Appendix M: Cross-Enterprise Document Sharing and IHE Roadmap
The IHE Cross-Enterprise Document Sharing Integration Profile is part of a family of IHE Integration Profiles grouped in a number of domain-specific Technical Frameworks Patient Care Coordination, Cardiology, Laboratory, Radiology, IT Infrastructure, etc.). XDS is a central foundation for Cross-Enterprise interoperability that may be combined with a number of the existing IHE Integration Profiles (see ITI TF-1: Appendix E ). However, a number of new IHE Integration Profiles need to be developed, pending the availability of the relevant base standards.
It is expected that the various IHE Domains (Cardiology, Laboratory, Radiology, IT Infrastructure, etc.) will produce new IHE Integration Profiles addressing the content of the documents that need to be shared. These various “content-oriented” Integration Profiles will rely on the XDS Integration Profile for managing the registration, discovery and access processes in a common manner.
Such an effort is underway with the IHE Patient Care Coordination Domain for medical summaries used in referrals and discharge summaries and other document types. See www.ihe.net .
The management of dynamic information (non-document-oriented) such as allergy lists, medication lists, problem lists, etc. is not addressed by XDS. However, a means to access this information in a structured form and to manage updates to such dynamic clinical information is a candidate for a specific Integration Profile.
There is a wide array of shared care delivery collaborative processes such as the placing and tracking of orders (e.g., drug prescriptions, radiology orders, etc.) for which XDS provides only a partial solution (the creation of the patient record with the resulting persistent artifacts). XDS offers a critical infrastructure for ePrescribing and eReferral in that it can ensure that the various providers share access to orders, prescriptions, dispensations, and results. The means to interoperate on the command/control part of these collaborative workflow processes is a candidate for specific Integration Profiles in the future.
The operation of any XDS Affinity Domain will require that a proper security model be put in place. It is expected that a range of security models should be possible. Although the XDS Integration Profile is not intended to include nor require any specific security model, it is required that XDS implementers group XDS actors with actors from the IHE Audit Trail and Node Authentication Profile and will need an Access Control capability that operates in such a cross-enterprise environment. Specific IHE Integration Profiles complementary to XDS are available (e.g., Cross-Enterprise User Authentication, Document Digital Signature, etc.).
XDS is an effective means to establish XDS Affinity Domains that include care delivery organizations at any level, local, regional or national. However, the establishment of independent but consistently XDS Affinity Domains will call for their federation, as patients expect their records to follow them as they move from region to region, or country to country. IHE foresees a need for transferring information from one XDS Affinity Domain to another, or to allow access from one XDS Affinity Domain to documents managed in other XDS Affinity Domains. XDS has been designed with this extension in mind. The Cross-Community Access (XCA) Integration Profile that complements XDS provides this function.