{Date} 1 Introduction to IHE & IBM HIE Infrastructure - SDMI

IBM Healthcare and Life Sciences 

Introduction to IHE & 

IBM HIE Infrastructure 

Peter Christen 

Healthcare Industry Leader 

pchristen@at.ibm.com 


IHE - Integrating the Healthcare Enterprise 

1 

• “initiative by healthcare professionals and industry to improve the way 

computer systems in healthcare share information” * 

• Not creator of standards, rather an integrator (form “profiles”) 

• Areas of focus include radiology, cardiology, patient care coordination, 

technical framework. 

* www.ihe.net 

© 2008 IBM Corporation 

{Date} 

1


Standards Adoption Process of IHE 

2 


Healthcare Information Exchange Problems 

3 


• How can clinical data be shared among different healthcare enterprises using 

different technology? 

• How can the same patient be identified across different institutions? 

• How can data exchange be secured and access to patient data be monitored? 



2


IHE Infrastructure Profiles: XDS, PIX/PDQ, ATNA 

4 

• Cross Cross-Enterprise Enterprise Doc Document ment Sharing (XDS) 

- Standards based architecture for sharing of clinical documents among 

healthcare enterprises 

• Patient Identifier Cross-Referencing (PIX) 

- Standards based architecture for reconciling patient ids from different 

domains 

• Patient Demographic Query (PDQ) 

- Standards based architecture for searching based on patient 

demographics. 

• Audit Trail and Node Authentication (ATNA) 

- Securing of any communication between endpoints and auditing of 

systems that receive/send patient information. 


Cross-Enterprise Document Sharing (XDS) Actors 

5 

• Document repository 

- Responsible for the persistent storage of documents 

- Assigns a URI to documents for subsequent retrieval by a consumer 

• Document registry 

- Maintains metadata about each registered document in a document entry 

• Clinical information is not exposed 

- Includes a link to the document in the repository 

• Document Source 

- Produces and publishes documents and metadata to a repository 

• Document Consumer 

- QQueries i a registry i t for f documents d t 

- Retrieves selected documents from one or more repositories 

• Patient Identity Source 

- Provides a unique identifier for each patient; maintains a collection of identity traits 




3


Cross Enterprise Document Sharing (XDS) Profile 

6 

Document 

Source 

XDS – Key Features 

7 

Patient 

Identity Source 

Patient Identity 

Feed 

Provide & Register 

Document Set 


Document 

Registry 

Register 

Document Set 

Document 

Repository 

Query 

Documents 

Retrieve 

Document 

Document 

Consumer 

• Document centric 

- Published clinical data is organized into “clinical documents” using 

agreed standard document types (HL7-CDA/CCD, PDF, DICOM, etc.) 

• Document content neutral 

- Document content is processed only by source and consumer 

systems. Infrastructure is generic 

• Standardized registry attributes 

- Documents are described by a standardized set of attributes. 

- Standardized queries are supported by all vendors 




4


Deployment Options 

Centralized vs distributed repositories (or mixed) 

8 

Source 

Source 



Other (new) IHE Infrastructure Profiles 

9 

Registry 


Registry 

Consumer 

Consumer 

• XDS.b – Cross Enterprise p Document Sharing g (Web ( Services) ) 

- supports the exchange of clinical documents across enterprises using 

more pure web-service based transactions. 

• XDS.I 

- XDS-I: XDS for Imaging 

• XCA – Cross Community Access 

- supports access of patient health information across communities 

- IBM was as pprimary a y aut author o 

• XUA – Cross Enterprise User Assertion 

- provides a means to communicate claims about the user identity of an 

authenticated principal (user, application, system) in transactions that 

cross enterprise boundaries (SAML, WS-Trust). 




5


XDS for Imaging (XDS-I) Profile 

10 

Image Document 

Source 

(Image Manager/ 

Image Archive ) 

Patient 

Identity Source 

Patient Identity 

Feed 

Provide & Register 

Document Set 


IHE XDS actors provided by IBM 

11 

Document 

Registry 

Register 

DDocument t SSet t 

Document 


Query 

Documents 

Retrieve 

Manifest 

Document 

Consumer 

Retrieve Images 


• XDS Registry 

- Supports latest features outlined by IHE profiles, such as XDS.a and XDS.b, XUA, XCA 

• XDS Repository 

- Supports latest features outlined by IHE profiles such as XDS.a and XDS.b, XUA 

- Several back-end data storage model supported such as GMAS (grid data storage), file system, relational or XML 

database, Content Management System 

• ATNA Audit Repository 

- Supports ATNA Record Audit Event interface to other healthcare applications 

• XUA Assertion Provider 

- Serves as a WS-Trust Security Token Service: creates & validates SAML Tokens 

- Interoperates with other Security Token Services 

• All are based on proven, scalable IBM middleware 

- WebSphere Application Server (Base & Network Deployment) 

• Network Deployment supports multi-server clustering for load balancing and failover 

- Tivoli Federated Identity Manager 

• Supports WS-Trust & SAML 

- DB2 Universal Database 



6


What is IBM’s Grid Medical Archive Solution (GMAS)? 

GMAS is a storage solution that intelligently manages the interaction between an application and 

its storage resources via client business rules 

App 1 App 2 App 3 App 4 App 10 ... 

d i gi 

t a l 

Before GMAS 

d i gi 

t a l 

d i gi 

t a l 

d i gi 

t a l 

d i gi 

t a l 

After GMAS 

App 1 App 2 App 3 App 4 App 10 ……. 

GMAS Storage Platform 

Location 1 Location 2 Loc 3 Location 1 Location 2 

“Siloed” infrastructure: 

• Difficulty sharing resources across applications 

• Requires application downtime for maintenance 

• Manual administration, upgrades & conversions 

• Inherently vulnerable to storage failures 

12 


IBM is strongly involved in IHE support 

13 

• International IHE 

- Co-Chair Co Chair ITI Technical Committee 

- Lead Authors for several new IHE profiles 

• Scanned Documents (ITI) 

• Cross Community Access (ITI) 

• Lab Public Health Reporting (PCC) 

• IHE Connectathon 

- IBM has tested with 100 vendors since 2006, adding 29 new test partners in 2008 

d i gi 

t a l 

d i gi 

t a l 

d i gi 

t a l 

Loc 3 

“Virtualized” infrastructure: 

• Collapses silos into a single shareable storage pool across 

applications 

• Enables maintenance, support & data conversion without 

application downtime 

• Automates upgrades, conversions & administration 

• No single point of failure 


• Healthcare exhibitions 

- IBM has participated to several industry events aimed at validation and demonstration of IHE profiles and the 

underlying standards they are based upon 

• XDS Registry, XDS Repository, ATNA Audit Repository, … 

- Host public server for client side vendor testing 

• IHE Client-side implementation donated to Open-source community 

- Open Healthcare Framework (http://www.ohf.org) supports PIX/PDQ, XDS, ATNA, XUA, XCA 



7


Where IBM IHE products are being used: 

National Healthcare Information Network in US 

Goal: 

Develop and evaluate prototypes of an NHIN architecture that 

maximize use of existing resources to achieve interoperability among 

healthcare applications 

NHIN Criteria: 

Architect a standards-based, scalable, reliable, secure, self-sustaining 

“network of networks” 

- Design and demonstrate a standards-based network prototype 

over one year project period 

- Demonstrate the solution in 3 healthcare marketplaces 

- Demonstrate the solution via three use cases 

Standards Used: 

- IHE XDS, PIX/PDQ, ATNA, XDS-I, HL7 v2/v3 

- SAML, WS-Security, TLS/SSL, XML dSIG, XAdES, XMLenc, WS- 

Policy, WS-Trust 

14 


Where IBM IHE products are being used: 

Public Health Laboratory-Based Surveillance System 

• MECIDS = Middle East Consortium for Infectious Disease 

Surveillance 

- Jordan, Palestine and Israel 

Pulmonary 

Clinic of 

Danville 

Eden 

Internal 

Family 

Tree 

OB/GYN 

• Establish national and international surveillance networks: 

- Monitor population health 

- Provide a common platform for communication, data sharing, 

and analysis 

- Collaborate 

• Initial scope of food-borne diseases 

- Salmonella, Shigella 

- Extend to more diseases easily 

• IBM IHE topology 

- 1 XDS registry & several XDS repositories per country 

- 1 XDS repository at ‘international’ level with de-identified data 

15 

Morehead 

Memorial 

Rockingham 

/ Danville 

Community 

Hub 

LabCorp 

MMoses CCone 

Outpatient 

Clinic 

Moses Cone 

Spectrum 

Labs 

THINC 

Community 

Hub 

SureScripts 

Medication 

History 

Duke 

Research 

Triangle / 

Pinehurst 

Community 

Hub 

FirstHealth 

DUAP - Durham 

Medical Center 

Moore Free 

Care Clinic 

Pinehurst 

Surgical 

Pinehurst 

Medical 

Southern Pines 

Women’s Ctr. 

NHIN Prototype 

Reference 

(clickable) 


PHIAD Brochure 

2008 v2.pdf 

© 2008 IBM (clickable) 

Corporation 


8


Interoperability in Healthcare 

a buzzword or key to succes? 

Peter Christen 

IBM Healthcare Industry Leader 

We bring you to the IHE electronic health record 


Interoperability showcase: overall view of scenarios 

Use XDS Registry, XDS Repository, 

Audit Repository 

IHE Security showcase 

(scenario 2) 

IHE XDS showcase 

( (scenario i 1) 

Use GMAS Data Storage 

GMAS showcase 

(scenario 3) 

Sc 1: Document (DICOM, PDF, CDAr2) exchange using XDS/XDS-I between hospital, GP and radiology 

Sc 2: Data security at document access (XUA); data security trough logging (ATNA) 

Sc 3: Document data storage over GMAS 

17 



9

18 


Overall Architecture & Actors 

Hospital GP 

PACS 

K-PACS 

Clinic 

CMO 

MPA PCPO open EMR 

eMPI XDS Registry XDS Repository XUA Assertion 

Provider 

Initiate 

Systems 

ATNA 


IBM HIE IBM HIE IBM TFIM IBM HIE 


GRID Data 

Storage 

GMAS 

at a later stage 

Patient 

Portal 


Scenario 1: Document exchanges (XDS, XDS-I) between hospital, GP 

and radiology 

19 

1. The patient complains of heavy knee 

pains 

2. He visits the GP which transfers him to 

a radiologist 

3. The radiologist make the analysis 

and creates a diagnostic finding 

4. The diagnostic finding is read by the 

GP and he transfers the patient to a 

hospital 

5. The patient is medicated in the 

hospital 

6. The patient is laid off 

7. The patient get an after treatment at 

the GP 



10


Scenario 1: IHE XDS Showcase Actors 

• IBM 

- Healthcare Information Exchange (HIE) Registry 

• XDS Registry, XDS.a & XDS.b support 

- HIE Repository 

• XDS Respository Respository, XDS XDS.a a & XDS XDS.b b support 

- HIE Audit Repository 


- Content Management Offering (CMO) acting as DICOM/XDS-I bridge 

• XDS-I document source 

• Systema 

- MPA acting as HIS (Hospital Information System) 

• XDS document source, XDS & XDS-I document consumer 

• ÄDV 

- PCPO acting as GP application 

• XDS & XDS-I document consumer 

20 

• Initiate Systems 

- eMPI 

• PIX Master Patient Index 

• Open-Source 

- K-PACS acting as a PACS system (IHE XDS-I compliant through IBM CMO) 



Scenario 1a: Document exchanges (XDS, XDS-I) between hospital, GP, 

radiology, patient monitoring service 

1. The patient complains of breathing 

problems 

22. He visits isits the GP which hich transfers him to a 

radiologist 

3. The radiologist make the analysis and 

creates a diagnostic finding 

4. The diagnostic finding is read by the GP 

and he transfers the patient to a hospital 

5. The patient undergoes testing and is 

medicated in the hospital 

6. The patient is provided with a Continua 

21 

compliant blood pressure cuff and pulse 

oximeter as part of a home based asthma 

care plan 

7. The patient is laid off 

8. Patient data from Continua medical 

devices are made available to GP 

9. The patient gets after care at the GP 



11


Scenario 1a: IHE XDS Showcase Actors 





• XDS Respository, XDS.a & XDS.b support 



- Content Management Offering (CMO) acting as DICOM/XDS-I bridge 

• XDS-I document source 

- Continua remote monitoring service (with partners incl. device manufacturers) 

• Systema 

- MPA acting as HIS (Hospital Information System) 

• XDS document source, XDS & XDS-I document consumer 

• ÄDV 

- PCPO acting as GP application 

• XDS & XDS-I document consumer 

22 

• Initiate Systems 

- eMPI 

• PIX Master Patient Index 


- K-PACS acting as a PACS system (IHE XDS-I compliant through IBM CMO) 


Scenario 1. IHE XDS showcase architecture overview 

K-PACS 

23 

Initiate Systems 

(Patient Identity Source ) 

Initiate Systems Internet Virtual Image 

IBM HIE 

XDS Registry 




XDS Repository 

IBM HIE Virtual Image 

IBM 

CMO Patient 

Monitoring 

Svces 

Systema MPA 


ADV PCPO 

Systema Virtual Image 

Device 

Hub 

Medical 

Devices 

Continua Architecture 



12


Scenario 2: Principal authentication & audit events 

1. Patient comes to a Clinic for an appointment with a physician 

2. Physician requires identification of patient 

33. Ph Physician i i identification id tifi ti is i required i d on the th CIS & checked h k d using i 

XUA (Cross Enterprise User Assertion) 

1. Token is retrieved from Assertion Provider 

2. Query to registry is done with retrieved token 

3. Registry checks token before serving query 

4. If token is validated, query is processed 

4. Depending p g on pphysician y identification 

used, the list of remote documents is 

displayed or not 

24 

5. Patient is able to view historical audit 

events, in order to see who accessed 

his medical data 


Scenario 2. IHE Security showcase actors 





25 

• XDS Respository Respository, XDS XDS.a a & XDS XDS.b b support 



- Tivoli Federated Identity Manager 

• XUA Assertion Provider 


- Open-EMR acting as Clinical Information System (CIS) 

• XDS document source 

- SQL Viewer 

• ATNA Audit Events Viewer 




13

26 

27 


Scenario 2. IHE XDS showcase architecture overview 

IBM TFIM 

XUA Assertion Provider 


XDS Registry 






IBM TFIM Virtual Image 

IBM HIE Virtual Image (scenario 1) 

Web browser 

Scenario 3: Document access through GMAS 

• Physician has the required acess 

permission i i on th the medical di l ddocument t 

• One of the storage device is unavailable 

because of a system crash 

• Despite the storage downtime, GMAS 

serves the document, thanks to the 

resilient & reliable features 

Open-EMR 

CIS Virtual Image 




14


Scenario 3. GMAS showcase actors 



• XDS Repository, XDS.a & XDS.b support 

- Grid Medical Archive Solution (GMAS) 

• Available through Network File System 

28 

29 


Scenario 3. GMAS showcase architecture overview 


XDS Registry 





SATA 

IBM HIE Virtual Image (scenario 1) 

IBM GMAS 

SCSI MAID TAPE 




15


Health Information Framework the entire picture 

HCLS Specific 

Simulations 

HCLS Specific 

Models 

Eclipse 

Open 

Health 

Framework 

30 

31 

Development 

Services 

Public 

Health 

Healthcare 

benefits 

organizations 

Healthcare 

providers 

Life Sciences 

(Pharma/ 

Biotech/Medical) 

BBusiness i Innovation I ti & OOptimization ti i ti Services S i 

Prolink / ProMap Methodology Business Process Management 

Patients 

Interaction Services Process Services Information Services 

Enterprise 

Services Bus 

SAFE, CCOW 

HCLS portlets 

Deidentification 

Transformation, Notification, 

Terminology, Discovery, Workflows 

WebSphere ESB 

Websphere Message Broker 

Provider & Payor Data Models 

PIX, PDQ, XDS 

HCLS UIMA, LSID 

XDS Imaging, Data Enrichment 

Partner Services Business App Services Access Services 

XDS client side 

Audit Logging 

eSignatures 

HL7 & DICOM Adapters 

HCLS Wrappers 

Patient Consent 

Lab Systems 

Scan Documents 

Summarization & Reporting 

X12 , CDA 


Infrastructure Services 

ATNA 

Audit Trail & Node 

Authentication 

XUA 

Cross Enterprise 

User 

Authentication 

Federated Identity 

Management 

Admin 

Console 

IT Service 

Management 




16

32 


IHE Umgebung für ELGA 

Quelle: „Ausblick auf die Elektronische Gesundheitsakte“ Dipl.-Ing. Dr. Alexander Schanner (Arge ELGA); Spital 2008 

33 


Overall Architecture & Actors 

Hospital GP 

eMPI XDS Registry XDS Repository 

PACS 

K-PACS 

XUA Assertion 

Provider 


Clinic 

CMO 

MPA PCPO open EMR 

Initiate 

Systems 

1 2 

1 1 

ATNA 


IBM HIE IBM HIE 

3 

IBM TFIM IBM HIE 

GRID Data 

at a later stage 

Storage 

4 

Patient 

GMAS 

Portal 



17

{Date} 1 Introduction to IHE & IBM HIE Infrastructure - SDMI

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