XDM / XDRXDM / XDR Point-to-Point Transmission of Point-to-Point Transmission of

DocumentsDocuments

IHE IT Infrastructure Webinar SeriesIHE IT Infrastructure Webinar Series

INTEGRATING THE HEALTHCARE ENTERPRISEINTEGRATING THE HEALTHCARE ENTERPRISE

IT Infrastructure Planning CommitteeIT Infrastructure Planning Committee

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