Appendix A - Actor Descriptions
Actors are information systems or components of information systems that produce, manage, or act on information associated with operational activities in the enterprise.
- Content Creator
- The Content Creator Actor is responsible for the creation of content and transmission to a Content Consumer.
- Content Consumer
- A Content Consumer Actor is responsible for viewing, import, or other processing of content created by a Content Creator Actor.
- Clinical Data Consumer
- A clinical data consumer makes use of clinical patient data.
- Clinical Data Source
- A Clinical Data Sources maintains patient information about vital signs, problem and allergies, results from diagnostic tests (e.g., Lab, Imaging, or other test results), medications, immunizations or historical or planned visits and procedures.
Appendix B - Transaction Descriptions
Transactions are interactions between actors that transfer the required information through standards-based messages. The PCC Technical Framework does not define any specific transactions, as these are assumed to be carried out through the use of transactions defined in other IHE Profiles.
- Query Existing Data
- Request information about recent patient information, used to obtain vital signs measurements, problems and allergies, diagnostic results, medications, immunizations, or procedures or visits relevant for a patient. The query may request information about some or all of the above topics, or may request information on a specific topic, or one entered for a specific encounter or date range.
Appendix C - How to Prepare an IHE Integration Statement
IHE Integration Statements are documents prepared and published by vendors to describe the conformance of their products with the IHE Technical Framework. They identify the specific IHE capabilities a given product supports in terms of IHE actors and integration profiles described in the technical frameworks of each domain.
Users familiar with these concepts can use Integration Statements to determine what level of integration a vendor asserts a product supports with complementary systems and what clinical and operational benefits such integration might provide. Integration Statements are intended to be used in conjunction with statements of conformance to specific standards (e.g., HL7, IETF, DICOM, W3C, etc.).
IHE provides a process for vendors to test their implementations of IHE actors and integration profiles. The IHE testing process, culminating in a multi-party interactive testing event called the Connectathon, provides vendors with valuable feedback and provides a baseline indication of the conformance of their implementations. The process is not intended to independently evaluate, or ensure, product compliance. In publishing the results of the Connectathon and facilitating access to vendors' IHE Integration Statements, IHE and its sponsoring organizations are in no way attesting to the accuracy or validity of any vendor's IHE Integration Statements or any other claims by vendors regarding their products.
IMPORTANT -- PLEASE NOTE: Vendors have sole responsibility for the accuracy and validity of their IHE Integration Statements. Vendors' Integration Statements are made available through IHE simply for consideration by parties seeking information about the integration capabilities of particular products. IHE and its sponsoring organizations have not evaluated or approved any IHE Integration Statement or any related product, and IHE and its sponsoring organizations shall have no liability or responsibility to any party for any claims or damages, whether direct, indirect, incidental or consequential, including but not limited to business interruption and loss of revenue, arising from any use of, or reliance upon, any IHE Integration Statement.
Structure and Content of an IHE Integration Statement
An IHE Integration Statement for a product shall include:
- The Vendor Name
- The Product Name (as used in the commercial context) to which the IHE Integration Statement applies.
- The Product Version to which the IHE Integration Statement applies.
- A publication date and optionally a revision designation for the IHE Integration Statement.
- The following statement: "This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below:"
- A list of IHE Integration Profiles supported by the product and, for each Integration Profile, a list of IHE Actors supported. For each integration profile/actor combination, one or more of the options defined in the IHE Technical Framework may also be stated. Profiles, Actors and Options shall use the names defined by the IHE Technical Framework Volume I. (Note: The vendor may also elect to indicate the version number of the Technical Framework referenced for each Integration Profile.)
Note that implementation of the integration profile implies implementation of all required transactions for an actor as well as selected options.
The statement shall also include references and/or internet links to the following information:
- Specific internet address (or universal resource locator [URL]) where the vendor's Integration Statements are posted
- URL where the vendor's standards conformance statements (e.g., HL7, DICOM, etc.) relevant to the IHE transactions implemented by the product are posted.
- URL of the IHE Initiative's web page for general IHE information www.himss.org/ihe.
An IHE Integration Statement is not intended to promote or advertise aspects of a product not directly related to its implementation of IHE capabilities.
Format of an IHE Integration Statement
Each Integration Statement shall follow the format shown below. Vendors may add a cover page and any necessary additional information in accordance with their product documentation policies.
|IHE Integration Statement||Date||12 Oct 2005|
|Any Medical Systems Co.||IntegrateRecord||V2.3|
|This product implements all transactions required in the IHE Technical Framework to support the IHE Integration Profiles, Actors and Options listed below:|
|Integration Profiles Implemented||Actors Implemented||Options Implemented|
|Cross-Enterprise Sharing of Medical Summaries||Document Consumer||View Option|
|Audit Trail and Node Authentication||Secure Node||none|
|Patient Identity Cross-referencing||Patient Identifier Cross-reference Consumer||PIX Update Notification|
|Internet address for vendor's IHE information:www.anymedicalsystemsco.com/ihe|
|Links to Standards Conformance Statements for the Implementation|
|Links to general information on IHE|
|In North America: www.ihe.het||In Europe: www.ihe-europe.org||In Japan: www.jira-net.or.jp/ihe-j|
IHE Integration Statement template
An IHE Integration Statement template (MS Word version) is available here.
The IHE Product Registry
The assumption of an integration statement is that all actors listed are functionally grouped and conform to any profile specifications for such groupings. In case of exceptions the vendor must explicitly describe the functional groupings.
IHE has developed a new Web-based database of Integration Statements. The IHE Product Registry enables developers to create, manage and publish Integration Statements for their commercial and open source healthcare IT systems. It allows users to browse for these systems based on their conformance with specific IHE Actors and Profiles. The system is open for use by developers and users now!
Appendix D - Braden Scale for Predicting Pressure Sore Risk
The following terms are used in various places within this technical framework, and are defined below. The complete IHE Glossary is available on the IHE Wiki at http://wiki.ihe.net/index.php/IHE_Glossary .
- An entity within a use case diagram that can perform an action within a use case diagram. Possible actions are creation or consumption of a message
- Acuity Assessment
Also known as triage category, this is the acuity of the patient assigned during the process of ED triage. A number of evidenced based triage scales exist, including the Emergency Severity Index (ESI), Canadian Triage and Acuity Scale (CTAS), the Australasian Triage Scale (ATS), and the Manchester Triage System. In many emergency departments, patients may simply be classified as emergent, urgent or non-urgent.
- Admit, Discharge & Transfer.
- Affinity Domain Policy
- Affinity Domain Policy that clearly defines the appropriate uses of the XDS Affinity Domain. Within this policy is a defined set of acceptable use Privacy Consent Policies that are published and understood.
- Formerly the American Society of Testing and Materials, now ASTM International. An SDO that develops a number of standards across a wide variety of industries, including healthcare.
- Audit Trail and Node Authentication. An IHE ITI profile.
- Care Context
- The participations surrounding the care provision act, and the attributes of that act. Everything in the document header. Data history, links to clinical reasoning.
- Continuity of Care Document(CCD)
- An HL7 Clinical Document Architecture (CDA) implementation alternative to ASTM ADJE2369 for institutions or organizations committed to HL7 standards. This specification was developed as a collaborative effort between ASTM and HL7. More information is available from http://www.hl7.org.
- Continuity of Care Record (CCR)
- A core data set of the most relevant administrative, demographic, and clinical information facts about a patient’s healthcare, covering one or more encounters. The CCR is Designation E2369-05 of the ASTM (American Society for Testing and Materials, International). More information is available from http://www.astm.org.
- Clinical Document Architecture (CDA)
- An HL7 standard for the exchange for clinical documents. It specifies the structure and semantics of clinical documents. More information is available from http://www.hl7.org.
- Content Binding
- A content binding describes how the payload used in an IHE transaction is related to and/or constrained by the data elements contained within the content sent or received in those transactions.
- Care Record Summary. An implementation guide that constrains CDA Release 2 for Care Record Summary documents.
- Consistent Time Integration Profile.
- Digital Imaging and Communication in Medicine
- Digital Signatures. An IHE ITI Profile.
- An Emergency Department Information System (EDIS) is an extended EHR system used to manage data in support of Emergency Department patient care and operations. The functions of an EDIS may be provided by a single application or multiple applications.
- Enterprise Master Patient Index.
- Electronic Medical Record, an Electronic Health Record system used within an enterprise to deliver care (also called EHR-CR by IHE-XDS).
- Estimated Time of Arrival
- the time the patient being referred can be expected to arrive in the emergency department.
- Enterprise User Authentication Integration Profile.
- Expected Actions
- Actions which should occur as the result of a trigger event.
- Healthcare Information and Management Systems Society.
- Health Level Seven
- Hospital Information System.
- Integrating the Healthcare Enterprise.
- Interaction Diagram
- A diagram that depicts data flow and sequencing of events.
- Information Technology.
- Logical Observation Identifiers Names and Codes (LOINC®)
- A vocabulary developed by the Regenstrief Institute aimed at standardizing laboratory and clinical codes for use in clinical care, outcomes management, and research. Additional information found at http://www.regenstrief.org/medinformatics/loinc/.
- Mode of Arrival
- The method of transportation used to transport the patient to the Emergency Department.
- Master Patient Index.
- Medical Record Number.
- Notification of Document Availability
- Object Identifier. (See also 'Globally Unique Identifier').
- Patient Identifier Cross-reference Domain
- Consists of a set of Patient Identifier Domains known and managed by a Patient Identifier Cross-reference Manager Actor. The Patient Identifier Cross-reference Manager Actor is responsible for providing lists of "alias" identifiers from different Patient Identifier Domains.
- Patient Identifier Domain
- A single system or a set of interconnected systems that all share a common identification scheme for patients. Such a scheme includes: (1) a single identifier-issuing authority, (2) an assignment process of an identifier to a patient, (3) a permanent record of issued patient identifiers with associated traits, and (4) a maintenance process over time. The goal of Patient Identification is to reduce errors.
- Portable Document Format.
- Patient Identifier Cross Referencing. An IHE ITI Profile.
- Patient Demographics Query. An IHE ITI Profile.
- Personal Health Record
- In the context of a "Pre-procedure History and Physical," the "procedure" is a surgery or an invasive examination of a patient that is required by quality review organizations to be preceded by a pre-procedure assessment of procedure risk and anesthesia risk. This assessment is typically referred to as a "Pre-operative" or "Pre-procedure History and Physical."
- Process Flow Diagram
- A graphical illustration of the flow of processes and interactions among the actors involved in a particular example.
- Proposed disposition
- the intended disposition (i.e. admission to ICU, discharge to home, transfer to psychiatric hospital), if known, that the referring provider expects the patient will end up after the emergency department intervention.
- Referral Source
- An individual, group, or agency that determined the patient should seek care at the ED. Referral source may be used to determine appropriate discharge referrals and services, or to provide surveillance data for program and service planning, or to examine referral patterns.
- The actions of an actor in a use case.
- Radiological Society of North America.
- A Latin abbreviation for signetur used to represent the instruction following the medication name.
- A brief description of the transaction.
SNOMED-CT® A comprehensive clinical terminology, originally created by the College of American Pathologists (CAP) and, as of April 2007, owned, maintained, and distributed by the International Health Terminology Standards Development Organisation (IHTSDO), a non-for-profit association in Denmark. The CAP continues to support SNOMED CT operations under contract to the IHTSDO and provides SNOMED-related products and services as a licensee of the terminology. More information available from http://www.ihtsdo.org/ or the United States National Library of Medicine at http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html
- Transport Mode
- the method the patient employs, or is provided to get to the emergency department.
- Trigger Event
- An event such as the reception of a message or completion of a process, which causes another action to occur.
- Unique Identifier (See also Globally Unique Identifier).
- Universal ID
- Unique identifier over time within the UID type. Each UID must belong to one of specifically enumerated species. Universal ID must follow syntactic rules of its scheme.
- Use Case
- A graphical depiction of the actors and operation of a system.
- Cross Enterprise User Authentication
- Cross Enterprise Document Sharing