IHE IT Infrastructure (ITI) Technical Framework Supplement. Cross-Enterprise Document Workflow (XDW) Trial Implementation

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1 Intgrating th Halthcar Entrpris 5 IHE IT Infrastructur (ITI) Tchnical Framwork Supplmnt 10 Cross-Entrpris Documnt Workflow (XDW) 15 Trial Implmntation 20 Dat: Octobr 13, 2014 Author: IHE ITI Tchnical Committ 25 Plas vrify you hav th most rcnt vrsion of this documnt. S hr for Trial Implmntation and Final Txt vrsions and hr for Public Commnt vrsions.

2 Forword This is a supplmnt to th IHE IT Infrastructur Tchnical Framwork V11.0. Each supplmnt undrgos a procss of public commnt and trial implmntation bfor bing incorporatd into th volums of th Tchnical Framworks. This supplmnt is publishd on Octobr 13, 2014 for trial implmntation and may b availabl for tsting at subsqunt IHE Connctathons. Th supplmnt may b amndd basd on th rsults of tsting. Following succssful tsting it will b incorporatd into th IT Infrastructur Tchnical Framwork. Commnts ar invitd and may b submittd at This supplmnt dscribs changs to th xisting tchnical framwork documnts. Boxd instructions lik th sampl blow indicat to th Volum Editor how to intgrat th rlvant sction(s) into th rlvant Tchnical Framwork volum. Amnd Sction X.X by th following: Whr th amndmnt adds txt, mak th addd txt bold undrlin. Whr th amndmnt rmovs txt, mak th rmovd txt bold strikthrough. Whn ntir nw sctions ar addd, introduc with ditor s instructions to add nw txt or similar, which for radability ar not boldd or undrlind. Gnral information about IHE can b found at: Information about th IHE IT Infrastructur domain can b found at: Information about th structur of IHE Tchnical Framworks and Supplmnts can b found at: and Th currnt vrsion of th IHE Tchnical Framwork can b found at: 2

3 CONTENTS Introduction... 5 Opn Issus and Qustions... 6 Closd Issus... 7 Volum 1 Intgration Profils History of Annual Changs Copyright Prmission Cross-Entrpris Documnt Workflow Contnt Profil Cross-Entrpris Documnt Workflow Contnt Profil Actors/ Transactions XDW Contnt Crator XDW Contnt Consumr XDW Contnt Updatr Cross-Entrpris Documnt Workflow Profil Options Viw Option Documnt Import Option XDW Actor Grouping and Profil Intractions XDW Procss Flow XDW Approach to Workflow XDW Workflow Architctur XDW Documnt Structur XDW Us-Cass and Procss Flow in an XDS Affinity Domain Rfrral Workflow Us Cas Rfrral Workflow Us Cas - Stp by Stp XDW Scurity Considrations Cross-Profil Considrations Volum 3 Cross-Transaction Spcifications and Contnt Spcification XDW Workflow Contnt Modul Rfrncd Standards Discussion of Contnt Standards XDW Workflow Documnt Elmnts from HL7 CDA Standard XDW Workflow Documnt Elmnts dfind by IHE XDW Profil XDW Workflow Documnt Elmnts from th OASIS Human Task Rlationship btwn Task and <taskevnt> Contnt Spcification Complt Exampl Workflow Documnt Managmnt Workflow Documnt Lifcycl Managmnt Associations Typs Crat workflow Updat Workflow Documnt

4 Association of a clinical documnt to a task and <taskevnt> Gt th Workflow Documnt and a clinical documnt associatd to th workflow Us of th vntcodlist to manag th status of a Workflow Documnt Paramtrs for Rquird Quris XDS Mtadata Documnt Mtadata XDS SubmissionSt Mtadata XDS Foldr Mtadata Volum 2x Appndix X Basic Unstructurd Workflow Dfinition Exampl X.1 Workflow dfinition idntifir X.2 Workflow dfinition idntifir X.3 Workflow opning and closing X.4 Tasks dscriptions X.4.1 Task typ born compltd X.4.2 Task typ two stats task

5 Introduction Th Cross-Entrpris Documnt Profil nabls participants in a multiorganizational nvironmnt to manag and track th tasks rlatd to patint-cntric workflows as th systms hosting workflow managmnt applications coordinat thir activitis for th halth profssionals and patints thy support. XDW builds upon th sharing of halth documnts providd by othr IHE profils such as XDS, adding th mans to associat documnts convying clinical facts to a patint-spcific workflow. XDW provids a common introprability infrastructur upon which a wid rang of spcific workflow dfinitions may b supportd. It is dsignd to support th complxity of halth srvics dlivry with flxibility to adapt as workflows volv. This profil dfins an instrumnt, calld a Workflow Documnt, to manag and track a shard workflow. It rcords th cration of tasks and maintains a historical rcord of tasks as thy mov through th associatd workflow. Th Workflow Documnt also maintains th rfrncs to halth information input and output associatd with ach task. Such shard workflow status information allows th various participating systms to coordinat thir actions by: bing awar of th history of a workflow for a patint; obtaining and rading th workflow s incomplt tasks; updating this shard documnt as th workflow tasks ar prformd according to a rfrncd Workflow Dfinition. XDW provids to offr a common, workflow-indpndnt introprability infrastructur that: provids a platform upon which a wid rang of spcific workflows can b dfind with minimal spcification and application implmntation fforts on th workflow dfinition (.g., Mdical Rfrrals Workflow, Prscriptions Workflow, Hom Car Workflow); bnfits many clinical and non-clinical domains by avoiding diffrnt compting approachs to workflow managmnt; incrass th consistncy of workflow introprability, and nabls th dvlopmnt of introprabl workflow managmnt applications whr workflow-spcific customization is minimizd; facilitats th intgration of multi-organizational workflows with th varity of xisting workflow managmnt systms usd within th participating organizations; offrs th ncssary flxibility to support a larg varity of diffrnt halthcar workflows by not bing ovrly constraind. Mor spcifically XDW supports workflows that ar: patint-cntric; 5

6 basd on businss/clinical nds that ar dfind xtrnally to th XDW Profil. Such workflow dfinitions hav to b known only by th applications within th participating systms, not by th XDW infrastructur (flxibility); xcutd in loosly connctd, distributd nvironmnts, whr cntralizd workflow managmnt systms ar not dsird, or in many instancs, possibl. Th XDW Workflow Architctur illustration (Figur 30-1) shows how th sharing of XDW Documnts btwn dg applications using Documnt Sharing infrastructur supports th managmnt of Workflow according to Workflow Dfinitions stablishd btwn participating applications Opn Issus and Qustions Figur 1-1: XDW Workflow Architctur 1. Th data structurs usd to dscrib tasks in XDW hav bn basd on th OASIS Human Task standard. XDW has bn dsignd to support workflow dfinitions that ar spcifid xtrnally to th XDW Profil (layr abov). Workflow dfinitions may b documntd using informal forms such as txtual dfinitions, as wll as formal computabl forms. It is xpctd that BPEL and/or BPMN will b usful standards supporting workflow dfinitions ar introducd. It is rcognizd that OMG with BPMN 2.0 has rcntly introducd data structur for usr tasks. Th trial implmntation vrsion of th XDW Profil has not chosn th data structur of BPMN 2.0 usr task, as it found out that it is a functional subst of Human Task. As th xprinc with XDW grows and th us of Human Task and BPMN2.0 maturs in th gnral IT markt, it should b xpctd that IHE will rfin th rquirmnts for computabl Workflow Dfinitions in halth, and considr th nd for volutions of XDW Workflow Tasks in its us of th OASIS or OMG family of workflow standards. 6

7 Closd Issus 1. Should thr b any clinical information insid th Workflow Documnt? No, XDW as spcifid rquirs that all th Clinical information b includd by rfrnc to xtrnal documnts. (Figur 1). This nsurs that a gnric Workflow Documnt structur is dfind, with only a fw attributs customizd for th workflow spcifics (.g., workflow dfinition IDs, workflow dscription, task cods, task dscription, possibl rfrncd documnts spcification, tc.). 2. It was dcidd to includ th managmnt of th status of th task that is task in th futur. Compltd Tasks ar a rcord of past up th most rcnt activity that has bn prformd. Futur activitis could b introducd insid th Workflow documnt as cratd, or in-progrss tasks, as wll as supporting documnts rfrncd as outputs (.g., ordrs, rqusts, tratmnt plans, tc.). This rflcts th rality that in a multiorganizational nvironmnt futur tasks ar an xpctation shard by on profssional with othrs that will rly upon thir mdical judgmnt and th latst information to prform or not such xpctd activitis within th constraints of th workflow dscription. 3. Th sam documnt can b rfrncd in th input or output of on or mor task 4. This profil spcifis no ruls for controlling th succssion of tasks xcpt through th rfrnc to a workflow dfinition as spcifid by th Workflow Documnt typcod and dscription. 5. IHE-ITI spcifis a classcod for XDW Workflow Documnt. 6. This profil is spcifid to b supportd with XDS, XDM and XDR; it is lft to th futur to spcify application of th profil in XCA (Cross-Community). 7. Should w b mor spcific in trm of kinds of quris hav to b supportd or implmntd by a Documnt Consumr in XDW? Show all workflow for patint, show m all opn workflow, I v a Workflow Documnt Id giv m th approvd on (walking through rplac associations or with foldr or how?) A sction has bn addd to dscrib qury stratgis in Volum A stp may rfr to anothr Workflow Documnt as input or output. If rfrrd as output, this implis that nw workflow documnt for a diffrnt workflow was cratd. Howvr, to hav a task rfr to anothr spcific task in th sam WD as inputs or outputs has not bn includd. 9. XDW dos not xplain how to dfin a notification systm about th chang (rplacmnt). Should an appndix b dvlopd to discuss? Bcaus XDW rlis on th XDS family of profils, introducing notification mchanism such as DSUB or NAV or a mattr of combining xisting profils. Th possibility is mntiond as a not on th volum 1 us cas. 7

8 In a Workflow Documnt, th rfrnc to an input or output documnt is a homcommunity ID and a documntid. It sms sufficint. 11. Appropriatnss of th us of FoldrID for rfrncing othr Workflow Documnts. (To rfrnc a Workflow Documnt that is insid anothr Workflow Documnt bnfits from th us of th FoldrID of th Workflow Documnt. This avoids rfrncing a spcific Workflow Documnt that may hav bn dprcatd du to furthr tasks bn addd.) Closd. Th us of th foldr has b adoptd and xplaind in Volum Appropriatnss of th us of Foldrs for managing back links from documnts to Workflow Documnts. Should this back link b mandatory or optional? (A prformanc improvmnt mchanism to find th Workflow Documnts rfrncing a spcific clinical documnt has not bn includd. An approach to hav any rfrncd documnts placd in th sam foldr as th Workflow Documnts has bn considrd but not includd. This Foldr mchanism could hav offrd a simplr back-link within an XDS affinity domain. Howvr it dos not scal up to documnt that may b rfrncd in a multicommunity nvironmnt (us of XCA) as it is xpctd that XDW would b xtndd in th futur to multi-communitis.) Th us of th backlink has bn lft as an implmntation choic; th us of th foldr has bn suggstd only for th us cass basd on an XDS infrastructur. 13. Dfinition of th information that will b in th hadr: opn/clos, crator, uniquid, Closd and dfind in Volum Managmnt of th closing of a workflow to avoid inactiv Workflow Documnt bing rturnd by quris. This introducs som form of stat of th workflow. Howvr, as XDW dos not want to dfin a mchanisms to dfin ovrall workflow status (this may b don through th dfinition of spcific tasks by th workflow spcific spcifications built on top of XDW. To mak that point clar, it is proposd to only introduc a workflow activ flag, which may b valud ithr as: opn or clos to mak clar that such a mchanism is quit limitd. It is proposd to plac this workflow activ flag in th documnt mtadata vnt cod list. It is proposd to not duplicat this workflow activ flag in th workflow documnt hadr, but to simply introduc a copy of th flag indication in th workflow task data that rsultd in modifying th workflow activ flag. Agrd. 15. A framwork for spcifying XDW-Basd Workflow Dfinition Profils is proposd in th form of an xampl. Th XDW Documnt Contnt spcification is sufficintly gnric to support without customizations in its structur (no nw data lmnts may b addd). It is sufficint to constrain alrady dfind data lmnts in th XDW Workflow Documnt such as dfining: (1) a st of Task Nam cods and Display nams allowd, (2) succssion ruls/constraints btwn ths stps, (3) th rfrncd input and output documnt contnt spcifications (.g., IHE PCC, Pharmacy, Laboratory, QRPH Contnt 8

9 profils), (3) th ability to span sub-workflows by crating nw Workflow Documnts, tc. This approach nabls th dvlopmnt of mor gnric XDW Workflow managmnt applications. A workflow dfinition for a basic unstructurd workflow has bn proposd in an appndix. Latr a guid for documnting workflow dfinition profils will b dvlopd as handbook. 16. This proposal uss th CDA as formal structur of th Workflow Documnt. Is it appropriat? If not propos a dtaild altrnativ. No. Th us of Human task was prfrrd. 17. This proposal dos not yt spcify tmplats, valu st if any, cods, tc. ths will b dfind, plas commnt. A workflow dfinition for a basic unstructurd workflow has bn proposd in an appndix. Latr a guid for documnting workflow dfinition profils will b dvlopd as handbook. 9

10 Volum 1 Intgration Profils 1.7 History of Annual Changs Add th following bullt to th nd of th bullt list in Sction Cross-Entrpris Documnt nabls participants in a multiorganization nvironmnt to track th tasks rlatd to patint-cntric workflows as activitis ar coordinatd. For th information of rviwrs, th following prmission is alrady part of th framwork Copyright Prmission Modify Sction 1.10 adding th copyright rights about OASIS Halth Lvl Svn, Inc., has grantd prmission to th IHE to rproduc tabls from th HL7 standard. Th HL7 tabls in this documnt ar copyrightd by Halth Lvl Svn, Inc. All rights rsrvd. Matrial drawn from ths documnts is crditd whr usd. Copyright OASIS All Rights Rsrvd. All capitalizd trms in th following txt hav th manings assignd to thm in th OASIS Intllctual Proprty Rights Policy (th "OASIS IPR Policy"). Th full Policy may b found at th OASIS wbsit. This documnt and translations of it may b copid and furnishd to othrs, and drivativ works that commnt on or othrwis xplain it or assist in its implmntation may b prpard, copid, publishd, and distributd, in whol or in part, without rstriction of any kind, providd that th abov copyright notic and this sction ar includd on all such copis and drivativ works. Howvr, this documnt itslf may not b modifid in any way, including by rmoving th copyright notic or rfrncs to OASIS, xcpt as ndd for th purpos of dvloping any documnt or dlivrabl producd by an OASIS Tchnical Committ (in which cas th ruls applicabl to copyrights, as st forth in th OASIS IPR Policy, must b followd) or as rquird to translat it into languags othr than English. Th limitd prmissions grantd abov ar prptual and will not b rvokd by OASIS or its succssors or assigns. This documnt and th information containd hrin is providd on an "AS IS" basis and OASIS DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTY THAT THE USE OF THE INFORMATION HEREIN 10

11 WILL NOT INFRINGE ANY OWNERSHIP RIGHTS OR ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. OASIS rqusts that any OASIS Party or any othr party that blivs it has patnt claims that would ncssarily b infringd by implmntations of this OASIS Committ Spcification or OASIS Standard, to notify OASIS TC Administrator and provid an indication of its willingnss to grant patnt licnss to such patnt claims in a mannr consistnt with th IPR Mod of th OASIS Tchnical Committ that producd this spcification. OASIS invits any party to contact th OASIS TC Administrator if it is awar of a claim of ownrship of any patnt claims that would ncssarily b infringd by implmntations of this spcification by a patnt holdr that is not willing to provid a licns to such patnt claims in a mannr consistnt with th IPR Mod of th OASIS Tchnical Committ that producd this spcification. OASIS may includ such claims on its wbsit, but disclaims any obligation to do so. OASIS taks no position rgarding th validity or scop of any intllctual proprty or othr rights that might b claimd to prtain to th implmntation or us of th tchnology dscribd in this documnt or th xtnt to which any licns undr such rights might or might not b availabl; nithr dos it rprsnt that it has mad any ffort to idntify any such rights. Information on OASIS' procdurs with rspct to rights in any documnt or dlivrabl producd by an OASIS Tchnical Committ can b found on th OASIS wbsit. Copis of claims of rights mad availabl for publication and any assurancs of licnss to b mad availabl, or th rsult of an attmpt mad to obtain a gnral licns or prmission for th us of such propritary rights by implmntrs or usrs of this OASIS Committ Spcification or OASIS Standard, can b obtaind from th OASIS TC Administrator. OASIS maks no rprsntation that any information or list of intllctual proprty rights will at any tim b complt, or that any claims in such list ar, in fact, Essntial Claims. Th nam "OASIS" is a tradmark of OASIS, th ownr and dvlopr of this spcification, and should b usd only to rfr to th organization and its official outputs. OASIS wlcoms rfrnc to, and implmntation and us of, spcifications, whil rsrving th right to nforc its marks against mislading uss. Plas s for abov guidanc. Add Sction Cross-Entrpris Documnt Workflow Contnt Profil Th Cross-Entrpris Documnt Profil nabls participants in a multiorganization nvironmnt to manag and track th tasks rlatd to patint-cntric workflows as th systms hosting workflow managmnt applications coordinat thir activitis for th halth profssionals and patints thy support. XDW builds upon th sharing of halth documnts providd by othr IHE profils such as XDS, adding th mans to associat documnts convying clinical facts to a patint-spcific workflow. XDW provids a common 11

12 335 introprability infrastructur upon which a wid rang of spcific workflow dfinitions may b supportd. It is dsignd to support th complxity of halth srvics dlivry with much flxibility to adapt as workflows volv. Add Sction Cross-Entrpris Documnt Workflow Contnt Profil Th Cross-Entrpris Documnt Profil nabls participants in a multiorganizational nvironmnt to manag and track th tasks rlatd to patint-cntric workflows as th systms hosting workflow managmnt applications coordinat thir activitis for th halth profssionals and patints thy support. XDW builds upon th sharing of halth documnts providd by othr IHE profils such as XDS, adding th mans to associat documnts convying clinical facts to a patint-spcific workflow. XDW provids a common introprability infrastructur upon which a wid rang of spcific workflow dfinitions may b supportd. It is dsignd to support th complxity of halth srvics dlivry with flxibility to adapt as workflows volv. This profil dfins an instrumnt, calld a Workflow Documnt, to manag and track a shard workflow. It rcords th cration of tasks and maintains a historical rcord of tasks as thy mov through th associatd workflow. Th Workflow Documnt also maintains th rfrncs to halth information input and output associatd with ach task. Such shard workflow status information allows th various participating systms to coordinat by: bing awar of th history of a workflow for a patint; obtaining and rading th workflow s incomplt tasks; updating this shard documnt as th workflow tasks ar prformd according to a rfrncd workflow dfinition. XDW provids to offr a common, workflow-indpndnt introprability infrastructur that: provids a platform upon which a wid rang of spcific workflows can b dfind with minimal spcification and applications implmntation fforts on th workflow dfinition (.g., Mdical Rfrrals Workflow, Prscriptions Workflow, Hom Car Workflow); bnfits many clinical and non-clinical domains by avoiding diffrnt compting approachs to workflow managmnt; incrass th consistncy of workflow introprability, and nabls th dvlopmnt of introprabl workflow managmnt applications whr workflow-spcific customization is minimizd; facilitats th intgration of multi-organizational workflows with th varity of xisting workflow managmnt systms usd within th participating organizations; 12

13 offrs th ncssary flxibility to support a larg varity of diffrnt halthcar workflows by not bing ovrly constraind. Mor spcifically XDW supports workflows that ar: patint-cntric; basd on businss/clinical nds which ar dfind xtrnally to th XDW Profil. Such workflow dfinitions hav to b known only by th applications within th participating systms, not by th infrastructur systms; xcutd in loosly connctd, distributd nvironmnts, whr cntralizd workflow managmnt systms ar not dsird, or in many instancs, possibl. Th XDW Workflow Architctur illustration (Figur 30-1) shows how th sharing of XDW Documnts btwn dg applications using Documnt Sharing infrastructur supports th managmnt of Workflow according to Workflow Dfinitions stablishd btwn participating applications Actors/ Transactions Figur 30-1: XDW Workflow Architctur Th XDW Contnt Profil is basd on thr actors, th Contnt Crator, th Contnt Consumr and th Contnt Updatr. Contnt is cratd by a Contnt Crator or a Contnt Updatr and is to b consumd by a Contnt Consumr or a Contnt Updatr. Th sharing or transmission of contnt or updats from on actor to th othr is addrssd by th us of IHE Intgration profils such as XDS, XDM or XDR (s PCC-TF-1: 2.1 for a dtaild xplanation of th us of Contnt Profils with Intgration Profils ). 13

14 395 Figur shows th actors dirctly involvd in th XDW Profil and th dirction that th contnt is xchangd. A product implmntation using this profil must group actors from this profil with actors from a workflow or transport profil to b functional. S Sction 30.3 XDW Actor Groupings and Profil Intractions. 400 Figur : XDW Actor Diagram 405 Tabl lists th contnt modul(s) dfind in th XDW Profil. To claim support of this profil, an actor shall support all rquird contnt moduls (labld R ) and may support optional contnt moduls (labld O ). Tabl : XDW Profil - Actors and Contnt Moduls Actors Contnt Moduls Optionality Rfrnc XDW Contnt Crator XDW Contnt Consumr XDW Contnt Updatr XDW Workflow Contnt Modul (s Not 1) XDW Workflow Contnt Modul (s Not 1) XDW Workflow Contnt Modul (s Not 1) R ITI TF-3: 5.4 R ITI TF-3: 5.4 R ITI TF-3: Not 1: Th XDW Workflow Contnt Modul dfins how to crat an agnostic unstructurd Workflow Documnt. Implmntations may also choos to support Contnt Moduls for spcific workflows dfind by IHE in workflow dfinition profils (.g., profils in th PCC domain: Cross-Entrpris Rfrral Workflow Dfinition (XBR-WD), Cross-Entrpris TlHomMonitoring Workflow Dfinition (XTHM-WD), Cross-Entrpris Tumor Board Workflow Dfinition (XTB-WD, tc.). 14

15 XDW Contnt Crator Th Contnt Crator is rsponsibl for crating contnt that will b shard or xchangd btwn othr IHE Actors. It is rquird to b groupd with othr Actors that prform th actual sharing or xchanging of information (s Sction 30.3). Th XDW Contnt Crator shall b abl to crat nw workflows by crating a nw XDW Workflow Documnt as dfind in ITI TF-3:5.4. This actor is workflow agnostic and it is rsponsibl only for th cration of th first vrsion of th XDW Workflow Documnt XDW Contnt Consumr Th Contnt Consumr is rsponsibl for accssing XDW Workflow Documnts that hav bn shard or xchangd btwn othr IHE Actors. It is rquird to b groupd with othr Actors that prform th actual sharing or xchanging of information (s Sction Th XDW Contnt Consumr Actor may only obtain and rad th last vrsion of a spcific XDW Workflow Documnt. Th XDW Workflow Documnt consumd can blong to any kind of clinical workflow XDW Contnt Updatr A Contnt Updatr shall b abl to contribut to xisting workflows by consuming an xisting XDW Workflow Documnt and rplacing it with an updatd Workflow Documnt. It is rquird to b groupd with othr Actors that prform th actual sharing or xchanging of information (s Sction 30.3). This actor shall b abl to consum and rad th most rcnt vrsion of a spcific XDW Workflow Documnt. Th XDW Contnt Updatr shall b abl to updat th XDW Workflow Documnt, acting on th contnt in many diffrnt ways (tracking a nw task initiatd or prformd, changing th status of tasks, adding documnts rfrnc in som tasks, changing th status of th whol workflow, tc.). Aftr th updat, th XDW Contnt Updatr shall b abl to rplac th prvious vrsion of th XDW Workflow Documnt with th nw on. This actor shall b abl to solv rac condition vnts (s sction ITI TF-3: ) Cross-Entrpris Documnt Workflow Profil Options Options that may b slctd for this Profil ar listd in th Tabl along with th Actors to which thy apply. Tabl : XDW - Actors and Options Actor Options Vol. & Sction Contnt Crator No options dfind - - Contnt Consumr Viw Option (Not 1) ITI TF-1: Documnt Import Option ITI TF-1: (Not 1) Contnt Updatr Viw Option (Not 1) ITI TF-1: Documnt Import Option (Not 1) ITI TF-1:

16 Not 1: Th Actor shall support at last on of ths options Viw Option A Contnt Consumr or a Contnt Updatr that supports th Viw Option shall b abl to: us th appropriat XD* transactions to obtain th Workflow Documnt along with associatd ncssary mtadata; intrprt th contnt of th Workflow Documnt and display its rquird contnt lmnts in a way which shows th tasks that ar not complt and th compltd task in a chronological way. Th rquird lmnts to display ar idntifid in th Viw column in ITI TF-3: Tabl and Tabl For ach task, it shall list th documnts rfrncd insid th Workflow Documnt and may optionally support th rtriv and th rndring of th documnts rfrncd insid th Workflow Documnt. Any additional display capabilitis that ar spcific to th rfrncd Workflow Dfinition profil may b providd Documnt Import Option A Contnt Consumr or a Contnt Updatr that supports th Documnt Import Option shall support th storag of th ntir Workflow Documnt (as providd by th XD* sharing framwork) along with applicabl mtadata to nsur its latr procssing. Documnts rfrncd in th Workflow Documnt may also b stord. This Option rquirs th propr tracking of th rlation btwn th Documnts rfrncd and th contnt of th Workflow Documnt origin. Onc a documnt has bn importd, th Contnt Consumr or th Contnt Updatr shall offr a mans to us th documnt without th nd to rtriv it again from th XD* sharing framwork. Whn viwd aftr it was importd, a Contnt Consumr and/or a Contnt Updatr may choos to accss th XD* sharing framwork to find out if th rlatd Documnt viwd has bn dprcatd or rplacd. Not: For xampl, whn using XDS, a Contnt Consumr may choos to qury th Documnt Rgistry about a documnt prviously importd in ordr to find out if this prviously importd documnt may hav bn rplacd 30.3 XDW Actor Grouping and Profil Intractions A XDW Contnt Crator, Contnt Updatr and Contnt Consumr shall b groupd with appropriat actors from th XDS, XDM and XDR Profil to xchang XDW Workflow Documnts. Th mtadata usd for documnt ntris in documnt sharing or intrchang has spcific rlationships or dpndncis (which w call bindings, s ITI TF-3:5.4.6) to th contnt of th clinical documnt a XDW Workflow Documnt. Whn XDW is usd in conjunction with XDS: an XDW Contnt Crator shall b groupd with an XDS Documnt Sourc; 16

17 480 an XDW Contnt Updatr shall b groupd with an XDS Documnt Sourc with th Documnt Rplacmnt Option; an XDS Documnt Consumr; an XDW Contnt Consumr shall b groupd with an XDS Documnt Consumr Whn XDW is usd in conjunction with XDR: an XDW Contnt Crator shall b groupd with an XDR Documnt Sourc; an XDW Contnt Updatr shall b groupd with an XDR Documnt Sourc; an XDR Documnt Rcipint; an XDW Contnt Consumr shall b groupd with an XDR Documnt Rcipint Whn XDW is usd in conjunction with XDM: an XDW Contnt Crator shall b groupd with an XDM Portabl Mdia Crator; an XDW Contnt Updatr shall b groupd with an XDM Portabl Mdia Crator; an XDM Portabl Mdia Importr; an XDW Contnt Consumr shall b groupd with an XDM Portabl Mdia Importr. Not: Th support of Workflow spanning XDS, XDR and XDM nvironmnts is not xplicitly addrssd XDW Procss Flow XDW Approach to Workflow XDW is a cor componnt of a common, workflow-indpndnt introprability infrastructur that provids a platform upon which a wid rang of spcific workflows can b dfind by contnt spcialization with minimal spcification and implmntation fforts (.g., Mdical Rfrrals, Prscriptions, Hom Car). 17

18 This sction first dscribs th ovrall architctur within which th XDW Profil oprats. Nxt, th structur of th XDW workflow documnt, th primary data structur that is shard among th workflow participants, is dscribd XDW Workflow Architctur A Workflow Dfinition is structurd as a st of logical or clinical tasks dfinitions and ruls. Each task dfinition dscribs an activity or a group of activitis that nds to b accomplishd by th ownr of th task. Th ruls in th workflow dfinition nsur that th diffrnt participants in a workflow oprat jointly to advanc within procss and to mov from on task to anothr in a consistnt way. Figur prsnts an ovrviw of th Workflow Architctur built around th XDW Profil. 520 Figur : XDW Architctur Ovrviw In this workflow architctur: Th first layr supports th sharing or xchang of documnts. This introprability foundation is nabld by a st of xisting IHE documnt sharing profils such as XDS, XDR and XDM along with documnt contnt profils and scurity/privacy profils such as ATNA and (optionally) BPPC; Th scond layr dfins a gnric data structur calld a Workflow Documnt which is shard among th workflow participants by using th first layr of this architctur. Likwis, th clinical and administrativ documnts that ar usd as input and producd as output by th tasks of workflows managd by th XDW Profil ar shard using th sam first layr of this architctur; Th third layr introducs th smantic dfinition of th workflows that can b undrstood and xcutd among th participating systms/applications. Th orchstration 18

19 of spcific workflows allows th workflow participants to shar a common undrstanding of th spcific tasks, th dpndncis btwn ths tasks, and a numbr of ruls that control th workflow xcution. Excution dtails ar convyd through th XDW Workflow Documnt dfind by th scond layr of th architctur. Th spcification of Workflow Dfinitions at this third layr is not part of th ITI XDW Profil and is currntly bst handld with a natural languag xprssion (S xampl of Basic Unstructurd Workflow Dfinition Profil, ITI TF-2x:Appndix X); Th fourth layr of this architctur contains th applications xcutd by th participating systms. Such applications bridg btwn XDW managd workflow and th locally managd workflow. Much of th dtails of th local workflows managd by ach application will b hiddn and ncapsulatd in highr granularity tasks xposd through XDW; as such dtails would not nd to b xtrnally xposd. Th workflow dfinitions convyd by th third layr should only contain highr granularity tasks that rquir workflow coordination across organizational boundaris XDW Documnt Structur Th XDW Profil uss th XDW Workflow Documnt to manag workflows. Th XDW Workflow Documnt nabls participants in a multi-organization nvironmnt to manag and track th xcution of patint-cntric workflows. Th structur of WorkflowDocumnt is organizd into Tasks and TaskEvnts. A Task dscribs an activity, or a group of activitis, that nd to b accomplishd or hav bn accomplishd. A Task is charactrizd by svral attributs: th typ of task, th ownr of th task, th currnt status of this task (on of th status valu that ar valid for this task), th rfrncs to documnts usd for input or producd as output th history of past Task Evnts for this task, that documnt th progrss of th task up to th prsnt stat Whn a prson or organization has bn assignd as ownr of a task, th task is placd undr xcution. (It movs from a CREATED or READY status to an IN_PROGRESS status). Whn th xpctd activity(is) is compltd succssfully th task movs to th COMPLETED status, othrwis to th FAILED status (for th stat diagram s ITI TF 3: ). Task Evnt is a rcord of a chang (status and/or othr attribut) of a task; a Task Evnt history is th list of Task Evnts for a spcific task. As shown in th Figur , th XDW Workflow Documnt is structurd into two parts: a first part with gnral workflow information about th documnt, 19

20 570 a scond part that collcts th diffrnt Tasks that ar compltd or not yt compltd in th workflow, as wll as for ach task, th rlatd Task Evnts that tracks its progrss. Task and Task Evnt spcification lvrags a propr subst of th task modl and spcification from th OASIS Human Task, a standard closly rlatd to wll-known workflow standards such as BPEL and BPMN. 575 Figur : Workflow Documnt Structur 580 Th Task and Task Evnts includ rfrncs to clinical or administrativ input/output documnts to th Task or Task Evnt: Th Input attribut contains rfrncs to documnts that ar rlvant for workflow participants in prforming th Task. For xampl, for a prformd xamination, this could contain a rfrnc to a rfrral rqust. It may also contain rfrncs to "parnt" workflows to which this workflow is a "child". 20

21 Th Output attribut contains rfrncs to documnts that wr producd as a rsult of prforming this Task. For xampl, this could contain a rfrnc to a rport writtn by a spcialist. It may also contain rfrncs to "child" workflows initiatd by this workflow as a parnt. At any tim, if a participant chooss to updat th workflow for a spcific patint, it shall ithr crat on (or mor) nw task or updat an xisting task and rcord a past taskevnt. Each updat to th Workflow documnt rsults in a nw instanc of th Workflow Documnt which is publishd as a rplacmnt. Th prior vrsion bing rplacd is thn placd in th status dprcatd (XDSDocumntEntry availabilitystatus) so that only th nwst Workflow Documnt is activ. Th tchnical dscription of th updating procss of th Workflow Documnt is spcifid in ITI TF-3: Whn a nw Workflow Documnt is cratd th Contnt Crator assigns it a workflow idntifir in th DocumntEntry.rfrncIdList mtadata attribut and in th workflow documnt. This workflow idntifir dos not chang during th volution of th workflow itslf, and allows th grouping of all th XDW Workflow Documnts that blong to th sam instanc of workflow. All subsqunt rplacmnt workflow documnts also carry th sam workflow idntifir so that this idntifir provids a stabl rfrnc to an instanc of a workflow, whil th Workflow Documnt DocumntEntry.uniquId is diffrnt for ach vrsion of th workflow documnt XDW Us-Cass and Procss Flow in an XDS Affinity Domain A broad rang of us cass may b supportd by th XDW Contnt Profil. Th purpos of this sction is to dscrib a typical us of XDW with no intnt to prsnt th bradth and flxibility of XDW. Th us cas dscribd in this sction provids th ncssary background to th radr in undrstanding th basic capabilitis of XDW. This us cas is not intndd as a Workflow Dfinition Profil spcification. Such Profils ar bing dvlopd by clinical IHE Domains in ordr to support thir spcific workflows Rfrral Workflow Us Cas This workflow is a thr stp procss: A. a physician rfrs a patint to anothr halthcar providr for a spcialist s consultation; B. th spcialist starts th consultation which may span on or mor visits C. th spcialist complts th consultation and producs a rport. Each stp will b dscribd both from a clinical and a tchnical point of viw. Th dscription will rly on two figurs: Figur rprsnts th volution of th Workflow Documnt during this Rfrral workflow. Each on of th thr stps A, B, C is dpictd in a column. 21

22 Figur is a squnc diagram of th transactions btwn systm actors in th sharing of th Workflow Documnt as it is updatd, using an infrastructur basd on th XDS Profil (although not shown hr, this us cas could b transposd on th XDR or XDM profils) Rfrral Workflow Us Cas - Stp by Stp W prsnt blow th dtaild chronological squnc of stps: A. A physician rfrs a patint to anothr halthcar providr for a spcialist s consultation In this task, th GP xamins th patint and rviws th patint s most rcnt laboratory rport. Th GP rfrs th patint to a spcialist, crating an Rfrral Documnt and rfrncing th laboratory rport. Th GP s softwar, as Contnt Crator, producs th -Rfrral Documnt and on Workflow Documnt to track th clinical workflow of th Rfrral. As shown in column A of Figur , at this momnt th Workflow Documnt cratd has only on task ( Rfrral Rqustd ) charactrizd by: a task status COMPLETED as inputs of th task th rfrncs to th laboratory rport analyzd by th GP as outputs of th task th rfrnc to th Rfrral documnt producd. In ordr to shar th documnts that ar producd during th task, th GP s Softwar (as a groupd Contnt Crator and XDS Documnt Sourc) submits th Rfrral Documnt and th Workflow Documnt to th XDS Documnt Rpository as shown in box A of Figur

23 640 Figur : Managmnt of th Workflow Documnt B. Th spcialist starts th consultation which may span on or mor visits In this task, th patint gos to th spcialist of his choic (or suggstd by his GP). 23

24 Th spcialist consults th Rfrral documnt and th associatd Workflow Documnt to undrstand th task that nds to b prformd. Th spcialist accsss th documnt by using his softwar, which is a grouping of a Contnt Updatr and an XDS Documnt Consumr, to qury and rtriv th Workflow Documnt and th Rfrral documnt, as shown in box B of Figur If consistnt with th Workflow Dfinition rfrncd in th Workflow Documnt, th spcialist accpts th patint and updats th Workflow Documnt so that no othr spcialist may prform th consultation. As shown in column B of Figur , at this stp of th workflow, th Workflow Documnt is updatd with a nw vrsion in which a nw task Rfrral Rfrrd is addd to th contnt of th prvious vrsion of th Workflow Documnt. Th task Rfrral Rfrrd is charactrizd by: a task status IN_PROGRESS as inputs of th task th rfrncs to th Rfrral documnt producd by th GP Th Spcialist s softwar, as a Contnt Updatr and an XDS Documnt Sourc, provids th updatd vrsion of Workflow Documnt to th XDS Documnt Rpository/Rgistry through a Rplac of th prvious vrsion of th Workflow Documnt (s box B in Figur ). C. Th spcialist complts th consultation and producs a rport Th spcialist nds th consultation and h producs a rport of th consultation. In this task, th softwar of th spcialist, as a Contnt Updatr, updats th Workflow Documnt changing th status of th rfrrd task. As shown in column C of th Figur th Workflow Documnt, th Rfrral Rfrrd task is charactrizd by: a task status COMPLETED as inputs of th task th rfrncs to th Rfrral documnt producd by th GP (th laboratory rport was not usd by th spcialist) as output of th task th rfrncs to th rport of th consultation Th history of th changs of th statuss of th task ar trackd insid th task as a list calld taskevnthistory. Th Spcialist s softwar, as a Contnt Updatr and Documnt Sourc, provids th updatd vrsion of Workflow Documnt to th Documnt Rpository through a rplac of th prvious vrsion of th Workflow Documnt (s box C in Figur ). At any tim th GP may rviw th Workflow Documnt and th nw documnts producd rlatd to this workflow. This is accomplishd through a qury and rtriv by th GP s softwar of th activ Workflow Documnt from th XDS Documnt Rgistry and th XDS Documnt Rpository. 24

25 Figur : Basic Procss Flow in XDW Profil, Simpl Rfrral us cas 685 Although not shown in this us cas, it would also b possibl to manag a systm of subscription and notification to communicat th progrss btwn th diffrnt stps through th us of th Documnt Mtadata Subscription (DSUB) Profil or th Notification of Documnt Availability (NAV) Profil. 25

26 XDW Scurity Considrations Th XDW Contnt Profil rlis on th scurity controls in th undrlining transport (.g., XDS). Th XDW contnt is an administrativ documnt that should not includ clinical information but administrativ information can b just as snsitiv as clinical information. Th XDW Workflow Documnt will b authord by diffrnt organizations. As th documnt is updatd th activ vrsion will b rplacd with a nwr vrsion as th workflow progrsss. Howvr, with clinical documnts it is not xpctd that organizations will rplac documnts authord by othr organizations, as typically a clinical documnt coms from only on organization or individual. Thrfor in ordr to adhr to th principl of last privilg organizations want to prvnt clinical documnts from bing rplacd by othr organizations, whil allowing XDW Workflow Documnts to b rplacd. It is rcommndd that organizations rtain gnral rstrictions on XDS documnts, but mak an xcption for XDW Workflow Documnts, basd on classcod. Whn a Workflow Dscription Profil is cratd a risk assssmnt following th Scurity Cookbook may rsult in additional scurity considrations byond thos for th usual clinical rport Cross-Profil Considrations Th XDW Profil and actors rly on an XDS documnt sharing infrastructur. Th nd for a fixd rfrnc to th whol workflow (workflow idntifir) rquirs that XDW actors oprat in an XDS affinity domain whr th Documnt Rgistry supports th Rfrnc ID Option. For mor dtails about this option s ITI TF-1: Th ITI XDW Profil dosn t hav a volum 2. It has on appndix in volum 2x which is at th nd of this documnt. 26

27 Volum 3 Cross-Transaction Spcifications and Contnt Spcification Add Sction XDW Workflow Contnt Modul This sction dfins th XDW Workflow Documnt by providing a schma and xplaining its us. This documnt dos not includ clinical information about th patint dirctly. It shall only contain information ncssary for organizing and dfining work tasks. All clinical information rgarding any task shall b providd through sparat documnts that ar rfrncd from th associatd input or output documnts Rfrncd Standards HL7 CDA Rlas 2.0 (dnotd HL7 CDA R2, or just CDA, in subsqunt txt) Wb Srvics Human Task (WS-) Spcification Vrsion 1.1, OASIS Discussion of Contnt Standards Th XDW Workflow Documnt is a documnt that incorporats lmnts from th HL7 CDA documnt structur and from th WS- structur. Th Workflow Documnt xists to coordinat th activitis of multipl popl in diffrnt organizations. Thy agr to shar ths documnts as a mthod of xchanging work information. Ths documnts ar usd by ths organizations to fd what is oftn considrd thir own intrnal task managmnt systms and hav thir own administrativ ruls for managing activitis. Sharing clinical documnts is oftn accomplishd as a normal part of providing halthcar. Th XDW workflow allows th work information to b shard in th sam way as othr patint rlatd clinical information. Intgrating th intrnal workflow managmnt systms of indpndnt organizations with indpndnt administrativ ruls, and prhaps in diffrnt lgal and rgulatory systms, is avoidd. Th XDW Workflow Documnt dos not contain clinical information about th patint. Th input, output, and othr lmnts of th task data shall contain rfrncs to documnts (XDSdocumntId) that contain th clinical information. XDW Workflow uss th XDS lifcycl managmnt tools to coordinat updats to th Workflow Documnt instad of rquiring an intgration of all th diffrnt task managmnt systms in th diffrnt organizations. Th XDW Workflow Documnt builds upon two othr standards, HL7 CDA and OASIS WS- Human Task. 27

28 Th XDW Workflow Documnt shall comply with th XDW XML Schma that includs lmnts from th CDA and OASIS Human Task standards. Accss to th schma fils from thos standards will b ndd. Th figur blow rprsnts th main lvl structur of th Workflow Documnt with th first lvl of th lmnts that composd th structur. It is possibl to divid th structurd into four parts: Part 1: lmnts drivd from HL7 CDA standard (Typ of th lmnt: CDA), Part 2: two lmnts, patint and author, dfind in th XDWSchma with th structur drivd from HL7 R-MIM standard (Typ of th lmnt: txdwpatint and txdwauthor), Part 3: lmnts dfind by IHE XDW Profil Part 4: th lmnt <TaskList> in which is dfind by lmnts drivd from th OASIS WS- standard. In this last sction th <TaskList> is a list of lmnts <XDWTask> composd of th <taskdata> (all data that dfin th XDWTask) and th <taskevnthistory> that contains a list of lmnts <taskevnt>. All th lmnts of th Figur ar dscribd in Sction

29 id titl ffctivtim lmnts from CDA Standard confidntialitycod languagcod XDWWorkflowDocumnt patint author lmnts from RIM Standard workflowinstancid workflowdocumntsquncnumbr workflowstatus workflowstatushistory lmnts dfind by XDW Profil workflowdfinitionrfrnc TaskList lmnts from OASIS WS- Figur : XDW.WorkflowDocumnt Structur 29

30 XDW Workflow Documnt Elmnts from HL7 CDA Standard Som lmnts ar incorporatd dirctly from th HL7 CDA standard. This mans that th lmnts, thir dfinitions, and th ruls for intrprting thm ar in th HL7 standard. Ths ar summarizd hr for convninc. <patint> and <author> lmnts hav bn dfind basd upon th HL7 CDA R-MIM. Th XDW schma dfins ths lmnts using lmnts from CDA, and was drivd by liminating all lmnts that ar not ndd for workflow idntification purposs. Th R-MIM includs lmnts that ar of clinical valu. Ths hav bn rmovd for workflow us XDW Workflow Documnt Elmnts dfind by IHE XDW Profil Th XDW Workflow Documnt also has lmnts that ar dfind by IHE (s Tabl ): <workflowinstancid> Evry vrsion of th Workflow Documnt shall hav th sam workflowinstancid valu. It is convyd in th DocumntEntry.rfrncIdList attribut of th workflow documnt s mtadata.. It shall b globally uniqu, bcaus it is shard by many organizations. <workflowdocumntsquncnumbr> This is usd to simplify managmnt of th changs to th Workflow Documnt as th workflow is xcutd. It shall b cratd as "1", and b incrmntd for ach updat to th Workflow Documnt. <workflowstatus> This shall b ithr OPEN which mans that furthr updats ar xpctd for this Workflow Documnt. Ths updats could b modifications to xisting tasks or addition of nw tasks or updat to an xisting task. Tasks shall not b dltd. CLOSED which mans that furthr updats to this Workflow Documnt ar not xpctd. A workflow with a CLOSED workflowstatus may continu to b updatd, aftr which th valu of workflowstatus may b transitiond back to OPEN or rmain CLOSED. Ths constraints will b dfind by th Workflow Dfinition rfrncd. <workflowstatushistory> This lmnt rprsnts th history of changs of status of th workflow documnt. It consists of sub-lmnts namd documntevnt. Each documntevnt dscribs a chang of status of th workflow documnt. In cas that th workflowdfinitionrfrnc dscribs a typ of workflow that can t chang its status from CLOSED to OPEN, th workflowstatushistory contain at most two documntevnt lmnts, on for th opning of th workflow corrsponding to th cration of th workflow documnt, and on to track th closing of th procss rlatd. Instad, if th workflowdfinitionrfrnc prmits th chang of status from CLOSED to OPEN (.g., OPEN-->CLOSED-->OPEN ) th lmnt workflowstatushistory will contain from 1 to N documntevnt lmnts to track ths changs. A documntevnt is dscribd by sub-lmnts dfind in Tabl

31 vnttim vnttyp workflowstatushistory 1 documntevnt 1 1 taskevntidntifir author prviousstatus actualstatus Figur : workflowstatushistory Elmnt <workflowdfinitionrfrnc>. This is th rfrnc to th workflow dfinition. This is usually containd in policy or procdur documnt or may b dfind by IHE as a spcific workflow dfinition profil. This profil placs no rstriction on th styl usd to documnt such Workflow dfinition. It is rcommndd to assign an OID to thos. It shall b rcordd by th crator of th initial Workflow Documnt and shall b prsrvd unchangd in all subsqunt vrsions of th documnt XDW Workflow Documnt Elmnts from th OASIS Human Task Th dscriptions of a task and of <taskevnt> ar takn from th OASIS Human Task standard. This standard dfins a way to dscrib a human task. It was dfind as an xtnsion to th BPEL and BPMN workflow standards. Ths standards ar in us to manag th workflow of automatd tasks undr th control of an intgratd task managmnt systm. It was rcognizd that whil ths standards do not hav th ability to control human task, thy ndd a way to dscrib tasks to b prformd by humans and othr organizations. Th lmnt <XDWTask> groups all information about on task in th workflow, th <XDWTask> is structurd in two sub lmnts: <taskdata> and <taskevnthistory>. <taskdata> dscribs a singl task. This is a list of dtails about th task, a dscription, th inputs to th task (.g., documnts), th outputs from th task (.g., documnts), fault dscriptions and commnts. Th <taskdtails> includ lmnts lik th task ID, dscription, stat, tc. (s Tabl ) <taskevnthistory> contains a list of th <taskevnt> lmnts that dscrib th changs of th task. For ach task, thr is on or mor <taskevnt> that dscribs th history of th task. Thr is a list of th <taskevnt>: an <vnttyp>, a dscription, th inputs to th <taskevnt> (.g., documnts), th outputs from th <taskevnt> (.g., documnts), fault dscriptions, commnts, and 31

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