Cross Enterprise Document Sharing(XDS) :1 Claudio Saccavini IHE-Italy Project Manager O3 Consortium - University of Padova Cross Enterprise Document Sharing(XDS)


IT Infrastructure Profiles :June 28-29, 2005 2 2004 Patient Identifier Cross-referencing for MPI (PIX) Retrieve Information for Display (RID) Consistent Time (CT) Patient Synchronized Applications (PSA) Enterprise User Authentication (EUA) 2005 Patient Demographic Query (PDQ) Cross Enterprise Document Sharing (XDS) Audit Trail and Note Authentication (ATNA) Personnel White Pages (PWP) 2006 Cross-Enterprise User Authentication (XUA) Document Digital Signature (DSG) – Notification of Document Availability (NAV) Patient Administration/Management (PAM) IT Infrastructure Profiles Cross-Enterprise Document Sharing (XDS) – Registration, distribution and access across health enterprises of clinical documents forming a patient EHR


Cross-Enterprise Document Sharing (XDS)Abstract / Scope :June 28-29, 2005 3 Cross-Enterprise Document Sharing (XDS)Abstract / Scope Provide support for document-based patient EHR Support for document storage within existing products Provide support for indexing of patient documents Support query and retrieval of patient documents Scalable architecture


Cross-Enterprise Document Sharing (XDS) Value Proposition :June 28-29, 2005 4 Cross-Enterprise Document Sharing (XDS) Value Proposition Points of view EHR-CR : Care-delivery Record Patient information Managed by a Care Delivery Organization EHR-LR : Longitudinal Record Documents shared by EHR-CR(s) Tracked by Registry Clinical Affinity Domain : Group of healthcare enterprises (EHR-CR) Common set of policies Share a single registry


Cross-Enterprise Document Sharing (XDS) Value Proposition :June 28-29, 2005 5 Cross-Enterprise Document Sharing (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.


Cross-Enterprise Document Sharing (XDS) Value Proposition :June 28-29, 2005 6 Cross-Enterprise Document Sharing (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.)


Cross-Enterprise Document Sharing (XDS) Value Proposition (cont) :June 28-29, 2005 7 Cross-Enterprise Document Sharing (XDS) Value Proposition (cont) 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.


Cross-Enterprise Document Sharing (XDS) Transaction Diagram :June 28-29, 2005 8 Cross-Enterprise Document Sharing (XDS) Transaction Diagram


Cross-Enterprise Document Sharing (XDS) Actors :June 28-29, 2005 9 Cross-Enterprise Document Sharing (XDS) Actors Document Source Source of documents and metadata about documents Document Repository Stores documents, requests indexing in Document Registry, supports retrieval Document Registry Indexes documents, supports search Patient Identity Source Feeds identity of known patients to Document Registry Document Consumer Initiates search and retrieval for consumer of documents


Actors & Transactions :June 28-29, 2005 10 Actors & Transactions


Actors & Transactions :June 28-29, 2005 11 Actors & Transactions Note 1: The Provide and Register Document Set is not required in implementations where the Document Source is grouped with the Document Repository Actor. Note 2: The Register Document Set Transaction is not required in implementations where the Document Registry Actor is grouped with the Document Repository Actor. However, it is strongly recommended that these transactions be supported to allow for future configuration with multiple Repositories. Note 3: If Assigning Authority of Patient ID presents in the Patient Identity Feed transaction, the Patient Identity Source is required to use an OID to identify the Assigning Authority. For technical details of the assigning authority information, see Transaction 8 in Technical Framework, Volume 2.


Actors & Options :June 28-29, 2005 12 Actors & Options Note1: For the XDS Document Consumer Actor, either one or both of the two options shall be selected.


Cross-Enterprise Document Sharing (XDS) Standards Used :June 28-29, 2005 13 Cross-Enterprise Document Sharing (XDS) Standards Used HealthcareContent Standards HL7 CDA, CEN EHRcomHL7, ASTM CCRDICOM … Internet Standards HTML, HTTP,ISO, PDF, JPEG … Electronic BusinessStandards ebXML, SOAP …


Cross-Enterprise Document Sharing (XDS) Standards Used :June 28-29, 2005 14 Cross-Enterprise Document Sharing (XDS) Standards Used Two “categories” of standards used XDS Infrastructure XDS Content


Cross-Enterprise Document Sharing (XDS) Standards Used :June 28-29, 2005 15 Cross-Enterprise Document Sharing (XDS) Standards Used XDS Infrastructure Standards OASIS/ebXML Registry Information Model v2.0 Basis of XDS Registry Information Model Registry Services Specifications v2.0 Registry Services Messaging Services Specifications v2.0 Offline protocols ISO/IEC 9075 Database Language SQL Registry Query Language SOAP with Attachments Protocol for communication with XDS Registries and Repositories SHA-1 [FIPS 180-1] Document Hashes


Cross-Enterprise Document Sharing (XDS) Standards Used :June 28-29, 2005 16 Cross-Enterprise Document Sharing (XDS) Standards Used XDS Infrastructure Standards (cont) HL7 Version 2.3.1 Messages for Patient Identity Management HL7 Version 2.5 Datatypes for XDS Registry Attribute values HL7 CDA Release 1 XDS Document concept definition Source of XDS Document Entry Attributes DICOM, ASTM CCR, HL7 CDA Release 2, CEN EHRcom Sources of XDS Document Entry Attributes


Cross-Enterprise Document Sharing (XDS) Standards Used :June 28-29, 2005 17 Cross-Enterprise Document Sharing (XDS) Standards Used HTTP Protocol for Retrieve Document Online SOAP bindings SMTP Offline ebMS bindings IETF Language Identifiers MIME Document Type codes UTF-8 Encoding of Registry Attributes XDS Infrastructure Standards (cont)


Cross-Enterprise Document Sharing (XDS) Standards Used :June 28-29, 2005 18 Cross-Enterprise Document Sharing (XDS) Standards Used XDS Content Standards Outside scope of XDS; layer on top of XDS Documented as Document Content Profiles Document use cases and translation of document content into registry metadata Publishable separately Guide for writing DCPs available Intended mostly for IHE domain committees Of concern only to Document Source and Document Consumer actors Examples include: HL7 CDA, DICOM, ASTM CCR


Cross-Enterprise Document Sharing (XDS) Proposed Options :June 28-29, 2005 19 Cross-Enterprise Document Sharing (XDS) Proposed Options Options center around Document Source actor Basic operations Submit single document Replace existing document Optional features Off-line mode Multi-document submission Document life-cycle management Submit addendum or transformation of document Folder management Create folder, add to folder


Cross-Enterprise Document Sharing (XDS) Related Profiles :June 28-29, 2005 20 Cross-Enterprise Document Sharing (XDS) Related Profiles Patient Identity Patient Identity Feed Notification from ADT system to Document Registry of patient admission/registration Submission to Registry requires validated patient ID Patient Demographics Query (PDQ) Identify patient based on query of demographic information Needed by Document Source: assign correct patient ID Needed by Document Consumer: query against correct patient ID


Cross-Enterprise Document Sharing (XDS) Transaction Diagram :June 28-29, 2005 21 Cross-Enterprise Document Sharing (XDS) Transaction Diagram


Cross-Enterprise Document Sharing (XDS) Patient ID Management :June 28-29, 2005 22 Cross-Enterprise Document Sharing (XDS) Patient ID Management


Cross-Enterprise Document Sharing (XDS) Related Profiles :June 28-29, 2005 23 Cross-Enterprise Document Sharing (XDS) Related Profiles Time/Audit/Authentication Constant Time (CT) Audit Trail and Node Authentication (ATNA) Cross-Enterprise User Authentication (XUA)


Cross-Enterprise Document Sharing (XDS) Related Profiles :June 28-29, 2005 24 Cross-Enterprise Document Sharing (XDS) Related Profiles New related profiles Notification of Availability (NAV) Send notification that documents are available Digital Signature (DSG) Signing of documents in repository/registry


Cross-Enterprise Document Sharing (XDS) Document Status :June 28-29, 2005 25 Cross-Enterprise Document Sharing (XDS) Document Status Each XDS Document contained in a XDS Document Registry will be assigned one of the following Availability Status codes: Approved: Available for patient care (assumes that it is authenticated, if applicable) Deprecated: Obsolete, but may still be queried and retrieved The XDS Document availability status is set to “approved” after the XDS Document Repository and the XDS Document Registry have successfully processed a submission request.


Cross-Enterprise Document Sharing (XDS) Document Relationship :June 28-29, 2005 26 Cross-Enterprise Document Sharing (XDS) Document Relationship XDS Documents may be related to predecessor documents by one of three methods: Replacement, Addendum Transformation Transformation-Replacement These relationships between XDS Documents are tracked in the XDS Document Registry.


ebXML Registry vs XDS :ebXML Registry vs XDS XDS is a Profile of the ebXML Registry standard ebXML Registry is two standards ebRIM (Registry Info Model) ebRS (Registry Services - protocols) XDS uses a SMALL subset of ebRIM and ebRS


ebRIM :ebRIM ebRIM defines a language for describing documents This language is constructed as objects and attributes of objects It is expressed as XML AKA Metadata


ebRS :ebRS Defines the methods/verbs/requests


Submission :Submission From Doc Src to Repository Contents: Metadata 0 or more Documents Encoding: SOAP with Attachments


Protocol Layering :Protocol Layering Metadata & Documents within SOAP with Attachments within HTTP Post within …


Query :Query ebRIM defines relational views into metadata storage Queries are written in subset of SQL XDS defines the necessary queries


Key ebRS Methods :Key ebRS Methods Document Source SubmitObjectsRequest Document Consumer AdhocQueryRequst Registry Adaptor ApproveObjectsRequest DeprecateObjectsRequest


Submission :34 Submission


Submission :35 Submission


Submission Set :36 Submission Set


Some important ebRIM objects are… :Some important ebRIM objects are…


Primary XDS Objects :Primary XDS Objects XDSDocumentEntry (ExtrinsicObject) Represents document in repository Contains many detailed attributes XDSSubmissionSet (RegistryPackage) Records Documents submitted together Significant clinical events Contains many detailed attributes


A Document is… :A Document is… A bit stream stored in a Repository A metadata element in the Registry representing the content in the Repository XDSDocumentEntry ExtrinsicObject


XML - XDSDocumentEntry :XML - XDSDocumentEntry … Declares object in registry


XML - XDSSubmissionSet : … XML - XDSSubmissionSet Defines submission set


XML - adding Document to Submission Set :XML - adding Document to Submission Set …


XML - Submission :XML - Submission … … …


XML - Attributes :XML - Attributes XDSDocumentEntry and XDSSubmissionSet Large number of attributes defined by XDS Some Required, some Optional Tables 3.14.4.1-5 and 3.14.4.1-6 define attributes with examples


XML - Attribute Types :XML - Attribute Types Main Slot Classification External Identifier


XML - Main Attribute Type :XML - Main Attribute Type Attribute of main element Name and Description elements Applies to submission set as well


XML - Slot Attribute Type :XML - Slot Attribute Type Name/Value pairing May have multiple unordered values (controlled by XDS) ^Welby^Marcus^^^Dr^MD ^Jones^Barnaby^^^Dr^MD


XML - Classification :3 part coding (coding scheme, code value, code value display name) Coding scheme name XML - Classification Which coded attribute


XML - Classification (2) :XML - Classification (2) classificationScheme - identifies which coded attribute (classCode, eventCode, healthcareFacilityTypeCode, etc.)


XML - External Identifiers :XML - External Identifiers Labeled with type, value, and name type name value


Attribute Order :Attribute Order The order in which attributes are coded is important/restricted Main (element attributes and title/description) Slots Classifications External Identifiers


Submission Response :Submission Response


SOAP :SOAP HTTP Header ---blank line--- HTTP Body - SOAP encoded


HTTP/SOAP Header :HTTP/SOAP Header POST /ebxmlrr/registry/soap HTTP/1.1 Accept: */* Accept-Language: en-us Referer: http://sst138.ncsl.nist.gov/web/soap/soap-diag-client.htm Content-Type: text/xml; charset=utf-8 SOAPAction: "" Accept-Encoding: gzip, deflate User-Agent: Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1) Host: gunshot.ncsl.nist.gov:8080 Connection: Keep-Alive Cache-Control: no-cache Content-Length: 851


HTTP/SOAP Body :HTTP/SOAP Body …


SOAP with Attachments :SOAP with Attachments Used to transfer metadata and documents from Document Source to Document Repository


Slide 57:POST /ebxmlrr/registry/soap HTTP/1.1 Content-Type: multipart/related; type="text/xml"; boundary=---------------------------7d4285f14803b8 SOAPAction: "" -----------------------------7d4285f14803b8 Content-Type: text/xml -----------------------------7d4285f14803b8 Content-Type: text/xml Content-Id: The Great Shark Hunt Hunter S. Thompson Life with FatherClarence Day -----------------------------7d4285f14803b8-- Note extra dashes metadata doc hdr


Be Careful :Be Careful Technically, XDS implementations must be able to handle any of the legal XML escape sequences: & for & &apos: for ' < for " for "


Be Careful :Be Careful SELECT eo.id FROM ExtrinsicObject eo, ExternalIdentifier ei WHERE eo.id = ei.registryobject AND ei.identificationScheme='urn:uuid:58a6f841-87b3-4a3e-92fd- a8ffeff98427' AND ei.value='NIST-query-2^^^&1.3.6.1.4.1.21367.2005.3.7&ISO' AND eo.status = 'Approved'


Be Careful :Be Careful select extrinsicobject.id from extrinsicobject,externalidentifier where extrinsicobject.objecttype = 'urn:uuid:7edca82f-054d-47f2-a032-9b2a5b5186c1' and extrinsicobject.status = 'Approved' and externalidentifier.identificationscheme = 'urn:uuid:58a6f841-87b3-4a3e-92fd-a8ffeff98427' and externalidentifier.value = '47122048^^^&AO_PD_ASSIPCA&ISO' and extrinsicobject.id = externalidentifier.registryobject


Be Careful :Be Careful ....


Supporting Infrastructure :Supporting Infrastructure NIST Implementation


Basics :Basics Tomcat (assuming Java) Apache - supports bidirectional authentication (half of ATNA) Ebxmlrr - Source Forge project Iheos - Source Forge project


Testing & Resources :Testing & Resources


Resources on ihe.net :Resources on ihe.net Schema Examples Registry initialization metadata


Test Kit :Test Kit Defines all tests for all XDS transactions including optional ones Includes example source code and metadata


Metadata Cookbook :Metadata Cookbook Primer on XDS metadata Will be updated for this season


NIST Public Registry :NIST Public Registry Implements Registry and Repository actors Instrumented to capture and log all events Logs viewable by tester Web page for tester to register patient IDs for testing Will be used for pre-Connectathon testing of Doc Src and Doc Con actors Will be present at Connectathon Will be present at HIMSS


Test Result Reporting :Test Result Reporting Will use Web tool Web tool, XDS test logging, XDS test requirements all linked


Last but not least ... :Last but not least ... www.o3consortium.org Registry and Repository implementation to test your actors before Barcelona 2006 Connect-a-thon Marco Biasio mbiasio@rad.unipd.it +39 049 8212378 skype: mbiasio


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