IHE IT Infrastructure Outreach toPatient Care Coordination Domain

Michael Nusbaum Michael Nusbaum IT Infrastructure Planning CommitteeIT Infrastructure Planning Committee

December 13December 13thth, 2010, 2010

Objectives of this Presentation

• To build awareness of the IT Infrastructure (ITI) To build awareness of the IT Infrastructure (ITI) DomainDomain

• To establish an ongoing liaison between ITI and To establish an ongoing liaison between ITI and your domain/deployment committeeyour domain/deployment committee

• To begin a conversation about your committee’s To begin a conversation about your committee’s strategic planning, and how ITI can support your strategic planning, and how ITI can support your committee to achieve your objectivescommittee to achieve your objectives

IT Infrastructure Domain (ITI)

• Supports profiles which supply necessary Supports profiles which supply necessary infrastructure for sharing healthcare infrastructure for sharing healthcare information.information.

• IT Infrastructure domain began in 2003 and IT Infrastructure domain began in 2003 and now has 27 profiles that it supports.now has 27 profiles that it supports.

• An infrastructure Interoperability component…An infrastructure Interoperability component…– Represents a common IT function or service that is Represents a common IT function or service that is

used as a building block for a variety of use casesused as a building block for a variety of use cases– May be imbedded in an application, but is often May be imbedded in an application, but is often

deployed as a shared resource deployed as a shared resource – Is a necessary ingredient, but is rarely visible to the Is a necessary ingredient, but is rarely visible to the

end userend user

Scope of the ITI Domain

• The ITI domain addresses the implementation of The ITI domain addresses the implementation of standards-based interoperability solutions to improve standards-based interoperability solutions to improve information sharing, workflow and patient care. information sharing, workflow and patient care.

• Efforts have been focused on the following categories:Efforts have been focused on the following categories:– Patient and Provider IdentityPatient and Provider Identity– Health Record SharingHealth Record Sharing– Security and PrivacySecurity and Privacy– Workflow EnablersWorkflow Enablers– Support ManagementSupport Management

Patient & Provider Identity

• Profiles in the Patient and Provider Identity Profiles in the Patient and Provider Identity category support the management of patient, category support the management of patient, provider and healthcare organization identity provider and healthcare organization identity including their localization. This includes the including their localization. This includes the ability to look up, cross-reference, update, remove, ability to look up, cross-reference, update, remove, merge, link and general management of identities.merge, link and general management of identities.

Health Record Sharing

• Profiles in the Health Record Sharing category support the Profiles in the Health Record Sharing category support the ability to share patient specific healthcare information ability to share patient specific healthcare information within and across Enterprises. This includes the ability to within and across Enterprises. This includes the ability to submit, locate/list, push, pull and retrieve patient specific submit, locate/list, push, pull and retrieve patient specific healthcare information.healthcare information.

Security & Privacy

• Profiles in the Security and Privacy category Profiles in the Security and Privacy category support the ability to ensure that healthcare support the ability to ensure that healthcare information is managed consistent with a information is managed consistent with a reasonable set of security and privacy policies. reasonable set of security and privacy policies.

Workflow Enablers

• Profiles in the Workflow Enablers category support Profiles in the Workflow Enablers category support standard sequences for performing workflow standard sequences for performing workflow activities.activities.

Support Management

• Profiles in the support management category Profiles in the support management category support the ability to share information needed for support the ability to share information needed for interoperable healthcare management such as interoperable healthcare management such as clinical coding, technical or IT management clinical coding, technical or IT management information information

Categories of Healthcare Communication Services

Security/Privacy

DocumentSharing

Patient and Provider Identity Management

Dynamic InformationAccess

WorkflowManagement

Source persisted and attested health

records

Specific health records snapshot

provided on demand

2 or more entitiessynchronize

a task

e.g. access last 6 mo. historical labs &

encounter summaries

e.g. order lab test, track status and receive results

e.g. get current list of allergies or med list

from source

HospitalsRegional Infrastructure

Health Record Sharing Workflow Enablers

Support Management

ITI Profiles

• Security/PrivacySecurity/Privacy– Cross-Enterprise User Assertion (XUA) ☼Cross-Enterprise User Assertion (XUA) ☼– Basic Patient Privacy Consents (BPPC) ☼Basic Patient Privacy Consents (BPPC) ☼– Enterprise User Authentication (EUA)Enterprise User Authentication (EUA)– Audit Trail and Node Authentication (ATNA) Audit Trail and Node Authentication (ATNA) ☼☼– Document Digital Signature (DSG)Document Digital Signature (DSG)

• Patient and Provider IdentityPatient and Provider Identity– Personnel White Pages (PWP)Personnel White Pages (PWP)– Patient Identifier Cross-Referencing (PIX)Patient Identifier Cross-Referencing (PIX)☼☼– Patient Demographics Query (PDQ) Patient Demographics Query (PDQ) ☼☼– Patient Identifier Cross-Referencing HL7 V3 (PIX V3)Patient Identifier Cross-Referencing HL7 V3 (PIX V3)☼☼– Patient Demographics Query HL7 V3 (PDQ V3) Patient Demographics Query HL7 V3 (PDQ V3) ☼☼– Patient Administration Management (PAM)Patient Administration Management (PAM)– Pediatric Demographics OptionPediatric Demographics Option– Cross-Community Patient Discovery (XCPD)Cross-Community Patient Discovery (XCPD) ☼ ☼

▀ ▀ colored text designates 2009 new profilescolored text designates 2009 new profiles☼ ☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

ITI Profiles (continued)

• Health Record SharingHealth Record Sharing– Cross-Enterprise Document Sharing - b (XDS.b) ☼Cross-Enterprise Document Sharing - b (XDS.b) ☼– Cross-Enterprise Sharing of Scanned Documents (XDS-SD)Cross-Enterprise Sharing of Scanned Documents (XDS-SD) ☼☼– Cross Community Access (XCA)Cross Community Access (XCA) ☼☼– Multi-Patient Queries (MPQ)Multi-Patient Queries (MPQ) ☼ ☼ – Cross-Enterprise Document Media Exchange (XDM) ☼Cross-Enterprise Document Media Exchange (XDM) ☼– Cross-Enterprise Document Reliable Interchange (XDR)Cross-Enterprise Document Reliable Interchange (XDR)– Retrieve Information for Display (RID)Retrieve Information for Display (RID)

• Workflow EnablerWorkflow Enabler– Patient Synchronized Applications (PSA) Patient Synchronized Applications (PSA) – Notification of Document Availability (NAV)Notification of Document Availability (NAV)– Retrieve Form for Data Capture (RFD) ☼Retrieve Form for Data Capture (RFD) ☼– Document Metadata Subscription (DSUB) ☼Document Metadata Subscription (DSUB) ☼

• Support ManagementSupport Management– Consistent Time (CT)Consistent Time (CT)– Sharing Value Sets (SVS)Sharing Value Sets (SVS)

▀ colored text designates 2009 new profiles☼ Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010

Health Record Sharing - Document Sharing

Document Exchange Profiles

Document Sharing

XDS

MediaInterchange

XDM

ReliableInterchange

XDR

Document Content Profiles (examples)

Consent

BPPCEmergency

EDRPre

Surgery

PPHP

Scanned Doc

XDS-SD

Laboratory

XD*-LabPHR

Exchange

XPHR

Discharge &Referrals

XDS-MS

Imaging

XDS-I

Cross-CommunityAccess

XCA

ITI Profiles are shown with a red border

IHE IT Infrastructure SupplementsPublished in 2010

• Enhanced Sharing Value Set (Enhanced SVS)Add supports for registering and updating value sets

• Healthcare Provider Directory (HPD)Supports healthcare provider search and feed

• XDS Metadata Update Service Supports update of metadata registered in a XDS Document Registry

• Dynamic/Deferred Document Sharing (D3S)Supports registration, query and retrieve of document content that is created at time of retrieval.

• XUA Extension for Access Control Extend XUA SAML assertion with authorization attributes

IHE IT Infrastructure Work Plan (2011)

• New Supplements For 2011

• XDS Link/Unlink Support• Cross Enterprise Document Workflow (XDW)• XCA Query and Retrieve• XD* Minimal Metadata • CDA Encryption• Pseudonymisation and De-Identification in IHE Profiles

(Handbook)

Analysis of ITI support efforts to date

Next Steps

• Validate the domain-specific column of analysis worksheet Validate the domain-specific column of analysis worksheet and provide feedback on categories and completeness of and provide feedback on categories and completeness of contentcontent

• Ascertain the extent of adoption of ITI profiles in your Ascertain the extent of adoption of ITI profiles in your domain/regiondomain/region

• Discuss how ITI liaison can be most effectively utilized to Discuss how ITI liaison can be most effectively utilized to support your domain/regionsupport your domain/region

• Develop your domain/region’s strategic approach for ITI Develop your domain/region’s strategic approach for ITI supportsupport

• Short-term:Short-term: Establish domain priorities to be proposed to Establish domain priorities to be proposed to ITI (target: July), in support of the domain’s preparation of ITI (target: July), in support of the domain’s preparation of profile proposals for submission to ITI’s 2011/2012 profile proposals for submission to ITI’s 2011/2012 planning cycle (Sept)planning cycle (Sept)