Integrating the Healthcare Enterprise
XDS
Cross-Enterprise Document Sharing
Integration Profile
Standards &Transactions & Implementation
Bill Majurski – NIST
IHE IT Infrastructure Technical Committee
http://www.sanita.forumpa.it/documenti/0/100/150/150/IHE_XDS_1.ppt
Sept 13-15, 2004
IHE Interoperability Worshop
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Introduction
Registry Standard
Things XDS adds to the Registry Standard
Structure of Actors and Transactions
Implementation
High-level focus – minimal XML
Sept 13-15, 2004
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IHE Interoperability Worshop
Registry Standard
ebXML Registry
OASIS Standard
 OASIS (Organization for the Advancement of Structured
Information Standards) is a not-for-profit, international
consortium that drives the development, convergence, and
adoption of e-business standards
 http://www.oasis-open.org
Adopted by ISO
Specifically a Document Registry
Focus on business documents
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IHE Interoperability Worshop
ebXML Registry Component
Standards
ebRIM – Registry Information Model
 Metadata
•
•
Data about documents
Defines basis for searches
ebRS – Registry Services
 Interfaces
 Protocols
 Actions/verbs
 Query language
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IHE Interoperability Worshop
ebXML Registry defines
Integrated Registry & Repository
Registry holds Metadata
Repository holds Documents
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IHE Interoperability Worshop
Metadata Building Blocks
Large collection of small objects
Document (ExtrinsicObject)
Association – Link between two objects
External Link – URI – link to web resource
Classification Scheme – Taxonomies
Classification – Link to term in taxonomy
RegistryPackage – Bundle of objects
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IHE Interoperability Worshop
Common Registry Object
Attributes
Id – object identifier (UUID)
Name – label only – not used in identification
Description – free text
objectType
Status – submitted/approved/deprecated…
Slots – name/value pairs
External Identifiers – primary search indexes
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Common Registry Object
Attribute Size Limitations
Name – 128 chars
Description – 256 chars
Slots
 name – 128 chars
 value – 128 chars
External Identifiers – 64 chars
External Link (URI) – 256 chars
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IHE Interoperability Worshop
General Document Registry
Operations
Submit metadata and documents
Update metadata and documents
Query metadata
Retrieve Documents
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IHE Interoperability Worshop
How does XDS relate to
ebXML Registry?
Applies
Constrains
Extends
Reconfigures
Integrates
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IHE Interoperability Worshop
ebXML Registry -> XDS
Reconfigures:
 Registry and repository as separate actors
Benefits:
 Repository may already be part of another
product/system.
 Common registry for many repositories
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IHE Interoperability Worshop
ebXML Registry -> XDS
Constrains:
 Metadata design
Benefits:
 Establishes mandatory metadata
 Relevant to medical documents
 Restriction on how documents may relate
 Defines reasonable space for queries
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IHE Interoperability Worshop
ebXML Registry -> XDS
Extends:
 Metadata submission to registry guaranteed
atomic
Benefits:
 Simpler registry client
 Well defined responsibilities
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IHE Interoperability Worshop
ebXML Registry -> XDS
Integrates:
 With other IHE profiles
Benefits:
 Integrate once – at specification level
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ebXML Registry -> XDS
Extends:
 By introducing the Submission Set (record of what
was submitted together)
Benefits:
 Related by medical event, parameters of the
submission, support for transactions
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ebXML Registry -> XDS
Extends:
 By introducing the Folder with constraints on its
contents
Benefits:
 Restricted content, standard parameters
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ebXML Registry -> XDS
Extends:
 By introducing new terminology
Benefits:
 Terms now exist to describe subtle issues in
standard
 New terms to describe how XDS deploys and
integrates ebXML Registry
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New Terms
XDS Document
XDS Repository Submission Request
XDS Registry Submission Request
XDS Submission Set
XDS Folder
XDS Registry Adaptor Function
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What does XDS Not Change?
Messages – all messages conform to
standard
Protocols - unchanged
Information Model – restricted but
unaltered
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XDS Actors
Patient Identity
Source
Document
Registry
Document
Source
Sept 13-15, 2004
Document
Consumer
Document
Repository
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XDS Actors and Transactions
Patient Identity
Source
Patient Identity
Feed
Document
Registry
Query
Registry
Document
Consumer
Register
Document Set
Document
Source
Provide &
Register
Document Set
Sept 13-15, 2004
Document
Repository
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Retrieve
Document
IHE Interoperability Worshop
Document Source Actor
Transactions
 Provide & Register Document Set
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Provide & Register Document
Set Transaction
Document Source has responsibility for
generating metadata
Send Repository Submission Request
containing metadata and documents to
repository
Status returned
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Repository Submission
Request
Repository Submission Request
Submission Set
Metadata
Document 1
Document 2
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Document Repository Actor
Patient Identity
Source
Patient Identity
Feed
Document
Registry
Query
Registry
Document
Consumer
Register
Document Set
Document
Source
Provide &
Register
Document Set
Sept 13-15, 2004
Document
Repository
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Retrieve
Document
IHE Interoperability Worshop
Document Repository Actor
Transactions
 Provide & Register Document Set
 Register Document Set
 Retrieve Document
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Provide & Register Document
Set Transaction
Documents stored in repository
Knows location of the cross-enterprise registry
Invoke Register Document Set Transaction
Success means documents accepted by
repository and metadata accepted by registry
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Register Document Set
Transaction
Compute
 Document address (URI) within repository
 Document size
 Document hash
Metadata amended to include URI, size, hash
Reject submission if document ID already present
in repository with different size/hash (optional)
Passes metadata to registry
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Retrieve Document
Transaction
Documents retrievable via HTTP GET
request
Uses URI generated by Document
Repository in Register Document Set
Transaction
Exact byte stream is returned
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IHE Interoperability Worshop
Document Consumer Actor
Patient Identity
Source
Patient Identity
Feed
Document
Registry
Query
Registry
Document
Consumer
Register
Document Set
Document
Source
Provide &
Register
Document Set
Sept 13-15, 2004
Document
Repository
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Retrieve
Document
IHE Interoperability Worshop
Document Consumer Actor
Transactions
 Query Registry
 Retrieve Document
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Query Registry Transaction
SQL query language
ebRIM defines information model for
queries
ebRIM defines subset of SQL that applies
Return is by reference or by value
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Simple SQL Query
Select all documents for patient ID 12345.34.259373
SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID
WHERE
doc.objectType=XDSDocumentEntry AND
patID.identificationScheme=XDSPatientID AND
patID.registryObject=doc.id AND
patID.value=‘12345.34.259373’ AND
doc.status=‘Approved’
XDSDocumentEntry and XDSPatientID are coded as UUIDs
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XDS
Query
Keys
Doc-level
XDSDocumentEntry Attribute
EbRIM Attribute Type
AuthorDepartment
Slot
AuthorInstitution
Slot
AuthorPerson
Slot
AvailabilityStatus
ebRIM Status attribute
ClassCode
External Classification
CreationTime
Slot
EventCodeList
External Classification
FormatCode
External Classification
HealthcareFacilityTypeCode
External Classification
legalAuthenticator
Slot
PatientId
External Id
PracticeSettingCode
External Classification
ServiceStartTime
Slot
ServiceStopTime
Slot
TypeCode
External Classification
UniqueId
External Id
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Retrieve Document
Transaction
Query Registry Transaction
 Can return metadata including document URI
Retrieve Document via HTTP GET
 Returns exact byte stream that was delivered to
Repository in Provide & Register Document Set
Transaction
 Not related to IHE RID Profile
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Document Registry Actor
Patient Identity
Source
Patient Identity
Feed
Document
Registry
Query
Registry
Document
Consumer
Register
Document Set
Document
Source
Provide &
Register
Document Set
Sept 13-15, 2004
Document
Repository
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Retrieve
Document
IHE Interoperability Worshop
XDS Registry Actor Structure
Document Registry Actor
Registry
Adaptor
Function
ebXML
Registry
Function
ebXML
Registry
Document
Repository
Actor
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Document Registry Actor
Transactions
 Register Document Set
 Query Registry
 Patient Identity Feed
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Register Document Set
Transaction
Receives metadata from Repository Actor
Validates metadata
Stores metadata in registry as atomic
operation
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Registry Submission Request
Registry Submission Request
Submission Set
Metadata
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Document Availability Management
Submitted
Registration in progress
Availability
Status Visible
to a Document
Source
Approved
Available for Patient Care
Deprecated
Obsolete
Availability
Status Visible
to a Document
Consumer
Deleted
Registry Status attribute: Life Cycle Status indicator
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Registry Adaptor Function
Validate Metadata
Valid patient ID
Required attributes
Valid coded values
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Registry Adaptor Function
(Cont)
Validate Metadata (Cont)
Submission Set semantics
 Example – all new documents for same patient
Folder semantics
 Example – all documents for same patient
Document Resubmission
Implement resubmission semantics
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Registry Adaptor Function
(Cont)
XDS Submission is atomic
ebXML Registry submission is not
Use Status Attribute as control
 Submitted – submission in progress
 Approved – submission complete - available to
query
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Registry Adaptor Function
(Cont)
Use two registry operations to store
metadata
Submit – store data, set status to
submitted
Approve – change status to Approved
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Query Registry Transaction
Process SQL query against registry
contents
Return list of
 Objects formatted in XML
 Object references
Remember to search for Approved objects
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IHE Interoperability Worshop
Simple SQL Query
Select all documents for patient ID 12345.34.259373
SELECT * FROM ExtrinsicObject doc, ExternalIdentifier patID
WHERE
doc.objectType=XDSDocumentEntry AND
patID.identificationScheme=XDSPatientID AND
patID.registryObject=doc.id AND
patID.value=‘12345.34.259373’ AND
doc.status=‘Approved’
XDSDocumentEntry and XDSPatientID are coded as UUIDs
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Patient Identity Feed
Transaction
Notification on
 Patient registration
 Updated Patient Information
From Patient Identity Source (ADT)
Registry Adaptor Function maintains list
of valid patient IDs
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Primary XDS Concepts
Submission Request
Submission Set
Document
Folder
Document Life Cycle Management
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Submission Requests
Patient Identity
Source
Document
Registry
Document
Consumer
Registry
Submission
Request
Document
Source
Repository
Submission
Request
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Document
Repository
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Document
Real document vs. metadata
Attributes
Relationships between documents
 Replace
 Append
 Transform
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Document in Registry
ExtrinsicObject object
 With objectType of XDSDocumentEntry
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Folder
‘Directory’ metaphor
 But, a document can reside in multiple Folders
Single patient
Attributes
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Folder in Registry
RegistryPackage object
Classified as XDSFolder
Contains document objects
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Submission Set
Collection of documents & Folders
Permanent label of what was submitted
together
Attributes
Documents included by
 Value (same patient)
 Reference (any patient)
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IHE Interoperability Worshop
Submission Set in Registry
RegistryPackage object
Classified as XDSSubmissionSet
RegistryPackage ‘contains’
 Documents (XDSDocumentEntry object)
 Folders (XDSFolder object)
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XDS
Query
Keys
Submission
Set
And
Folder
XDSSubmissionSet Attribute
Query
Key
EbRIM Attribute Type
AuthorDepartment
O
Slot
AuthorInstitution
R
Slot
AuthorPerson
R
Slot
Comments
R
ebRIM Description attribute
ContentTypeCode
R
External Classification
SourceId
R
External Id
SubmissionTime
R
Slot
UniqueId
R
External Id
XDSFolder Attribute
Query
Key
EbRIM Attribute Type
CodeList
R
External Classification(s)
Comments
R
ebRIM Description attribute
lastUpdateTime
R
Slot
PatientId
R
External Id
UniqueId
R
External Id
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Document Resubmission
Given multiple:
 Providers involved with a patient (Document
Sources)
 Repositories
Single Registry
Document resubmission will happen!
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Document Resubmission
(Cont)
Key Attributes:
XDSDocumentEntry.uniqueID
 Unique document ID
 Assigned by Document Source
XDSDocumentEntry.hash
 Hash code of contents of document
 Computed by Document Repository
ebXML Registry document id (UUID)
 Assigned by Document Source
 Internal to Registry
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Document Resubmission
(Cont)
Document submitted twice…
Document altered slightly
 Different hash code
Submitted by different office
 Assigned different document id
Detection of duplicate is beyond XDS!
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Document Resubmission
(Cont)
Document submitted twice…
Document altered slightly
 Different hash code
Document Id already present in
Repository/Registry
Submission is rejected!
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Document Resubmission
(Cont)
Document submitted twice…
Document is identical
 Same hash code
Document Id already present in
Repository
New UUID (internal registry ID)
Submission is accepted!
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Online/Offline & Protocols
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Online
Direct network connection between all
actors
All Transactions
Online ‘mode’ required in profile
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Offline
Document Source connects to Document
Repository via SMTP
Remote, asynchronous submission via
email
Single transaction available
 Provide & Register Document Set Transaction
Offline ‘mode’ is optional in profile
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Online Protocols
SOAP Messages with Attachments
 W3C Note 11 December 2000
MIME – Multipurpose Internet Message
Extensions
 RFC 2045 - Part One: Format of Internet Message Bodies
 RFC 2046 - Part Two: Media Types
 RFC 2047 - Part Three: Message Header Extensions for
Non-ASCII Text
 RFC 2048 - Part Four: Registration Procedures
 RFC 2049 - Part Five: Conformance Criteria and
Examples
 RFC 2387 - The MIME Multipart/Related Content-type
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Offline Protocol
Uses ebXML Message Service
Specification v2.0 (ebMS)
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Implementation Scenarios
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Document Submission
Document Source Actor
 Provide & Register Document Set
 Online/Offline
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Document Retrieval
Document Consumer Actor
 Query Registry Transaction
 Retrieve Document Transaction
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Clinical Information System
Product already creates/stores documents
Implement together
Document Source Actor
Document Repository Actor
Required Transactions
Register Document Set
Retrieve Document
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Replace Documents
Replacement, Addendum, Transformation
Document Consumer Actor
 Query Registry Transaction
 Needed to discover details of existing documents
Document Source Actor
 Provide & Register Document Set
 Submit new documents and metadata
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Place Existing Documents in a
Folder
Document Consumer Actor
 Query Registry Transaction
 Discover details of existing documents
Document Source Actor
 Provide & Register Document Set
 Submit new Folder metadata
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Provide XDS Registry
Document Registry Actor
Register Document Set Transaction
Query Registry Transaction
Patient Identity Feed Transaction
Including
ebXML Registry functionality
Registry Adaptor functionality
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Construct Registry given
ebXML Registry
Implementation
Build Registry Adaptor Function as front
end to ebXML Registry
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Construct XDS Registry
without ebXML Registry
Implementation
Build to two specifications:
 ebXML Registry Standard (subset)
 XDS Profile - Registry Adaptor Function
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Implementation Resources
Implementation guide






Clinical Coding
Example software
Example queries
Metadata cookbook (how-to)
Metadata Schema
Sample metadata submissions
FAQ: http://www.connect-a-thon.net/bb
Live registry with test data
Testing
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Questions?
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More information….
IHE Web sites:
http://www.himss.org/IHE
http://www.rsna.org/IHE
http://www.acc.org/quality/ihe.htm.
Technical Frameworks:
•
ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation
•
•
May 2004: Radiology
August 2004: Cardiology, IT Infrastructure
Non-Technical Brochures :
•
•
•
•
•
Calls for Participation
IHE Fact Sheet and FAQ
IHE Integration Profiles: Guidelines for Buyers
IHE Connect-a-thon Results
Vendor Products Integration Statements
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