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August 24, 2016 Readers Write 3 Comments

Moving and Sharing Clinical Information Across Boundaries
By Sandra Lillie


In Gartner’s recent depiction of the Hype Cycle for Healthcare Technology, Integrating the Healthcare Enterprise (IHE) XDS has now progressed well past early adopters and rapidly toward productivity and optimization. In many regions outside the United States, it is the de facto standard for content management, and within the US, it is receiving increasing consideration for adoption in use cases supporting specialty images, standards-based image sharing and the like.

XDS is a suitable foundation for integration of clinical systems, and as noted earlier, is more widely adopted in EMEA for this purpose. It is capable of moving and sharing clinical information within and between organizations and capable of creating a patient-centric record based on multiple document (types).

XDS centralizes registration of documents, reducing the problem of deciding which system holds “the truth.” Focusing on “standardizing the standards,” XDS supports the moving and sharing of clinical information across boundaries, both within and between enterprises. This is increasingly vitally important in delivering patient-centered care across the care continuum.

Today we also have XDS-I, also referred to as XDS.b for Imaging. It is built upon the XDS.b profile with one key difference – the actual DICOM imaging study stays put in its original location until requested for presentation. This is accomplished by registering the location of the imaging study in the XDS registry while using a vendor-neutral archive that is smart enough to serve as its own XDS-I repository.

DICOM is a standard format for the storage and communication of medical images, such as x-rays. Instead of publishing the document (which would be large in imaging) to the repository, however, the imaging document source (the VNA in this case) publishes a “manifest.” This manifest contains an index of all the images within a study, coupled with a path to the VNA where they can be retrieved. This reduces the amount of data that has to move around, allowing for more efficient image sharing while minimizing the complexity and costs of image storage.

What are the implications to healthcare organizations of using XDS?

  • Documents retain their native format, allowing ready viewing by applications.
  • Standards support interoperability and sharing of both documents and enterprise image studies.
  • IHE conducts annual Connectathons in the United States and Europe to validate interoperability and enable widespread ability for vendors to act as sources and suppliers of content.

Major benefits include:

  • XDS enables movement and sharing of clinical information across boundaries, both within and between enterprises. This capability is increasingly important in delivering patient-centered care across the continuum, supporting the organization of documents across time in a patient context, allowing clinicians to realize a more complete picture of the patient.
  • XDS offers a lower-cost method for implementing care coordination through a solution that can easily respond to queries for patient-centered documents and enterprise images.
  • Use of standards simplifies healthcare IT integrations, requiring less administrative overhead.

Now is the time for US healthcare providers to seriously consider the advantages of XDS. XDS profiles provide an effective alternative for managing clinical content exported from legacy (sunsetted) systems and for supporting healthcare information sharing.

Sandra Lillie is industry manager for enterprise imaging for Lexmark Healthcare.

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Currently there are "3 comments" on this Article:

  1. XDS is just one member of the family of cross-enterprise document sharing profiles from the IHE ITI Technical framework. As noted, it has found broader acceptance in countries with single payer/single point of healthcare authority, where patient identity is not an issue, and where a central repository for document metadata has a natural governing structure.

    In the US, the distributed nature of the healthcare system is better suited for the XCA/XCPD/XDR set of profiles, and these are in fact widely used. The Nationwide Healthcare Information Network (NwHIN) is based on the transactions from these profiles, and so are the CommonWell and Epic’s CareEverywhere networks.

    The following press release from Greenway from 2013 is, I believe, one example of using XCA and XCPD to exchange information across boundaries.

  2. Important comment by Eddie T. Head.

    In the US, XDS profiles are good for large healthcare systems that have internal “boundaries” that make sharing patient data and images otherwise difficult, or nonexistent, as long as a consistent ID is maintained for the same patient. But in the US, it is common for an individual patient to have a different ID for each healthcare system they visit, making XCA related profiles the ones to highlight as the key technical enablers for sharing patient data across boundaries of separate healthcare systems.

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