Integrating the Healthcare Enterprise

Sept 13-15, 2004 IHE Interoperability Worshop1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

XDS

Cross-Enterprise Document Sharing

Integration Profile

Standards &Transactions & ImplementationBill Majurski – NIST

IHE IT Infrastructure Technical Committeehttp://www.sanita.forumpa.it/documenti/0/100/150/150/IHE_XDS_1.ppt


IntroductionIntroduction

Registry Standard

Things XDS adds to the Registry Standard

Structure of Actors and Transactions

Implementation

High-level focus – minimal XML


Registry StandardRegistry Standard

ebXML Registry

OASIS Standard OASIS (Organization for the Advancement of Structured

Information Standards) is a not-for-profit, international consortium that drives the development, convergence, and adoption of e-business standards

http://www.oasis-open.org

Adopted by ISO

Specifically a Document Registry

Focus on business documents


ebXML Registry Component ebXML Registry Component StandardsStandards

ebRIM – Registry Information Model Metadata

• Data about documents• Defines basis for searches

ebRS – Registry Services Interfaces Protocols Actions/verbs Query language


ebXML Registry definesebXML Registry defines

Integrated Registry & Repository

Registry holds Metadata

Repository holds Documents


Metadata Building BlocksMetadata Building Blocks

Large collection of small objects

Document (ExtrinsicObject)

Association – Link between two objects

External Link – URI – link to web resource

Classification Scheme – Taxonomies

Classification – Link to term in taxonomy

RegistryPackage – Bundle of objects


Common Registry Object Common Registry Object AttributesAttributes

Id – object identifier (UUID)

Name – label only – not used in identification

Description – free text

objectType

Status – submitted/approved/deprecated…

Slots – name/value pairs

External Identifiers – primary search indexes


Common Registry Object Common Registry Object Attribute Size LimitationsAttribute Size Limitations

Name – 128 chars

Description – 256 chars

Slots name – 128 chars value – 128 chars

External Identifiers – 64 chars

External Link (URI) – 256 chars


General Document Registry General Document Registry OperationsOperations

Submit metadata and documents

Update metadata and documents

Query metadata

Retrieve Documents


How does XDS relate to How does XDS relate to ebXML Registry?ebXML Registry?

Applies

Constrains

Extends

Reconfigures

Integrates


ebXML Registry -> XDSebXML Registry -> XDS

Reconfigures: Registry and repository as separate actors

Benefits: Repository may already be part of another

product/system. Common registry for many repositories



Constrains: Metadata design

Benefits: Establishes mandatory metadata Relevant to medical documents Restriction on how documents may relate Defines reasonable space for queries



Extends: Metadata submission to registry guaranteed

atomic

Benefits: Simpler registry client Well defined responsibilities



Integrates: With other IHE profiles

Benefits: Integrate once – at specification level



Extends: By introducing the Submission Set (record of what

was submitted together)

Benefits: Related by medical event, parameters of the

submission, support for transactions



Extends: By introducing the Folder with constraints on its

contents

Benefits: Restricted content, standard parameters



Extends: By introducing new terminology

Benefits: Terms now exist to describe subtle issues in

standard New terms to describe how XDS deploys and

integrates ebXML Registry


New TermsNew Terms

XDS Document

XDS Repository Submission Request

XDS Registry Submission Request

XDS Submission Set

XDS Folder

XDS Registry Adaptor Function


What does XDS Not Change?What does XDS Not Change?

Messages – all messages conform to standard

Protocols - unchanged

Information Model – restricted but unaltered


Document Source

Document Consumer

Document Registry

Patient Identity Source

XDS ActorsXDS Actors

Document Repository


Document Source

Document Consumer

Document Registry


XDS Actors and TransactionsXDS Actors and Transactions

Document Repository

Patient Identity Feed

Query Registry

Register Document Set

Retrieve Document

Provide & Register Document Set


Document Source ActorDocument Source Actor

Transactions Provide & Register Document Set


Provide & Register Document Provide & Register Document Set TransactionSet Transaction

Document Source has responsibility for generating metadata

Send Repository Submission Request containing metadata and documents to repository

Status returned


Repository Submission Repository Submission RequestRequest

Metadata

Document 1

Document 2

Repository Submission Request

Submission Set


Document Source

Document Consumer

Document Registry


Document Repository ActorDocument Repository Actor

Document Repository


Query Registry


Retrieve Document



Document Repository ActorDocument Repository Actor

Transactions Provide & Register Document Set Register Document Set Retrieve Document


Provide & Register Document Provide & Register Document Set TransactionSet Transaction

Documents stored in repository

Knows location of the cross-enterprise registry

Invoke Register Document Set Transaction

Success means documents accepted by repository and metadata accepted by registry


Register Document Set Register Document Set TransactionTransaction

Compute Document address (URI) within repository Document size Document hash

Metadata amended to include URI, size, hash

Reject submission if document ID already present in repository with different size/hash (optional)

Passes metadata to registry


Retrieve Document Retrieve Document TransactionTransaction

Documents retrievable via HTTP GET request

Uses URI generated by Document Repository in Register Document Set Transaction

Exact byte stream is returned


Document Source

Document Consumer

Document Registry


Document Consumer ActorDocument Consumer Actor

Document Repository


Query Registry


Retrieve Document



Document Consumer ActorDocument Consumer Actor

Transactions Query Registry Retrieve Document


Query Registry TransactionQuery Registry Transaction

SQL query language

ebRIM defines information model for queries

ebRIM defines subset of SQL that applies

Return is by reference or by value


Simple SQL QuerySimple SQL Query

Select all documents for patient ID 12345.34.259373

SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID

WHERE

doc.objectType=XDSDocumentEntry AND

patID.identificationScheme=XDSPatientID AND

patID.registryObject=doc.id AND

patID.value=‘12345.34.259373’ AND

doc.status=‘Approved’

XDSDocumentEntry and XDSPatientID are coded as UUIDs


XDSXDSQueryQueryKeysKeysDoc-levelDoc-level

XDSDocumentEntry Attribute EbRIM Attribute Type

AuthorDepartment Slot

AuthorInstitution Slot

AuthorPerson Slot

AvailabilityStatus ebRIM Status attribute

ClassCode External Classification

CreationTime Slot

EventCodeList External Classification

FormatCode External Classification

HealthcareFacilityTypeCode External Classification

legalAuthenticator Slot

PatientId External Id

PracticeSettingCode External Classification

ServiceStartTime Slot

ServiceStopTime Slot

TypeCode External Classification

UniqueId External Id


Retrieve Document Retrieve Document TransactionTransaction

Query Registry Transaction Can return metadata including document URI

Retrieve Document via HTTP GET Returns exact byte stream that was delivered to

Repository in Provide & Register Document Set Transaction

Not related to IHE RID Profile


Document Source

Document Consumer

Document Registry


Document Registry ActorDocument Registry Actor

Document Repository


Query Registry


Retrieve Document



Document Registry Actor

ebXML Registry

XDS Registry Actor StructureXDS Registry Actor Structure

ebXML Registry Function

Registry AdaptorFunction

Document Repository

Actor


Document Registry ActorDocument Registry Actor

Transactions Register Document Set Query Registry Patient Identity Feed


Register Document Set Register Document Set TransactionTransaction

Receives metadata from Repository Actor

Validates metadata

Stores metadata in registry as atomic operation


Registry Submission RequestRegistry Submission Request

Metadata

Registry Submission Request

Submission Set


Document Availability ManagementDocument Availability Management

Availability Status Visible to a Document Source

ApprovedAvailable for Patient Care

DeprecatedObsolete

Deleted

SubmittedRegistration in progress

Availability Status Visible to a Document Consumer

Registry Status attribute: Life Cycle Status indicator


Registry Adaptor FunctionRegistry Adaptor Function

Validate Metadata

Valid patient ID

Required attributes

Valid coded values


Registry Adaptor Function Registry Adaptor Function (Cont)(Cont)

Validate Metadata (Cont)

Submission Set semantics Example – all new documents for same patient

Folder semantics Example – all documents for same patient

Document Resubmission

Implement resubmission semantics



XDS Submission is atomic

ebXML Registry submission is not

Use Status Attribute as control Submitted – submission in progress Approved – submission complete - available to

query



Use two registry operations to store metadata

Submit – store data, set status to submitted

Approve – change status to Approved


Query Registry TransactionQuery Registry Transaction

Process SQL query against registry contents

Return list of Objects formatted in XML Object references

Remember to search for Approved objects


Simple SQL QuerySimple SQL Query

Select all documents for patient ID 12345.34.259373

SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID

WHERE

doc.objectType=XDSDocumentEntry AND

patID.identificationScheme=XDSPatientID AND

patID.registryObject=doc.id AND

patID.value=‘12345.34.259373’ AND

doc.status=‘Approved’

XDSDocumentEntry and XDSPatientID are coded as UUIDs


Patient Identity Feed Patient Identity Feed TransactionTransaction

Notification on Patient registration Updated Patient Information

From Patient Identity Source (ADT)

Registry Adaptor Function maintains list of valid patient IDs


Primary XDS Concepts Primary XDS Concepts

Submission Request

Submission Set

Document

Folder

Document Life Cycle Management


Document Source

Document Consumer

Document Registry


Submission RequestsSubmission Requests

Document Repository

Repository Submission Request

Registry Submission Request


Document Document

Real document vs. metadata

Attributes

Relationships between documents Replace Append Transform


Document in Registry Document in Registry

ExtrinsicObject object With objectType of XDSDocumentEntry


Folder Folder

‘Directory’ metaphor But, a document can reside in multiple Folders

Single patient

Attributes


Folder in Registry Folder in Registry

RegistryPackage object

Classified as XDSFolder

Contains document objects


Submission Set Submission Set

Collection of documents & Folders

Permanent label of what was submitted together

Attributes

Documents included by Value (same patient) Reference (any patient)


Submission Set in RegistrySubmission Set in Registry

RegistryPackage object

Classified as XDSSubmissionSet

RegistryPackage ‘contains’ Documents (XDSDocumentEntry object) Folders (XDSFolder object)


XDSXDSQueryQueryKeysKeysSubmis-Submis-sionsionSetSetAndAndFolderFolder

XDSSubmissionSet Attribute Query Key

EbRIM Attribute Type

AuthorDepartment O Slot

AuthorInstitution R Slot

AuthorPerson R Slot

Comments R ebRIM Description attribute

ContentTypeCode R External Classification

SourceId R External Id

SubmissionTime R Slot

UniqueId R External Id

XDSFolder Attribute Query Key

EbRIM Attribute Type

CodeList R External Classification(s)

Comments R ebRIM Description attribute

lastUpdateTime R Slot

PatientId R External Id

UniqueId R External Id


Document Resubmission Document Resubmission

Given multiple: Providers involved with a patient (Document

Sources) Repositories

Single Registry

Document resubmission will happen!


Document Resubmission Document Resubmission (Cont) (Cont)

Key Attributes:

XDSDocumentEntry.uniqueID Unique document ID Assigned by Document Source

XDSDocumentEntry.hash Hash code of contents of document Computed by Document Repository

ebXML Registry document id (UUID) Assigned by Document Source Internal to Registry



Document submitted twice…

Document altered slightly Different hash code

Submitted by different office Assigned different document id

Detection of duplicate is beyond XDS!




Document altered slightly Different hash code

Document Id already present in Repository/Registry

Submission is rejected!




Document is identical Same hash code

Document Id already present in Repository

New UUID (internal registry ID)

Submission is accepted!


Online/Offline & ProtocolsOnline/Offline & Protocols


OnlineOnline

Direct network connection between all actors

All Transactions

Online ‘mode’ required in profile


OfflineOffline

Document Source connects to Document Repository via SMTP

Remote, asynchronous submission via email

Single transaction available Provide & Register Document Set Transaction

Offline ‘mode’ is optional in profile


Online ProtocolsOnline Protocols

SOAP Messages with Attachments W3C Note 11 December 2000

MIME – Multipurpose Internet Message Extensions RFC 2045 - Part One: Format of Internet Message Bodies RFC 2046 - Part Two: Media Types RFC 2047 - Part Three: Message Header Extensions for

Non-ASCII Text RFC 2048 - Part Four: Registration Procedures RFC 2049 - Part Five: Conformance Criteria and

Examples RFC 2387 - The MIME Multipart/Related Content-type


Offline ProtocolOffline Protocol

Uses ebXML Message Service Specification v2.0 (ebMS)


Implementation ScenariosImplementation Scenarios


Document SubmissionDocument Submission

Document Source Actor Provide & Register Document Set Online/Offline


Document RetrievalDocument Retrieval

Document Consumer Actor Query Registry Transaction Retrieve Document Transaction


Clinical Information SystemClinical Information System

Product already creates/stores documents

Implement together

Document Source Actor

Document Repository Actor

Required Transactions


Retrieve Document


Replace DocumentsReplace Documents

Replacement, Addendum, Transformation

Document Consumer Actor Query Registry Transaction Needed to discover details of existing documents

Document Source Actor Provide & Register Document Set Submit new documents and metadata


Place Existing Documents in a Place Existing Documents in a FolderFolder

Document Consumer Actor Query Registry Transaction Discover details of existing documents

Document Source Actor Provide & Register Document Set Submit new Folder metadata


Provide XDS RegistryProvide XDS Registry

Document Registry Actor

Register Document Set Transaction

Query Registry Transaction

Patient Identity Feed Transaction

Including

ebXML Registry functionality

Registry Adaptor functionality


Construct Registry given Construct Registry given ebXML Registry ebXML Registry ImplementationImplementation

Build Registry Adaptor Function as front end to ebXML Registry


Construct XDS Registry Construct XDS Registry without ebXML Registry without ebXML Registry

ImplementationImplementation

Build to two specifications: ebXML Registry Standard (subset) XDS Profile - Registry Adaptor Function


Implementation ResourcesImplementation Resources

Implementation guide Clinical Coding Example software Example queries Metadata cookbook (how-to) Metadata Schema Sample metadata submissions

FAQ: http://www.connect-a-thon.net/bb

Live registry with test data

Testing


Questions?Questions?


More information….More information….IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.

Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0

Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure

Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements

Integrating the Healthcare Enterprise

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