
Id=Y921
Id=D456
Id=DF45
Patient Identification
B
February 7,Domain
2005
Id=3TY
Id=2RT
Patient
Identification
Cross-reference
Domain
B:X456
C: ?
B:X456
C: 2RT
Patient
Identity
Cross References
Patient Identification
Domain C
Patient Identity
Consumer
IHE EU-Conference & Workshop
Patient Identifier Cross-referencing for MPI
Standards Used
HL7 Version 2.5
 ADT Registration and Update Trigger Events
•
•
•
•
•
A01:
A04:
A05:
A08:
A40:
inpatient admission
outpatient registration
pre-admission
patient update
merge patient
 Queries for Corresponding Identifiers (ADT^Q23/K23)
 Notification of Identifiers Lists Updates (ADT^A31)
February 7, 2005
IHE EU-Conference & Workshop
PIX Integration Profile & MPI
The typical view
Patient Identity Crossreference Manager
Patient Identification Domain A
(Master Domain)
Patient Identification
Domain B
February 7, 2005
Master Patient
Index
Master (A) Patient
Identity Source
Patient Identification
Domain C
IHE EU-Conference & Workshop
PIX Integration Profile & MPI
The Equivalent IHE Model
Master Patient
Index
Patient Identity Crossreference Manager
Patient Identification Domain A
(Master Domain)
Master (A) Patient
Identity Source
Patient Identification
Domain B
February 7, 2005
Patient Identification
Domain C
IHE EU-Conference & Workshop
IHE IT Infrastructure
Retrieve Information
Retrieve
Information
Retrieve
Information
forfor
Display
Display
for Display
Access a patient’s clinical
Access a patient’s clinical
Access ainformation
patient’s
clinical
information
and
documents
in
a
information
and
documents
in
formataready
toready
be presented
format
to be ready to be
and documents
in
a
format
to the requesting
presented user
topresented
the requesting user
to the requesting user
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
Enterprise User
Enterprise
User
Authentication
Authentication
Consistent Time
Coordinate time across
networked systems
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
Retrieve Information for Display
Abstract / 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
February 7, 2005
IHE EU-Conference & Workshop
Retrieve Information for Display
Value 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.
February 7, 2005
IHE EU-Conference & Workshop
Retrieve Information for Display
Key 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
February 7, 2005
IHE EU-Conference & Workshop
Retrieve Information for Display
Transaction Diagram
Display
Retrieve Specific Info for Display [11]
Information
Source
Retrieve Document for Display [12]
Types of
Requests
Summary of All Reports
Summary of Laboratory Reports
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
List of Medications
Persistent Document
February 7, 2005
IHE EU-Conference & Workshop
Query Keys – Transaction [11]
Retrieve Specific Information for Display
Parameter
Name
REQ
Description
Request
Type
R
requestType specifies what type of information shall be
retrieved. This parameter shall always be valued.
patientID
R
This attribute identifies the subject of the results being
queried for. Its value shall include identification of
assigning authority.
lowerDate
Time
O
Used to constrain the earliest date/time of creation of
information.
upperDate
Time
O
Used to constrain the latest date/time of creation of
information.
MostRecen
tResults
R
The numeric value that indicates the number of most
recent results to be included into the response, i.e., 1
indicates to provide the latest result.
February 7, 2005
IHE EU-Conference & Workshop
Query Keys – Transaction [12]
Retrieve Document for Display
Parameter
Name
REQ
Description
Request
Type
R
This parameter is required to have a value of
“DOCUMENT”.
Document
UID
R
Identifies document’s UID as known to both actors.
PreferredC
ontentType
R
This parameter is required to identify the preferred
format: JPEG. PDF, CDA L1 that the document is to
be provided (as MIME content type).
February 7, 2005
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
Patient Synchronized
Applications
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
Synchronize multiple applications on a
desktop to the same patient
to the requesting user
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
Enterprise User
Enterprise
User
Authentication
Authentication
Consistent Time
Coordinate time across
networked systems
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
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)
February 7, 2005
IHE EU-Conference & Workshop
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)
February 7, 2005
IHE EU-Conference & Workshop
Patient Synchronized Applications
Actors
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.
February 7, 2005
IHE EU-Conference & Workshop
Patient Synchronized Applications
Transactions Diagram
Join Context[5] 
Patient Context
Participant
Actor
Change Context[6] 
 Follow Context[13]
Context Manager
Actor
Leave Context[7]

These transactions are required for both Actors for compliance
February 7, 2005
IHE EU-Conference & Workshop
Patient Synchronized Applications
Key Technical Properties
Standards Used:
 HL7 Context Management “CCOW” Standard, Version 1.4
 Support for both Windows and Web Technology
 Support of “Patient Subject”
IHE Constraints:
 Specifies use of Patient.Id.IdList item
•
•
Ensures maximum interoperability with PIX Profile
Protects against future deprecation of patient identifier items (HL7
2.3.1, 2.4, 2.5, CCOW).
February 7, 2005
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
Patient Synchronized
Enterprise User Authentication
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
Provide users a single name
and centralized authentication process
across all systems
Consistent Time
Coordinate time across networked
systems
IHE EU-Conference & Workshop
Enterprise User Authentication
Scope
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.
February 7, 2005
IHE EU-Conference & Workshop
Enterprise User Authentication
Value 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.
February 7, 2005
IHE EU-Conference & Workshop
Consistent Time
Scope and Value Proposition
Meet a basic security requirement
 System clocks and time stamps of the many computers in a
network must be synchronized.
 Lack of consistent time creates a “security hole” for attackers.
 Synchronization ±1 second is generally sufficient.
Achieve cost savings/containment
 Use the Network Time Protocol (NTP) standard defined in RFC
1305.
 Leverage exisisting Internet NTP services, a set-up option for
mainstream operating systems.
February 7, 2005
IHE EU-Conference & Workshop
EUA and CT
Key Technical Properties
Standards Used
 Kerberos v5 (RFC 1510)
• Stable since 1993,
• Widely implemented on current operating system platforms
• Successfully withstood attacks in its 10-year history
• Fully interoperable among all platforms
 HL7 CCOW, user subject
 Network Time Protocol (RFC 1305)
Minimal Application Changes
 Eliminate application-specific, non-interoperable
authentication
 Replace less secure proprietary security techniques
 Leverage NTP interfaces built-into operating systems
February 7, 2005
IHE EU-Conference & Workshop
Enterprise User Authentication
Key Attributes
Limited network overhead
 Kerberos is network-efficient, developed at a time when
high-speed networks were rare.
 CCOW is similarly network-efficient
Kerberos and CCOW work with any user
authentication technology
 Tokens, biometric technologies, smart cards, …
 Specific implementations require some proprietary
components, e.g., biometric devices.
 Once user authentication is complete, network transactions
are the same for all technologies.
February 7, 2005
IHE EU-Conference & Workshop
Enterprise User Authentication
Transaction Diagram with CCOW Option
Kerberos
Authentication Server
Get User
Authentication [2] 
Kerberized Server
Other IHE Actor
 Get Service Ticket [3]
 Kerberized
Communication [4]
Client
Authentication
Agent
Join Context[5]
Change Context [6] 
Leave Context[7] 
Context Manager
February 7, 2005
Other IHE
Transaction
Other IHE Actor
Join Context[5] 
Follow Context [13] 
Leave Context[7] 
User Context
Participant
IHE EU-Conference & Workshop
Consistent Time
Transaction Diagram
Time Server
Maintain Time [ITI-1]↑
Time Client
February 7, 2005
IHE EU-Conference & Workshop
IHE IT Infrastructure
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
Enterprise User
Enterprise
User
Authentication
Authentication
Consistent Time
Coordinate time across
networked systems
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
Synergy between IHE IT Int. Profiles
RID with EUA/CT & PIX
Example of support of
multiple actors/profiles
Patient
Identity X-ref
Manager
Display
Information
Source
Client
Authentication
Agent
Patient
Identity
Consumer
Time Client
Time
Server
February 7, 2005
Kerberos
Authentication
Server
40
IHE EU-Conference & Workshop
Synergy between IHE IT Int. Profiles
Apps with PSA, EUA & PIX
Application B
Context
participant
Patient
Identity X-ref
Manager
Example of support of
multiple actors/profiles
Patient
Identity
Consumer
Application A
Context
participant
Context
Manager
Client
Authentication
Agent
Time Client
February 7, 2005
Time
Server
Kerberos
Authentication
Server
41
IHE EU-Conference & Workshop
Integrating the Healthcare Enterprise
A Pause for Questions ?
www.IHE-europe.org
February 7, 2005
IHE EU-Conference & Workshop
WWW.IHE.NET
IHE IT Infrastructure 2003-2004
IHE IT Infrastructure 2004-2005
New
Cross-Enterprise
Document Sharing
Registration, distribution and
access across health
enterprises of clinical
documents forming a patient
electronic health record
Retrieve Information
Information
Retrieve
for Display
Display
for
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information
and
documents
formata ready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
New
Audit Trail & Node
Authentication
Patient Identifier
Cross-referencing for
MPI
Map patient identifiers
across independent
identification domains
February 7, 2005
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Consistent Time
Coordinate time across
networked systems
New
Personnel White Page
Access to workforce
contact information
Patient Demographics
Query
New
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Enterprise User
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
New
New
Retrieve
Retrieve Information
Information
Cross-Enterprise
for
Display
for Display
Document Sharing
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information
and
documents
formataready
be presented
formattoready
to be
to the requesting
presented user
Registration, distribution and
to the requesting user
access
New
across health enterprises
Audit Trail & Node
of clinical documents forming
Authentication
a distributed patient
Centralized privacy audit trail
Patient
Identifier
and node to node authentication
electronic health record
Cross-referencing for
MPI
Map patient identifiers
across independent
identification domains
February 7, 2005
to create a secured domain.
Consistent Time
Coordinate time across
networked systems
Personnel White Page
Access to workforce
contact information
Patient Demographics
Query
New
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Enterprise User
Enterprise
User
Authentication
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
Introduction:
EHR Cross-Enterprise Document Sharing
First step towards the
longitudinal dimension of the EHR
Focus:
February 7, 2005
Support document sharing between
EHRs in different care settings and
organizations
IHE EU-Conference & Workshop
Typically, a patient goes through
a sequence of encounters
in different Care Settings
Long Term Care
Acute Care
(Inpatient)
Other Specialized Care
(incl. Diagnostics Services)
GPs and Clinics
(Ambulatory)
Continuity of Care:
Patient Longitudinal Record
February 7, 2005
IHE EU-Conference & Workshop
Finding the records of a patient-Manual & tedious
community
Laboratory Results
Specialist Record
Hospital Record
Records
Sent
Clinical IT System
Clinical Encounter
February 7, 2005
The challenge:
Finding and accessing easily
documents from other care providers
In the community.
IHE EU-Conference & Workshop
Sharing records that have been published
community
Laboratory Results
Specialist Record
Hospital Record
Reference
to records
4-Patient data
presented to
Physician
Clinical IT System
3-Records
Returned
Index of patients records
(Document-level)
Sharing System
Temporary Aggregate
Patient History
7, 2005
ClinicalFebruary
Encounter
1-Patient
Authorized
Inquiry
2-Reference
to Records
for Inquiry
IHE EU-Conference
& Workshop
Building and accessing Documents
EHR-LR:
Longitudinal Record
as used
across-encounters
Documents Registry
Long Term Care
Acute Care
(Inpatient)
Document
Repository
Other Specialized Care
or Diagnostics Services
PCPs and Clinics
(Ambulatory)
EHR-CR: Care Record systems
supporting care delivery
Submission of Document References
Retrieve of selected Documents
February 7, 2005
IHE EU-Conference & Workshop
XDS – Value Proposition
Foundation for Health IT Infrastructures: Shared
Electronic Health Record, in a community, region, etc.
Effective means to contribute and access clinical
documents across health enterprises.
Scalable sharing of documents between private
physicians, clinics, long term care, pharmacy, acute
care with different clinical IT systems.
Easy access: Care providers are offered means to
query and retrieve clinical documents of interest.
February 7, 2005
IHE EU-Conference & Workshop
XDS - Value Proposition
Distributed: Each Care delivery organization “publishes” clinical
information for others. Actual documents may remain in the
source EHR-CR.
Cross-Enterprise: A Registry provides an index for published
information to authorized care delivery organizations belonging
to the same clinical affinity domain (e.g. an LHII).
Document Centric: Published clinical data is organized into
“clinical documents”. using agreed standard document types
(HL7-CDA, ASTM-CCR, PDF, DICOM, etc.)
Document Content Neutral: Document content is processed only
by source and consumer IT systems.
Standardized Registry Attributes: Queries based on meaningful
attributes ensure deterministic document searches.
February 7, 2005
IHE EU-Conference & Workshop
Integration Model 1:
EHR-CR with Repository at Source
An EHR-CR completes a phase of care for a patient where it:

Has these documents available as Repository Actor.

Registers documents with a Registry actor.
Any other EHR-CR may query the Registry actor, and chose to
retrieve some of these documents from any Document Repository
Actor.
EHR-CR
EHR-CR
2 Register
Document
Registry
3 Query
Document Source
Document
Repository
February 7, 2005
Document
Consumer
4 Retrieve
IHE EU-Conference & Workshop
Integration Model 2:
EHR-LR with Third Party Repository
An EHR-CR completes a phase of care for a patient where it:

Provides the documents to a Repository Actor of its choice.

Documents are Registered with a Registry Actor.
Any other EHR-CR may query the Registry actor, and chose to
retrieve some of these documents from any Document
Repository Actor.
EHR-CR
EHR-CR
Document
Registry
3 Query
Document
Consumer
2 Register
Document Source
4 Retrieve
1 Provide &
Register
February 7, 2005
Document
Repository
IHE EU-Conference & Workshop
Integration Model 3:
EHR-CR feed a EHR-CR/EHR-LR hub
An EHR-CR completes a phase of care for a patient where it:

Provides and Registers a set of documents to a Document
Repository in an EHR-CR.
The EHR-CR Consumer Actor has the documents and may
respond to queries and provide them to other document
consumers.
EHR-CR
EHR-CR
Document Source
1 Provide & Register
Document
Consumer
Document
Registry
Document
Repository
February 7, 2005
IHE EU-Conference & Workshop
Patient Access also possible
A patient accesses own record:
 Query and Retrieve a set of documents using for
example a portal application that offers the ability
to display documents’ content.
This is a particular case of an EHR-CR, where the
patient is interested her/his own care. Patient may
also register and provide documents.
February 7, 2005
IHE EU-Conference & Workshop
Conclusion:
IHE Cross-Enterprise Document Sharing
IHE XDS is a critical element to enable sharing of
health information between EHR Systems.
Access Control and Doc Content Profiles are on the
IHE Roadmap for 2005.
In collaboration with well established standards
bodies (HL7, ASTM, CEN, OASIS, IETF, DICOM, etc.)
and other EHR related initiatives world-wide
(EuroREC, etc.), IHE is contributing to a more
cost-effective and rapid deployment of
community, regional and national health IT
infrastructures.
February 7, 2005
IHE EU-Conference & Workshop
How real is XDS ?
Specification work since Nov 2003
Public Comments June-July 2004


600 constructive comments received.
Validity of XDS approach confirmed around the world.
Stable specification IHE Technical Framework
Published Aug 15th, 2004 (TI Supplement)
IHE Connectathon - January 2005 (USA)-17 vendors
HIMSS Feb 2005 - show-wide demonstration
IHE Connectathon - April 2005 (Europe)-27 vendors
Several Implementation Projects by health authorities in 2005
February 7, 2005
IHE EU-Conference & Workshop
Exposition d’interopérabilité HIMSS 2005
Organisée par HIMSS, un des sponsors IHE aux
USA.
Intégrant les milieux hospitaliers et ambulatoires :
 partage inter-entreprise de l’information de santé entre les
milieux de soins hospitaliers et ambulatoires.
Intégrant les dossier patient électroniques sur les
stands des fournisseurs:
 milieu hautement interactif, basé sur les normes, visant à
démontrer l’interopérabilité pratique entre les entreprises de
soins.
February 7, 2005
IHE EU-Conference & Workshop
Exposition d’interopérabilité HIMSS 2005
Visiteurs géreront leur dossier de soin
électronique au sein du « réseau régional
HIMSS ».
Environnement communiquant s’appuyant sur le
profil IHE Cross-enterprise Document Sharing:
 Bati autour d’un « XDS document registry » central.
 Des « XDS ocument repositories » distribués.
 17 DES qui publient/partagent divers documents
(Résumé Patient-CCR, HL7-CDA, HL7-lab, PDF).
February 7, 2005
IHE EU-Conference & Workshop
Exposition d’interopérabilité HIMSS 2005
Fournisseurs testés au connectathon présentant un produit:
Partage d’information inter-entreprise en milieu hospitalier, 20
fournisseurs:
Cedara
Gusrada/Care Science NIST
Dictaphone
IDX
Novell
Eastman Kodak
InterSystems
Open Text
Eclipsys
Infinitt
Sentillion
Emageon
Kryptiq
Siemens
Epic
MedCommons
Univ. Of Washington
GE Healthcare
Mortara Instruments
Partage d’Information en milieu ambulatoire, 13 fournisseurs:
Allscripts
GE Healthcare
MidMark
CapMed/SanDisk
IDX
NextGen
Cerner
Krytiq
WebMD
Eclipsys
MedcomSoft
ETIAM
MediNotes
February 7, 2005
IHE EU-Conference & Workshop
HIMSS 2005 – Show-Wide Interoperability
Cross-enterprise Showcase Booth
Radiology
IT
Infrastructure
Vendor System
Vendor Booth
Allscripts
Vendor Booth
CapMed
In-Patient/Out-patient
Cerner
Eclipsys
Vendor Booth
GE Healthcare
Cardiology
IDX
Vendor Booth
HIMSS “RHIO” with
Infinitt
Cross-enterprise
InterSystems
Vendor Booth
doc sharing
Krytiq
PCP
MedCommons
Vendor Booth
MediNotes
Diag Center
NextGen
OpenText
Multispecialty
Home
Siemens
Clinic
Vendor
Booth
WebMD
Ambulatory Showcase Booth
Vendor Booth
February 7, 2005
IHE EU-Conference & Workshop
Sécurité pour XDS
Se base sur le Profil IHE Audit Trail & Node Authentication
ATNA crée un domaine sécurisé
sur internet:
• User Accountability (Audit trail)
Patient Identity
Source Secured
• Node-to-Node Access Control
• Node-level user authentication
Node
Patient
Identity
Feed
Les Contrôles d’accès
utilisateurs sont prévus
pour 2005.
Secured
Node
Query
Documents
Document
Registry
Register
Document Set
Provide&Register
Document Set
Secured
Node
Document
Source
Secured
Node
February 7, 2005
Secured
Node
Document
Consumer
Retrieve
Document
Document
Repository
Secured
Node
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
New
Cross-Enterprise
Document Sharing
Registration, distribution and
access across health
enterprises of clinical
documents forming a patient
electronic health record
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
New
Retrieve
Retrieve Information
Information
for
Display
for Display
Personnel White Page
Access to workforce
Patient Demographics
Query
contact information
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
Retrieval of a patient list
including patient names,
identifiers, contacts, and visit
to the requesting user
New
information
Patient Synchronized
New
Applications
Audit Trail & Node
Synchronize multiple
Authentication
applications on a desktop to the
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Consistent Time
Coordinate time across
networked systems
same patient
Enterprise User
Enterprise
User
Authentication
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
Patient Demographics Query
Abstract/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
February 7, 2005
IHE EU-Conference & Workshop
Patient Demographics Query
Value 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
February 7, 2005
IHE EU-Conference & Workshop
Patient Demographics Query
Value Proposition (cont’d)
Allow search on full or partial data
Retrieve information from any domain to
which the client has query access
Allows use of matching algorithm (e.g.,
soundex) to find near matches
February 7, 2005
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
New
New
Cross-Enterprise
Document Sharing
Retrieve
Retrieve Information
Information New
for
Display
for Display
Audit Trail & Node
Authentication
Registration, distribution and
access across health
enterprises of clinical
documents forming a patient
electronic health record
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
to the requesting user
Centralized privacy audit trail
and node to node
authentication to create a
Patient Identifier secured domain.
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
Consistent Time
Coordinate time across
networked systems
Personnel White Page
Access to workforce
contact information
Patient Demographics
Query
New
Patient Synchronized
Applications
Synchronize multiple
applications on a desktop to the
same patient
Enterprise User
Enterprise
User
Authentication
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
IHE and Security
User Identity  PWP, EUA
User Authentication  EUA
Node Authentication  ATNA
Security Audit Trails  ATNA
Data Integrity Controls  CT, ATNA TLS option
Data Confidentiality  ATNA TLS option
Access Controls  Future item in IHE roadmap
February 7, 2005
IHE EU-Conference & Workshop
Scope
Defines basic security features for an individual
system for use as part of the security and
privacy environment for a healthcare enterprise.
Extends the IHE radiology oriented Basic
Security profile (defined in 2002) to be
applicable to other healthcare uses.
Supports two categories of network
environments
First of a family of profiles with different kinds
of authentication.
February 7, 2005
IHE EU-Conference & Workshop
IHE Goal with ATNA
IHE makes cross-node security management
easy:
 Only a simple manual certificate installation is
needed.
 Separate the authentication, authorization, and
accountability functions to accommodate the
needs of different approaches.
 Enforcement driven by ‘a posteriori audits’ and
real-time visibility.
February 7, 2005
IHE EU-Conference & Workshop
Integrating trusted nodes
• Local access control (authentication of user)
• Strong authentication of remote node (digital certificates)
• network traffic encryption is not required, it is optional
• Audit trail with:
• Real-time access
• Time synchronization
Secured System
Secured System
Secure network
System B
System A
Central
Audit Trail
Repository
February 7, 2005
IHE EU-Conference & Workshop
IHE IT Infrastructure 2004-2005
New
Cross-Enterprise
Document Sharing
Registration, distribution and
access across health
enterprises of clinical
documents forming a patient
electronic health record
Retrieve
Retrieve Information
Information
for
Display
for Display
Access
Accessa apatient’s
patient’sclinical
clinical
information
and
documents
in in
a
information and documents
formataready
be presented
formattoready
to be
to the requesting
presented user
Patient Demographics
Personnel White
Page
Query
New
to the requesting user
Access to workforce
Patient Synchronized
New
Applications
Audit Trailcontact
& Node information
Authentication
Patient Identifier
Patient Identifier
Cross-referencing
for
Cross-referencing
MPI
for MPI
Map patient identifiers
Map patient
identifiers
across
independent
across
independent
identification domains
identification domains
February 7, 2005
New
Centralized privacy audit trail
and node to node authentication
to create a secured domain.
Consistent Time
Coordinate time across
networked systems
Synchronize multiple
applications on a desktop to the
same patient
Enterprise User
Enterprise
User
Authentication
Authentication
Provide users a single name
and centralized authentication
process
across all systems
IHE EU-Conference & Workshop
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
February 7, 2005
IHE EU-Conference & Workshop
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
February 7, 2005
IHE EU-Conference & Workshop
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
February 7, 2005
IHE EU-Conference & Workshop
PWP - Transactions
Find Personnel
White Pages
Personnel
White
Pages
Consumer
February 7, 2005
DNS
Server
Query for
Healthcare
Workforce
Member Info
Personnel
White
Pages
Directory
Provide access to healthcare staff information
to systems in a standard manner.
IHE EU-Conference & Workshop
Integrating the Healthcare Enterprise
Thank You
Questions ?
WWW.IHE.NET
February 7, 2005
IHE EU-Conference & Workshop