Mobile Cross-Enterprise Document Data Element Extraction

The Mobile Cross-Enterprise Document Data Element Extraction (mXDE) Profile provides the means to access data elements extracted from shared structured documents.

Summary

The Mobile Cross-Enterprise Document Data Element Extraction (mXDE) Profile provides the means to access data elements extracted from shared structured documents. The profile enables the deployment of health data exchange infrastructures where fine-grained access to health data coexists and complements the sharing of coarse-grained documents and the fine-grained data elements they contain.

This profile is based on the reality that health information sharing relies on different granularities of exchange:

* Document-Level Granularity: share and access documents as a composition of various data elements to reflect the information known and produced during a care or administrative workflow step. This level of granularity is optimum to ensure that contained data has clarity of context in care delivery and reflects source attestation (responsibility) of clinical data shared.
* Data Element-Level Granularity: access a specific type of data element (e.g., vital signs, medications, etc.). This level of granularity is optimum when the list of data elements relevant to a “time span” or a set of encounters is of interest. Examples of situations where this level of granularity may be optimum include access to a list of allergies at the time of medication dispensation, or information reconciliation at the time of hospital admission.

Each granularity level delivers unique benefits and this profile provides efficient access to both levels.

This profile defines rules to ensure consistency and traceability of information used for clinical decisions. When a data element is accessed by a Clinical Data Consumer, identifiers from that data element can be used to access one or more documents in which this data element was originally recorded, providing a valuable broader clinical context.

The flows of information are depicted in the figure on the left:

1 - Specific data elements are extracted from the structured documents per mXDE Profile.
2 - Data elements (e.g. allergies) queried using the FHIR based QEDm Profile.
3 - Each data element is referenced to the document(s) from which it was extracted per mXDE Profile.
4 - Clinician accesses context of any data element of interest using source documents (XDS, MHD Profiles)
providing the clinical context in which the observation was recorded.

Details

The sharing of documents across community, regional, or national health information exchange platforms is one of the fundamental paradigms of exchange of health records. Currently, these kinds of records are often shared using IHE profiles such as Cross-Enterprise Document Sharing (XDS), Cross-Community Access (XCA), and Mobile access to Health Documents (MHD).

However, many health information exchange platforms that support document sharing are considering extending their services by offering cross-document data aggregation. This can be addressed, in part, with the access to documents dynamically created with the On-Demand Document Source Actor in the XDS Profile, and, in part, with profiles such as PCC’s Query for Existing Data for Mobile (QEDm) Profile that supports the granular access to specific data elements (e.g., list of medications, list of allergies).

The mXDE Profile takes it one step further. It allows an integrated approach to health records by using existing services from the IHE profiles mentioned above.

The mapping of the document to data elements is outside the scope of the mXDE Profile. It needs to be specified for each deployment based on the specific document content and data elements managed.

Figure 45-1 conceptually depicts the sharing of health information supported by mXDE, highlighting that health information could be shared at different levels of granularity: Document-Level Granularity (shown with the green documents) and the Data Element-Level Granularity (shown with orange hexagons). The health data exchange infrastructure depicted as a “hub” in the middle is providing a location service to access both document-level or data element-level health data in a patient-centric manner.

Document-Level Granularity “publication” is out of scope of this profile but may be performed using the XDS Provide and Register ITI-41 transaction, the MHD Provide Document Bundle ITI-65 transaction or other means.
Data Element-Level Granularity access is central to mXDE and is discussed in Section 45.1. The Provenance information, returned with each fine-grained data element in the Query responses, allows identification of the document from which the fine-grained data element was extracted.
Document-Level Granularity “consumption” is central to mXDE and is discussed in Section 45.1. Using the identification of the document from which a data element was extracted, it is possible to access the clinical context in which that data element was observed.

This profile supports a variety of deployment models. Two of those are discussed in Section 45.7

Systems Affected

HIE Infrastructure systems that have ready access to Documents and Metadata, and ability to decompose into Data Elements.
Display systems may query, retrieve and display Data-Elements.
Reporting workstations may retrieve, process and include details from Data-Elements and need Provenance to the source Documents.

Actors & Transactions:

The mXDE Profile includes two actors:

The Data Element Extractor Actor accesses documents to extract data elements and create the links to the data elements’ source documents.
The Data Element Provenance Consumer Actor uses the provided links from data elements to source documents to obtain broader clinical context in which the data elements were recorded.

Three alternative groupings of actors are supported by mXDE. Each one is depicted by a separate figure below that shows the actors directly involved in the mXDE Profile and the relevant transactions between them. These groupings are further specified in Section 45.3.

Grouped actors are shown with conjoined boxes. The actors shown with dotted line boxes are specified by other IHE profiles.