Full metadata Subscription and Pull- style Notification (FSPN) Brief Profile Proposal for 2012/13...

Full metadata Subscription and Pull-Full metadata Subscription and Pull-style Notification style Notification

(FSPN) (FSPN)

Brief Profile Proposal for 2012/13Brief Profile Proposal for 2012/13presented to thepresented to the

ITI Planning CommitteeITI Planning CommitteeMauro Zanardini (consorzio Arsenàl.IT)Mauro Zanardini (consorzio Arsenàl.IT)

October, 30October, 30thth October 2012 October 2012

DSUB.b DSUB.b oror

ITI Planning CommitteeITI Planning Committee

Proposal goals:Proposal goals:

The goals of the Proposal are two:The goals of the Proposal are two:

1.1. To To extend functionalities of DSUB extend functionalities of DSUB (Document metadata Subscription) (Document metadata Subscription) profile with these purposes: profile with these purposes: – full metadata subscription, full metadata subscription, – extend notification payloadextend notification payload– Pull-style notificationPull-style notification

2.2. Define modalities to create subscription and/or deliver Define modalities to create subscription and/or deliver notification in accordance to access policies definednotification in accordance to access policies defined

This allows:This allows:• The Creation of The Creation of systems of notification adaptable for Workflow systems of notification adaptable for Workflow

Management Systems Management Systems based on XDW. based on XDW. • The definition a The definition a new modality to convey notifications applicable to new modality to convey notifications applicable to

Recipients that can’t show public IP or that can’t grant continuity of Recipients that can’t show public IP or that can’t grant continuity of service. service.


TheThe ProblemProblem

Build a Notification System to Build a Notification System to empowerempower the XDW Workflow the XDW Workflow Management:Management:

• The The only fixed reference to a specific workflow is the only fixed reference to a specific workflow is the folderIdfolderId: if an actor : if an actor want to be acknowledged for a specific workflow it want to be acknowledged for a specific workflow it SHALLSHALL subscribe the subscribe the related folderIdrelated folderId

• The payload of a notification (created for a workflow update) The payload of a notification (created for a workflow update) SHOULDSHOULD contain the folder object that has been updated.contain the folder object that has been updated.

• Actors involved in a distributed workflow doesn’t grant continuity of service, Actors involved in a distributed workflow doesn’t grant continuity of service, many times are masked by a firewall and/or can’t show a public IP. In these many times are masked by a firewall and/or can’t show a public IP. In these cases a Push-and-forget style of notification is not applicable. cases a Push-and-forget style of notification is not applicable. Pull-stylePull-style is is more flexible and already defined by more flexible and already defined by WS-BaseNotification WS-BaseNotification standard. standard.


Use-case (1/3)Use-case (1/3)

Mr. Brown goes to his GP’s (Dr. Smith) to have a consultation because he Mr. Brown goes to his GP’s (Dr. Smith) to have a consultation because he has a dizziness. Dr. Smith prescribes two specialistic consultations (creating has a dizziness. Dr. Smith prescribes two specialistic consultations (creating two eReferral workflow documents):two eReferral workflow documents):

•both the Workflow Documents are characterized by the same document metadata.both the Workflow Documents are characterized by the same document metadata.•he creates subscriptions for both the folders that contain the two Workflow Documents. he creates subscriptions for both the folders that contain the two Workflow Documents.

WD. 1WD. 1 WD. 2WD. 2

folderId.1 folderId.2

Same Metadata

Specific references to Workflows



Mr. Brown goes to the healthcare provider of his choice to perform one of the Mr. Brown goes to the healthcare provider of his choice to perform one of the visits: visits: •The HCP takes in charge the eReferral and it schedules an appointment for the patient. The The HCP takes in charge the eReferral and it schedules an appointment for the patient. The Workflow Document related is updated. Workflow Document related is updated. •The Broker finds a subscription (created by the GP) for the specific folder updated and The Broker finds a subscription (created by the GP) for the specific folder updated and consequently it generates a notification with the folder object as payload.consequently it generates a notification with the folder object as payload.•Delivering of folder objects is the only way to give the GP’s the possibility to access the most Delivering of folder objects is the only way to give the GP’s the possibility to access the most recent version of the Workflow Document recent version of the Workflow Document

Notification:-Workflow Document

Notification:-Workflow Document

Notification Broker

Notification Broker

Notification Recipient


Notification:-FolderNotification:-Folder

The WD can be an already deprecated version

Using the folderId it can find every time the last WD



The notification can’t be sent to the Recipient because the GP’s The notification can’t be sent to the Recipient because the GP’s software is a not skilled application. software is a not skilled application. •The Recipient can use a Pull-style notification to be acknowledged for updates. The Recipient can use a Pull-style notification to be acknowledged for updates.

•Notifications are not lost and they are managed by a Pull-point directly created Notifications are not lost and they are managed by a Pull-point directly created by the GP’s application. This software can access the pull-point and can poll all by the GP’s application. This software can access the pull-point and can poll all

notifications pending in a simple and secure waynotifications pending in a simple and secure way. .



Notification Broker

Notification Broker

NAT or Firewall

Pull PointPull

Point

Notification delivered directly to the recipient are lost

Notification delivered to the Pull-point are managed and stored

Polling of all notification pending


Some Numbers for Veneto Region:Some Numbers for Veneto Region:

Data coming from the Veneto region (4.900.000 habitants):Data coming from the Veneto region (4.900.000 habitants):

Actors not allowed use a DSUB system of notification:Actors not allowed use a DSUB system of notification:3500 GPs;3500 GPs;14.500 Hospital Clinicians; 14.500 Hospital Clinicians;

Clinical processes in which they are involved:Clinical processes in which they are involved:60.000.000 prescriptions per year: for specialist consultation, laboratory 60.000.000 prescriptions per year: for specialist consultation, laboratory investigation or pharmaceutical services. Each prescription involves at least investigation or pharmaceutical services. Each prescription involves at least 2 notifications to the Requester;2 notifications to the Requester;500.000 patients can be potentially involved in telemonitoring processes; 500.000 patients can be potentially involved in telemonitoring processes; 750.000 hospitalizations per year;750.000 hospitalizations per year;

Each GP receives almost 600 notifications/week related to Each GP receives almost 600 notifications/week related to ePrescriptions, and has to follow the telemonitoring processes for ePrescriptions, and has to follow the telemonitoring processes for

almost 140 patients, who collect data every day and generate alarms almost 140 patients, who collect data every day and generate alarms which have to be readily managed. which have to be readily managed.


Existing profiles and standards Existing profiles and standards (1/3):(1/3):

1.1. Query Approach:Query Approach: LLarge number of useless queries to the registry. arge number of useless queries to the registry. High complexity of requests made by the Recipient for multiple patientId High complexity of requests made by the Recipient for multiple patientId

and multiple content (this two points can involve and multiple content (this two points can involve overloading for a overloading for a registry or long time for responsesregistry or long time for responses))

There is not a system to track events occurred and notified, but not There is not a system to track events occurred and notified, but not acknowledged by the Recipient. It can be done only with a notification acknowledged by the Recipient. It can be done only with a notification queue manager and outpacing the push-and-forget style. queue manager and outpacing the push-and-forget style.

In a query scenario the Recipient has to know what it would like to find In a query scenario the Recipient has to know what it would like to find (or the patient related), using DSUB the subscription can be created by (or the patient related), using DSUB the subscription can be created by an actor distinct from the Recipient. an actor distinct from the Recipient.



2.2. NAV profile:NAV profile: Requires that the Source knows the email address of the recipient for Requires that the Source knows the email address of the recipient for

each content publishedeach content published.. It is not definied how a recipient can ask to be acknowledged for a It is not definied how a recipient can ask to be acknowledged for a

specific content specific content Notification delivered using SMTP can convey only:Notification delivered using SMTP can convey only:

UUID of documents published, location of the registry, free text, email address of the UUID of documents published, location of the registry, free text, email address of the sender. sender.

SMTP server can create system of notification not suitable for a SMTP server can create system of notification not suitable for a environment with large number of actors.environment with large number of actors.



3.3. Hybrid approaches (DSUB+NAV or DSUB+XDM): allow to wrap DSUB Hybrid approaches (DSUB+NAV or DSUB+XDM): allow to wrap DSUB functionalities with SMTP infrastructure to deliver notifications functionalities with SMTP infrastructure to deliver notifications

Customized approach that requires to use NAV out of the standardsCustomized approach that requires to use NAV out of the standards.. Customized transactions are required to translate DSUB sintax into NAV Customized transactions are required to translate DSUB sintax into NAV

sintax and vice versa. sintax and vice versa. Communication is not secure (with NAV).Communication is not secure (with NAV). This approach can’t avoid the need of the extension of DSUB (allowing This approach can’t avoid the need of the extension of DSUB (allowing

full metadata subscription and full object delivery). full metadata subscription and full object delivery).

Document Metadata

Notification Broker

Document Metadata

Notification Broker

Notification Sender

Notification Sender

Notification Receiver

Notification Receiver

Document Metadata Notification RecipientDocument Metadata Notification Recipient

SMTPSMTPITI-25 Send Notification

ITI-26 Receive Notification

Full metadata Subscription and Pull- style Notification (FSPN) Brief Profile Proposal for 2012/13...

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