XDM / XDRXDM / XDR Point-to-Point Transmission of Point-to-Point Transmission of
DocumentsDocuments
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INTEGRATING THE HEALTHCARE ENTERPRISEINTEGRATING THE HEALTHCARE ENTERPRISE
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Contents
• Introduction• XDM• XDR• Summary• References
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Introduction
• Point-to-Point Transmission of Documents refers to:– Cross-Enterprise Document Media Interchange (XDM) – Cross-Enterprise Document Reliable Interchange (XDR)
• Based on XDS– XDM = exchange of XDS metadata and documents on media– XDR = exchange of XDS metadata and documents over reliable
protocols– Maximal re-use of XDS objects & meta-data
• As with XDS both are “document content agnostic”– All XDS “content profiles” apply (e.g., XDS-MS, XD-Lab, XPHR, etc.)
• When to use– When document sharing infrastructure not in place– Where XDS is not desirable or available to one of the participants– Complementary to sharing documents via XDS
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XDM
Cross-Enterprise Document Media Interchange (XDM)
• Documents and metadata shared using standard media types (e.g., email, CD, USB)
• Intended to be easy to implement using:– Existing email clients– CD burners– USB ports
• Meant for person-to-person communication– In pocket media– Send via email
• Imposes common file and directory structure
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XDM
• Supports transfer of data about multiple patients within one exchange– Multiple submission sets
• Requires recipient to support human intervention to control importing of data – Manual operation
• Works with XDS– XDS Query/Retrieve can feed XDM transmission– Point-to-point transfer via XDM can feed XDS submission
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XDM
• Use Cases– Physician to Patient to Specialist
• Test result and referral information given to patient on CD-R to be taken to specialist of his choice.
– Patient Visiting ED• Patient maintains copy of his EHR at home and brings a memory
stick with him to the ED.
– Physician to Physician• Primary physician emails zip file attachment about his patient to
specialist
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XDM
• Actors & Transaction
• Options
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XDM Exchange of Health Information
PhysicianOffice
Hospital
Discharge summary +Lab report
Write
Read
InterchangeMedia Discharge summary
+ Lab report
Read
Home
XDM
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XDM
• Standards
– DICOM PS 3.10 Media Storage and File Format for Data Interchange (DICOM file format). http://dicom.nema.org/
– DICOM PS 3.12 Media Formats and Physical Media for Data Interchange, Annex F - 120mm CD-R media, Annex R - USB Connected Removable Devices, Annex V - ZIP File Over Media, and Annex W - Email Media. http://dicom.nema.org/
– XHTML™ 1.0 The Extensible HyperText Markup Language (Second Edition). A Reformulation of HTML 4 in XML 1.0. W3C Recommendation 26 January 2000, revised 1 August 2002. http://www.w3.org/TR/xhtml1.
– XHTML™ Basic. W3C Recommendation 19 December 2000. http://www.w3.org/TR/xhtm-basic.
– MDN: RFC 3798 Message Disposition Notification. http://www.rfc-editor.org/rfc/rfc3798.txt
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XDM
• Security & Privacy
– The Portable Media Importer shall check the hash value and size as found in the XDS metadata to detect corruption within the metadata or media.
– Basic Patient Privacy Enforcement Option
– In the case of physical media, encryption of the CD-R or USB shall not be used.
– In the case the media used is the ZIP file over Email, the transaction shall be secured by S/MIME (see IHE ATNA) and comply with the security process as defined in the DICOM Part 15 Appendix (Secure Use of ZIP File Media over Email)
– Portable Media Importers/Exporters that import/export media shall generate one or more ATNA “Import”/”Export” events into the audit trail to describe the media event.
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Cross-Enterprise Document Reliable Interchange (XDR)
• Documents and metadata shared using a reliable messaging system
• Permits interchange between EHRs, PHRs, and other health IT systems in the absence of XDS infrastructure
• Allows for automatic transfer of documents for a single patient (one submission set)
• Supports the reuse of the Provide and Register Document set (ITI-41) with web services as transport
XDR
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• More like XDS than XDM– Direct transfer between source and consumer – No registry or repository actors involved
• Optionally identify intended recipients
• Works with XDS– XDS Query/Retrieve can feed XDR transmission– Point-to-point transfer via XDR can feed XDS submission
XDR
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• Use Cases• Primary Physician to Specialist
• Referral information for patient sent to specialist ahead of visit
• Hospital to Long-term Care• Patient summary information sent to long-term care facility
upon patient transfer from hospital
• Physician to Physician• Patient MRI test results sent from physician in specialized
care facility to another specialist for consultation
XDR
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• Actors & Transaction
• Options
XDR
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Send Existing Reliable
Messaging System
Receive
A referral summary A referral summary
XDR
SpecialistOffice
PhysicianOffice
XDR Exchange of Health Information
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• Standards– ebRIM - OASIS/ebXML Registry Information Model v3.0
– ebRS- OASIS/ebXML Registry Services Specifications v3.0
– Appendix V - ITI TF-2x:Appendix V Web Services for IHE Transactions. Contains references to all Web Services standards and requirements of use
– MTOM - SOAP Message Transmission Optimization Mechanism http://www.w3.org/TR/soap12-mtom/
– XOP - XML-binary Optimized Packaging http://www.w3.org/TR/2005/REC-xop10-20050125/
XDR
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• Security & Privacy
• Basic Patient Privacy Enforcement Option
• Relevant XDS Affinity Domain security considerations are discussed in the XDS Security Considerations Section (see ITI TF-1: 10.7)
XDR
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Summary
Health Document Exchange Options - Flexible Infrastructure
Publish
Query/Retrieve
Send to
Existing Reliable
Messaging System Send to
Write ReadInterchangeMedia
XDS
XDR
XDM
M8354673993
A8763114355L-716
XDS INFRASTRUCTURE
Query/Retrieve
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**** Update **** Summary
Specialist, Radio or Lab GP / PCP Doctor A
Care Facility Hospital Acute
Care / ED
Patient Transfer
Personal Health Record (PHR)to ED/Primary Care EMR
Acute Care DischargeAcute Care Dischargeto Extended Care Facility (ECF)to Extended Care Facility (ECF)
Remote advice
Consulting to referring physicians
Hospital-doctor communication
Combining XDM / XDR
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References
• To learn more about IHE…– IHE web site: www.ihe.net
• IHE official material• Frequently Asked Questions• Technical Framework documents
– Integration Profiles – See Volume 1 of each for Use cases
• Vendor Products Integration Statements
– IHE IT Infrastructure Wiki: http://wiki.ihe.net/index.php?title=IT_Infrastructure
• IHE committee pages• Implementation Notes• Ongoing committee work