Cross-Enterprise Document Sharing

Cross-Enterprise Document Sharing (XDS) is an interoperability profile that facilitates the registration, distribution and access across health enterprises of patient electronic health records.

Summary

Cross-Enterprise Document Sharing (XDS) is focused on providing a standards-based specification for managing the sharing of documents between any healthcare enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility and personal health record systems. This is managed through federated document repositories and a document registry to create a longitudinal record of information about a patient within a given clinical affinity domain. These are distinct entities with separate responsibilities:

• A Document Repository is responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests.
• A Document Registry is responsible for storing information about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored.
• Documents are provided by one or more Document Sources
• They are then accessed by one or more Document Consumers

Benefits

Facilitates management of the Electronic Health Record

• facilitates the registration, distribution and access across health enterprises of patient electronic health records.
• focused on providing a standards-based specification for managing the sharing of documents between any healthcare enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility.

Details

The Cross-Enterprise Document Sharing (XDS) Integration Profile:

• assumes that the enterprises belong to one or more XDS Affinity Domains. An XDS Affinity Domain is a group of healthcare enterprises that have agreed to work together using a common set of policies and share a common infrastructure.

Examples of XDS Affinity Domains include:

• Community of Care supported by a regional health information organizations in order to serve all patients in a given region.
• Nationwide EHR
• Specialized or Disease-oriented Care

• Cardiology Specialists and an Acute Cardiology Center
• Oncology network
• Diabetes network

• Federation of enterprises

• A regional federation made up of several local hospitals and healthcare providers

• Government sponsored facilities (e.g., VA or Military)
• Insurance Provider Supported Communities

• The concept of a document in XDS is not limited to textual information. As XDS is document content neutral, any type of clinical information without regard to content and representation is supported. This makes the XDS IHE Integration Profile equally able to handle documents containing simple text, formatted text (e.g., HL7 CDA Release 1), images (e.g., DICOM) or structured and vocabulary coded clinical information (e.g., CDA Release 2, CCR, CEN ENV 13606, DICOM SR). In order to ensure the necessary interoperability between the document sources and the document consumers, the XDS Affinity Domain must adopt policies concerning document format, structure and content.

Systems Affected

Systems involved in this profile are:

• Enterprise-wide information systems that manage a patient’s Electronic Health Record, such as a Hospital Information System.

Actors & Transactions:

Specification

Profile Status: Final Text

Formal Profile Specification: IHE IT Infrastructure Technical Framework Version 2 or later

• Vol. 1 -
  • Section 10,
    • Document Replace Option
    • Document Addendum Option
    • Document Transformation Option
    • Folder Management Option
    • Asynchronous Web Service Option
    • Reference ID Option
    • On-Demand Option
    • Persistence of Retrieved Option
    • Basic Patient Privacy Enforcement Option
  • Appendix E Cross Profile Considerations,
  • Appendix J Content and Format of XDS Documents,
  • Appendix K XDS Concepts
• Vol. 2a - Sections 3.18 Registry Stored Query
• Vol. 2b - Sections 3.41 Provide and Register Document Set
• Vol. 2b - Sections 3.42 Register Document Set
• Vol. 2b - Sections 3.43 Retrieve Document Set
• Vol. 2x - Appendix A, B, K, L, M, N, V, W
  • Vol. 2x - Appendix A Web Services Definition
  • Vol. 2x - Appendix B Definition of a Document
  • Vol. 2x - Appendix K XDS Security Environment
  • Vol. 2x - Appendix M Using Patient Demographics Query in a Multi-Domain Environment
  • Vol. 2x - Appendix N Common Datatypes
  • Vol. 2x - Appendix V Web Services for IHE Transactions
  • Vol. 2x - Appendix Implementation Materials
• Vol. 3 - Section 4.0 Metadata used in Document Sharing
• IHE Format Codes vocabulary

CDA mapping to XDS Metadata:

• PCC TF-2:4.1.1

Additional Supplements: Trial Implementation

• XDS Metadata Update
• Remove Metadata and Documents (RMD)
• Delayed Document Assembly

Underlying Standards:

• ebMS OASIS/ebXML Messaging Services Specifications v3.0
• ebRIM OASIS/ebXML Registry Information Model v3.0
• ebRS OASIS/ebXML Registry Services Specifications v3.0
• HTTP HyperText Transfer Protocol HTTP/1.1 (IETF RFC2616)
• ISO/IEC 9075 Database Language SQL
• HL7 Version 2.5
• HL7 Version 2.3.1 Chapter 2 – Control, Chapter 3 – Patient Administration

History

Originally published Trial Implementation August 15, 2004

XDS.b Originally published Trial Implementation August 15, 2007 (Original got renamed to XDS.a)

See Also

Document Sharing

Related Profiles:

• Patient Identifier Cross-Referencing PIX
• Patient Demographics Query PDQ
• Notification of Document Availability NAV
• Cross-enterprise Sharing of Scanned Documents XDS-SD
• Security/Privacy
  • Audit Trail and Node Authentication ATNA
  • Consistent Time CT
  • Basic Patient Privacy Consents BPPC
  • Cross-Enterprise User Assertion (XUA)
  • Document Digital Signature DSG
• Other Derivatives
  • Cross-Community Access XCA
  • Cross-enterprise Document Media Interchange XDM
  • Cross-enterprise Document Reliable Interchange XDR

XDS Purchasing describes considerations when purchasing equipment to deploy this Profile.

Sample Transactions

Annotated example of Provide and Register Transaction

raw examples

The XDS FAQ answers typical questions about what the Profile does.

XDS Implementation provides additional information about implementing this Profile in software.

References

Where in the World is CDA and XDS?

The XDS Factor

From Regional Healthcare Information Organizations to a National Healthcare Information Infrastructure

Cross-enterprise image sharing sees breakthrough

Medical Data GRIDs as approach towards secure cross enterprise document sharing (based on IHE XDS).

IHE Update: Bigger, Better Events, New Standards & Guides

Architecture for a Distributed National Electronic Health Record System in Austria

SAPHIRE: A semantic Web service based Clinical guideline deployment infrastructure exploiting IHE XDS (Turkey)

<List References (good and bad) (with link if possible) to Journal Articles that mention IHE's work (and hopefully include some analysis). Go ahead, Google: IHE <Profile Name> abstract or something. You might be surprised. >

This page is based on the Profile Template

Current: IT Infrastructure Technical Framework.