PCC TF-1/XPHR
XPHR Integration Profile
The Exchange of Personal Health Record Content (XPHR) integration profile describes the content and format of summary information extracted from a PHR system used by a patient for import into healthcare provider information systems, and visa versa. The purpose of this profile is to support interoperability between PHR systems used by patients and the information systems used by healthcare providers. This profile does not address all the data exchange requirements of PHR systems. A PHR system may leverage other IHE Integration and Content Profiles for interoperability in addition to the XPHR Content Profile. For example, a PHR Systems may implement XDS-MS to import medical summaries produced by EHR systems, XDS-I to import imaging information, XDS-Lab to import laboratory reports, et cetera.
Exchange of Personal Health Record Content (XPHR)
Upon seeing a healthcare provider for the first time, patients are requested to provide a great deal of information, including, their address, telephone numbers, birth date, sex, marital status, emergency contacts, insurance information, a medical and family history, and current medications and allergies. This information is also reviewed and updated on subsequent visits. This information is usually obtained by having the patient fill out one or more forms, whose contents are then manually transferred in to the information systems used by the healthcare provider. Automating this process will reduce transcription errors during the transfer of information, speed up the registration and check-in processes for patients, and also makes it possible for patients to have more participation in the management of their health information.
Providers also need to participate in helping patients to manage their healthcare information, however, providers should not be solely responsible for updating the patient's health record, since they often are only participating in a portion of the patient's overall health activities.
While PHR systems will allow patients to manage their healthcare information, and EHR and other information systems allow healthcare providers to manage the electronic records they maintain for their patients, but these two systems, operating separately, are not sufficient to allow patients and providers to collaborate in the care of the patient. What is needed is a way to integrate the activities of patients using a PHR system and healthcare providers using an EHR or other information system to provide for collaborative care between the patient and their provider.
The XPHR profile is intended to provide a mechanism for patients to supply the information most often requested by their healthcare providers, and to allow those same providers to assist patients in keeping their personal healthcare information up to date. It achieves this by allowing patients to provide a summary of their PHR information to providers, and gives providers a mechanism to suggest updates to the patient's PHR upon completion of a healthcare encounter.
Actors/Transaction
There are two actors in the XPHR profile, the Content Creator and the Content Consumer. Content is created by a Content Creator and is to be consumed by a Content Consumer. The sharing or transmission of content from one actor to the other is addressed by the appropriate use of IHE profiles described below, and is out of scope of this profile. A Document Source or a Portable Media Creator may embody the Content Creator Actor. A Document Consumer, a Document Recipient or a Portable Media Importer may embody the Content Consumer Actor. The sharing or transmission of content or updates from one actor to the other is addressed by the use of appropriate IHE profiles described in the section on Content Bindings with XDS, XDM and XDR.
Options
| Actor | Option |
|---|---|
| Content Consumer | View Option (1) |
| Document Import Option (1) | |
| Section Import Option (1) | |
| Discrete Data Import Option (1) | |
| Content Creator | Update Option |
Content Consumer Options
View Option
This option defines the processing requirements placed on Content Consumers for providing access, rendering and management of the medical document. See the View Option in PCC TF-2 for more details on this option.
A Content Creator Actor should provide access to a style sheet that ensures consistent rendering of the medical document content as was displayed by the Content Consumer Actor.
The Content Consumer Actor shall be able to present a view of the document using this style sheet if present.
Document Import Option
This option defines the processing requirements placed on Content Consumers for providing access, and importing the entire medical document and managing it as part of the patient record. See the Document Import Option in PCC TF-2 for more details on this option.
Section Import Option
This option defines the processing requirements placed on Content Consumers for providing access to, and importing the selected section of the medical document and managing them as part of the patient record. See the Section Import Option in PCC TF-2 for more details on this option.
Discrete Data Import Option
This option defines the processing requirements placed on Content Consumers for providing access, and importing discrete data from selected sections of the medical document and managing them as part of the patient record. See the Discrete Data Import Option in PCC TF-2 for more details on this option.
Content Creator Options
Update Option
XD* Binding
It is expected that exchanges of PHR content will occur in an environment where the physician offices and hospitals have a coordinated infrastructure that serves the information sharing needs of this community of care. Several mechanisms are supported by IHE profiles:
- A registry/repository-based infrastructure is defined by the IHE Cross-Enterprise Document Sharing (XDS) and other IHE Integration Profiles such as patient identification (PIX & PDQ), and notification of availability of documents (NAV).
- A media-based infrastructure is defined by the IHE Cross-Enterprise Document Media Interchange (XDM) profile.
- A reliable messaging-based infrastructure is defined by the IHE Cross-Enterprise Document Reliable Interchange (XDR) profile.
- All of these infrastructures support Security and privacy through the use of the Consistent Time (CT) and Audit Trail and Node Authentication (ATNA) profiles.
For more details on these profiles, see the IHE IT Infrastructure Technical Framework, found here: http://www.ihe.net/Technical_Framework/.
Thus, implementors of the Content Consumer and Content Creator Actors must also implement either the ITI XDS, XDM or XDR Profiles to exchange content, using the bindings listed below.
| Content | Binding | Actor | Optionality |
| PHR Extract Module PCC TF-2: 5.4.1.5 |
Medical Document Binding to XD* PCC TF-2: 4.1 |
Content Creator | R |
| Content Consumer | R | ||
| PHR Update Module PCC TF-2: 5.4.1.6 |
Medical Document Binding to XD* PCC TF-2: 4.1 |
Content Creator | O |
| Content Consumer | R |
XPHR Content Modules
PHR Extract Module
The content exchanged shall be structured and coded as required by the PHR Extract Module Content specified in PCC TF-2: 5.4.1.5. The PHR Manager Actor creates a PHR Extract and shares it with the PHR Reviewer. The PHR Reviewer Actor can optionally create an PHR Extract and share it with a PHR Manager if both actors implement the Initialize PHR Option.
PHR Update Module
The content exchanged shall be structured and coded as required by the PHR Update Module Content specified in PCC TF-2: 5.4.1.6. The PHR Reviewer Actor creates a PHR Update document as an addendum to a previously exchanged PHR Extract document. This Update is an addendum to the prior document, and reflects changes to that document that are suggested by the PHR Reviewer Actor. The PHR Manager actor shall support viewing of an Update document, and may support import of the Update (see section 4.5.1 PHR Manager Options below) to reflect those changes to the PHR. The purpose of this content module is to provide a mechanism whereby healthcare providers, using applications that implement the PHR Reviewer Actor, can suggest updates to a PHR for a patient.