IHE integration profiles: XDS – Cross Enterprise Sharing of Healthcare Information
Overview of IHE IT Infrastructure Integration Profiles
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Transcript of Overview of IHE IT Infrastructure Integration Profiles
Overview of IHE IT Infrastructure Overview of IHE IT Infrastructure Integration ProfilesIntegration Profiles
IHE IT Infrastructure Technical CommitteeCharles Parisot, GE Medical Systems Information Technologies
HIMSS/RSNA IHE IT Infrastructure 2
IHEIntegrationProfiles B
A Proven Standards Adoption ProcessA Proven Standards Adoption Process
IHE Integration Profiles:– Detailled selection of standards and options each solving a specific
integration problem– A growing set of effective provider/vendor agreed solutions– Vendors can implement with ROI– Providers can deploy with stability
Standards
Easy toIntegrateProducts
IHEIntegrationProfile A
IHEDemonstration
IHEConnectathon
ProductWith IHE
User Site
RFPRFP
IHETechnical
Framework
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The Product World…..The Product World…..
Product XYZfrom Vendor T
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The IHE The IHE WWorld….orld….
IHE Actor
ActorActor
Actor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE Actor
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Mapping IHE to ProductsMapping IHE to Products
Poduct XYZfrom Vendor T
IHE Actor
ActorActor
Actor
IHEIHETransactionTransactionIHEIHE
TransactionTransaction
IHEIHETransactionTransaction
IHE Actor
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The IHE Technical ApproachThe IHE Technical Approach
Identify the transactions required to integrate a specific information flow between several information systems/devices
For each transaction, select a single standard (e.g.HL7 messages, RFC) for use in implementing the transaction
Specify in detail the use of the standard in implementing the transaction
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IHE IHE : : An Integration ProfileAn Integration Profile
24: Report Submission
Structured Report Export: 28
25: Report Issuing
Report Creator
26: Query Reports27: Retrieve Reports
Report Repository
Report Reader
External Report Repository Access
Report Manager
Enterprise Report Repository
Actors cooperating
through TransactionsTransactions to perform a specific task
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IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
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IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
Retrieve Information for Display
Access a patient’s clinical information and documents
in a format ready to be presented
to the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents
in a format ready to be presented
to the requesting user
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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.
Retrieve Information for DisplayRetrieve Information for Display
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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.
Retrieve Information for DisplayRetrieve Information for Display
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Key Technical Properties: Standards Used:
– Web Services (WSDL for HTTP Get).– General purpose IT Presentation Formats: XHTML, PDF,
JPEG plus CDA L1.– Client may be off-the-shelf browser or display app.
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
Retrieve Information for DisplayRetrieve Information for Display
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Transaction Diagram
Retrieve Information for DisplayRetrieve Information for Display
Display InformationSource
Retrieve Specific Info for Display [11]
Summary of All ReportsSummary of Laboratory ReportsSummary of Radiology ReportsSummary of Cardiology ReportsSummary of Surgery ReportsSummary of Intensive Care ReportsSummary of Emergency ReportsSummary of Discharge ReportsList of AllergiesList of Medications
Retrieve Document for Display [12]
Persistent Document
Types ofRequests
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IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
Synchronize multiple applications on a desktop to
the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to
the same patient
Patient Synchronized Applications
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Abstract / Scope
Patient Synchronization of Multiple Disparate Applications
Single Patient Selection
When combined with PIX Profile, allows patient synchronization across patient identity domains
Patient Synchronized ApplicationsPatient Synchronized Applications
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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
Patient Synchronized ApplicationsPatient Synchronized Applications
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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
Patient Synchronized ApplicationsPatient Synchronized Applications
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Transaction Diagram
Patient Synchronized ApplicationsPatient Synchronized Applications
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IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user Synchronize multiple applications
on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
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Patient Identifier Cross-referencingPatient Identifier Cross-referencingAbstract / ScopeAbstract / Scope
Allow all enterprise participants to register the identifiers they use for patients in their domain
Support domain systems’ queries for other systems’ identifiers for their patients
Optionally, notify domain systems when other systems update identifiers for their patients
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Patient Identifier Cross-referencingPatient Identifier Cross-referencingValue PropositionValue 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
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Patient Identifier Cross-referencingPatient Identifier Cross-referencingID Domains & TransactionsID Domains & Transactions
Patient Identification Domain C
Other IHE Actor
Identity Patient
Cross References
Patient Identity Consumer
Patient Identification Domain B
Patient Identity
Feed Patient Identity
Source
Patient Identity Cross-reference
Manager
Patient Identification Cross-reference Domain
Patient Identity Feed & Patient Identity References
Internal Domain transactions
Other IHE Actor
Patient Identity Cross References
Patient Identity Consumer
Patient Identification Domain A
Patient Identity
Feed Patient Identity
Source
Internal Domain transactions
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Patient Identifier Cross-referencingPatient Identifier Cross-referencingKey Technical PropertiesKey Technical Properties
Standards Used– HL7 Version 2.3.1 and Version 2.4
ADT Registration and Update Trigger Events– A01: inpatient admission– A04: outpatient registration– A05: pre-admission– A08: patient update– A40: merge patient
Queries for Corresponding Identifiers (ADT^Q23/K23) Notification of Identifiers Lists Updates (ADT^A31)
Key Properties– ADTs remain in charge of their domains– No need for a master ID or MRN, but supported as another ID domain
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IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles
Retrieve Information for Display
Access a patient’s clinical information and documents
in a format ready to be presented
to the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents
in a format ready to be presented
to the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Enterprise User Authentication
Provide users a single name
andcentralized
authentication process
across all systems
Enterprise User Authentication
Provide users a single name
andcentralized
authentication process
across all systems
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Enterprise User AuthenticationEnterprise User AuthenticationAbstract / ScopeAbstract / Scope
Support a single enterprise governed by a single set of security policies and having a common network domain.
Establish one name per user that can then be used on all of the devices and software in a healthcare enterprise.
Facilitate centralized user authentication management.
Provide users with single sign-on.
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Enterprise User AuthenticationEnterprise User AuthenticationValue PropositionValue Proposition
Start at the beginning– Recognize user authentication as a necessary step for
most application and data access operations.– Enable benefits from future integration profiles, such as
authorization management. Achieve cost savings/containment.
– Centralize user authentication management.– Simplify multi-vendor implementations
Provide workflow improvement for users.– Increase user acceptance.– Decrease unproductive user task-switching time.
Increase level of assurance in security protection.
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Enterprise User AuthenticationEnterprise User AuthenticationKey Technical PropertiesKey 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 subjectMinimal Application Changes
– Eliminate application-specific, non-interoperable authentication.
– Replace less secure proprietary security techniques.
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Enterprise User AuthenticationEnterprise User AuthenticationTransaction DiagramTransaction Diagram
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IHE IT InfrastructureIHE IT Infrastructure5 Integration Profiles5 Integration Profiles
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Enterprise User Authentication
Provide users a single nameand
centralized authentication process
across all systems
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Retrieve Information for Display
Access a patient’s clinical information and documents in a
format ready to be presentedto the requesting user
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Patient Identifier Cross-referencing
for MPI
Map patient identifiers across independent
identification domains
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Synchronize multiple applications on a desktop to the same patient
Patient Synchronized Applications
Consistent Time
Coordinate time across networked
systems
Consistent Time
Coordinate time across networked
systems
Synergy between IHE IT Int. ProfilesSynergy between IHE IT Int. ProfilesRID with EUA/CT & PIXRID with EUA/CT & PIX
Display
Client AuthenticationAgent
Time Client
Information Source
KerberosAuthentication
Server
TimeServer
Patient Identity Consumer
Patient Identity X-ref
Manager
Example of support ofmultiple actors/profiles
Synergy between IHE IT Int. ProfilesSynergy between IHE IT Int. ProfilesApps with PSA, EUA & PIXApps with PSA, EUA & PIX
Application A
Client AuthenticationAgent
Time Client KerberosAuthentication
Server
TimeServer
Patient Identity Consumer
Patient Identity X-ref
Manager
Context Manager
Application BContext participant
Context participant
Example of support ofmultiple actors/profiles
How to proceed with IHE ITHow to proceed with IHE IT Infra Infra1. Read IHE Fact Sheet & this presentation
• www.himss.org/ihe
2. Read ITI Technical Framework Vol 1 Integration Profiles
• www.himss.org/ihe :
3. Read ITI Technical Framework Vol 2 Transactions
• www.himss.org/ihe :
4. Join the IHE IT Infrastructure Tech. Committee consolidation meeting July 28-August 1 in Oakbrook (Chicago).
How to proceed with IHE How to proceed with IHE RadiologyRadiology
1. 12 Radiology Integration Profiles that can be combined with the IT Infrastructure Int. Profiles.
• www.rsna.org/ihe
2. Read Rad Technical Framework Vol 1 (Int. Profiles)
• www.rsna.org/ihe :
3. Read Rad Technical Framework Vol 2 (transactions)
• www.rsna.org/ihe :
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IHE Integration profilesIHE Integration profilesPatient
Informa-tion
Reconci-liation
,
Access to Radiology Information
Consistent Presentation
of Images
Basic Security
-
Evidence
Documents
Key Image
Notes
Simple
Image and Numeric Reports
Presentation of Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
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imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Scheduled Workflow ProfileScheduled Workflow Profile
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
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Integration profiles, the easy way Integration profiles, the easy way to deal with transactionsto deal with transactions
easy-to-understand, coherent functional sets and
a convenient way for users and vendors to communicate
about integration requirements and needed functionality in daily life.