Cross-Community Architecture White Paper

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1. Proposed Profile: Cross-Community Architecture White Paper

  • Proposal Editor: Karen Witting and Tony Mallia
  • Profile Editor: Karen Witting and Tony Mallia
  • Date: N/A (Wiki keeps history)
  • Version: N/A (Wiki keeps history)
  • Domain: ITI


The Cross Community Information Exchange White Paper published in 2006 begins the exploration of topics around exchanging clinical information across communities but does not go into nearly enough depth on the subject and is missing many important topics. This White Paper replaces the 2006 white paper by exploring the topic is much greater depth, adding subjects beyond the original white paper and integrating activities and thoughts that have developed in the intervening years.

This is a Technical Committee White Paper

2. The Problem

As electronic medical records become more prevalent there is an increasing need to share medical data across organizations. The model developing within the United States suggests that medical data sharing will happen first at a local level, as part of Regional Health Information Organizations (RHIOs) and then between RHIO’s. The Integrating the Healthcare Enterprise (IHE) organization has defined an integration profile called Cross-enterprise Document Sharing (XDS) which defines document sharing within a RHIO or, using XDS terminology, within an XDS Affinity Domain. The Cross Community Access defines a community as a coupling of facilities/enterprises that have agreed to work together using a common set of policies for the purpose of sharing clinical information via an established mechanism. An XDS Affinity Domain is a community whose established sharing mechanism is XDS. This white paper will explore all the issues involved in sharing clinicial information between communities.

3. Key Use Case

4. Standards & Systems

5. Technical Approach

Proposed outline of the paper is:

Cross-Community Process Analysis

This section will analyze the technical and business processes involved in sharing clinical information across communities. Some of the topics (to be extended as necessary) are:

  • Community Joins a Cooperative
  • Community to Community Connectation Administration
  • Person Identity and Authorization Administration
  • Locating patient records
  • Managing terminology
  • Policy management

This section will specify a set of profiles which are needed to support interoperability of the processes described in the previous section

  • Connection Management
  • Person Disclosure Authorization Management
  • Patient Identity Feed
  • Locating patient records

This section will specify a set of actors involved in the profiles.

  • Community Connection Manager
  • Community Registry
  • Gateway
  • Lateral Person Identifier Cross-referencing Manager
  • Location Service

This section will specify a set of transactions involved in the profiles.

Breakdown of tasks that need to be accomplished

  • Collect business and technical processes to be analyzed.
  • Analyze processes from a global perspective
  • Identify key profiles needed to enable interoperability
  • Identify actors and transactions needed to enable interoperability

6. Support & Resources

This paper must be suffient level of detail to be able to get useful feedback from future implementors.

7. Risks

<List technical or political risks that will need to be considered to successfully field the profile.>

8. Open Issues

<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>

9. Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

Effort Evaluation (as a % of Tech Cmte Bandwidth):

  • 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor: