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.

FAQ

This is not normative text, but provided informatively due to the frequency that questions are asked.

Optimal Query

(Text originally published in the Document Sharing Metadata Handbook)

The FindDocuments query has 17 query parameters, but 7 of them play a critical role. These parameters are the “critical few”, especially for the initial query that performs the primary filtering (further discussed in Section 3.4) among all available documents for a patient that may be in the thousands with a mature deployment. This primary filtering optimizes the use of query to return the best possible results, avoiding missing any results that should be considered. This favors false-positives (results that are not desired), over false-negatives (missed results). The query results returned include full metadata for each entry found; local refinement of these results (see section 2.2 below) is used to further eliminate these false-positives.

The other 12 parameters may also be used, but the effectiveness of these additional parameters in primary filtering is limited. See section 2.1.2 for further explanation.

Here are the 7 query parameters and metadata attributes that are combined for primary filtering:

• patientId - this is required in XDS/XCA. You must have a Patient ID you are interested in. Use of PIX, PDQ, XCPD, or some other Patient Identity Management system is a prerequisite, that will not be further discussed in this handbook.
• classCode – classCode is used to group documents into logical classes which are useful to primary filtering success. A small number of controlled value set of pre-negotiated code values should be defined to group documents into broad logical 'classifications', designed so that for any use case where someone is looking for documents they can pick one term from this value set.
• practiceSettingCode - this is the clinical specialty where the act that resulted in the document was performed. Like the classCode, this should have been filled with a controlled value set of pre-negotiated code values that represents broad classifications of clinical specialties. By restricting the value set to the high-level clinical specialties, one should avoid the misfiling associated with documents produced by sub-specialties.
• serviceStartTime - serviceStopTime – When there is a timerange of the service event that you are interested, you will query against the serviceStartTime and service StopTime metadata element to find documents that indicate they fit your timerange. .

service Start to Stop Time

The service times are specific to the time range of the treatment or episode. This is different than the document creation time, which is when the document was created. The query results will return any document whose “service time” falls within that range. It is important to note that these parameters work together to give a period of time.

Given you are interested in a specific time range (Start -> Stop).

The serviceStartTimeFrom and serviceStopTimeTo are clear they should bound that time with a little slop to deal with poor timeclocks:

• serviceStartTimeFrom parameter in the query should be set to a few minutes before the time you are interested in being the Start of the service time range
• serviceStopTimeTo parameter in the query should be a set to a few minutes after the time you are interested in being in the Stop of the service time range

Some DocumentEntries will have a service start time but not have a service stop time. This is common in chronic care, radiology, and other circumstances where the end of the service has not happened or where the end is unknowable, therefore you should include a query parameter that would eliminate DocumentEntries that have a declared start time well after the time range you are interested in:

• serviceStartTimeTo parameter in the query should be set to a few minutes before the time you are interested in being the Stop of the service time range

Some DocumentEntries will have a service stop time but not a service start time. This is not common, but will happen where there is no clear start time to an observation, therefore you should include a query parameter that would eliminate DocumentEntries that have a declared stop time well before the time range you are interested in:

• serviceStopTimeFrom parameter in the query should be set to a few minutes after the time you are interested in being the Start of the service time range

Some DocumentEntries will have neither service start or stop. These will be returned regardless of any timeframe query parameters. Your Community Metadata Specification should encourage all metadata publications populate the serviceStartTime and serviceStopTime element as much as possible to avoid false-positive query results.

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. 2

• 3.18 Registry Stored Query
• 3.41 Provide and Register Document Set
• 3.42 Register Document Set
• 3.43 Retrieve Document Set

Vol. 2x

• Appendix A Web Services Definition
• Appendix B Definition of a Document
• Appendix K XDS Security Environment
• Appendix M Using Patient Demographics Query in a Multi-Domain Environment
• Appendix N Common Datatypes
• Appendix V Web Services for IHE Transactions
• Appendix W Implementation Materials

Vol. 3

excerpts (Not all sub-sections below level 3 are listed here)

Vol. 3 - Section 4.0 Metadata used in Document Sharing

• 4.1 - Abstract Metadata Model
  • 4.1.1 - Metadata Object Types
  • 4.1.2 - Association Types
  • 4.1.3 - Metadata Object Types
    • 4.1.3.1 - The Purpose of Metadata
    • 4.1.3.2 - DocumentEntry Metadata Attributes
    • 4.1.3.3 - SubmissionSet Metadata Attributes
    • 4.1.3.4 - Folder Metadata Attributes
  • 4.1.4 - Submission Request
• 4.2 - ebRIM Representation
  • 4.2.1 - Metadata Object Types
  • 4.2.2 - Association Types
  • 4.2.3 - Metadata Attributes
    • 4.2.3.1 General Information about Metadata Attributes
      • Attribute Value Length
      • Coded Attributes
      • External Identifiers
      • Author Attributes
      • UUIDs
      • Extra Metadata Attributes
      • Metadata Attribute Data Types aka Table 4.2.3.1.7-2: Data Types (previously Table 4.1-3)
      • General format of DocumentEntry, Folder and SubmissionSet Attribute Tables
      • Metadata Attribute Cardinality
      • classificationScheme vs. classifcationNode
    • 4.2.3.2 DocumentEntry Attributes
      • author
      • availabilityStatus
      • classCode
      • comments
      • confidentialityCode
      • creationTime
      • entryUUID
      • eventCodeList
      • formatCode
      • hash
      • healthcareFacilityTypeCode
      • homeCommunityId
      • languageCode
      • legalAuthenticator
      • mimeType
      • patientId
      • practiceSettingCode
      • repositoryUniqueId
      • serviceStartTime
      • serviceStopTime
      • size
      • sourcePatientId
      • sourcePatientInfo
      • title
      • typeCode
      • uniqueId
      • URI
      • referenceIdList
      • limitedMetadata
      • objectType
    • 4.2.3.3 SubmissionSet Attributes
      • author
      • availabilityStatus
      • comment
      • contentTypeCode
      • entryUUID
      • homeCommunityId
      • intendedRecipient
      • patientId
      • sourceId
      • submissionTime
      • title
      • uniqueId
      • LimitedMetadata
    • 4.2.3.4 Folder Attributes
      • availabilityStats
      • codeList
      • comments
      • entryUUID
      • homeCommunityId
      • lastUpdateTime
      • patientId
      • title
      • uniqueId
      • LimitedMetadata
  • 4.2.4 - Success and Error Reporting
  • 4.2.5 - Metadata Vocabulary
• 4.3 - Additional Document Sharing Requirements
  • 4.3.1 - Submission Metadata Attribute Optionality
  • 4.3.2 - Requirements on Query Type Transactions

Additional

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

Document Sharing Metadata Handbook

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.