IHE Korea. Daegu 2010 Connectathon eworkshop Todd Cooper, Breakthrough Solutions Foundry, Inc.

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1 IHE Korea Daegu 2010 Connectathon eworkshop Todd Cooper, Breakthrough HIMSS Page CE-IT Symposium Copyright Plug-and-Play All Rights 2010 Breakthrough Reserved Solutions Foundry, Page Inc. 1

2 eworkshop Agenda Connectathon Overview & Workshop Review Technical Profile Overview Connectathon Testing Support Showcase Testing & Preparation Next steps Attachments: ftp://ftp.ihe.net/international/korea/2010_connectathon_showcase/ihe-korea_connectath_eworksop_ HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 2

3 eworkshop Agenda Connectathon Overview & Workshop Review Technical Profile Overview Connectathon Testing Support Showcase Testing & Preparation Next steps HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 3

4 IHE Standards Adoption Process Develop technical specifications Identify available standards ( standards (e.g. e.g. HL7, DICOM, IETF, OASIS) Testing at Connectathons IHE Demonstrations Products with IHE Document Use Case Requirements Timely access to information Easy to integrate products products 4 Page 4

5 IHE Process Overview Page 5

6 IHE Testing Process You are here! Users Testing Results Deploy Systems Sponsors: Project Management Team Vendors Sponsors: Exhibits Develop Testing Tools Interview Implement Profile Actors Approves Test Logs In-House Testing Connectathon Demonstration Product + Integration Statement IHE Technical Framework (IHE Profile Specifications) Page 6

7 IHE Connectathon Requirements Extensive information Specific requirements in the Connectathon Quality document: Connectathon_Quality_Assurance_Criteria.pdf Page 7

8 IHE Connectathon Requirements Page 8

9 IHE Connectathon Requirements From the Quality document: Page 9

10 IHE Connectathon Requirements Specific Requirements include Sponsored by IHE-Korea Announcement to IHE International Board + IHE Testing & Tools Committee 99 months in advance Open call for participation (w/ Profiles available for testing) 6 months in advance Oversight by an approved IHE Connectathon Manager NOTE: The Testing and Tools Committee can waive the requirements on a case-by by-case basis. And they did! Page 10

11 IHE Korea Connectathon Update Page 11

12 IHE Korea Connectathon Update Presented to IHE Testing & Tools and they approved the request that IHE Korea Daegu 2010 testing event be designated an official IHE Connectathon! Page 12

13 IHE Korea Connectathon Update Call for Participation issued including a Connectathon Conference. We re on our way but now for the hard part: Implementation & testing! Page 13

14 Locked in the dungeon make it work! Page 14

15 IHE Process Overview Page 15

16 IHE Connectathon Results Page 16

17 IHE Connectathon Results 2010 Daegu Results Posted Here including YOUR company! IHE Disclaimer: Check IHE Integration Statement / Product Registry for actual system details Page 17

18 IHE Product Registry Users / purchasers search this registry to locate products that support specific IHE profiles. Connectathon success allows you to post IIS for your products! Page 18

19 eworkshop Agenda Connectathon Overview & Workshop Review Technical Profile Overview Connectathon Testing Support Showcase Testing & Preparation Next steps HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 19

20 Connectathon Testing is based on specifications laid out in the Technical Framework period. Part 1: Integration Profiles model the business process problem (use case) and its solution. Part 2: Transactions define how current standards are used to solve the business problem defined in the Integration Profiles. Connectathon: Vendors register to test their product as an actor(s) within an Integration Profile Page 20

21 Devices Aggregation Manager Telehealth Service Center Health Records PAN Personal Area Network LAN Local Area Network WAN Wide Area Network HRN Health Reporting Network SDE #1 SDE #2 SDEs #3+ Page 21

22 IHE Korea Connectathon Focused on WAN I/F Devices Aggregation Manager Telehealth Service Center Health Records PAN Personal Area Network LAN Local Area Network WAN Wide Area Network HRN Health Reporting Network Page 22

23 Continua/IHE PCD DEC WAN Messaging HL7 V2.6 constrained by IHE DEC PCD-01 and RTM. Semantics IEEE and 104xx terms IEEE terms and info model Message Transport Web Services WS-I BP IHE IT Infrastructure TF Vol 2 Appendix V Rev 6.0 WS-I BP over SOAP 1.2 Plus WSI-BSP, TLS and IHE ATNA (beyond the firewall) HL7 MLLP IHE HL7 V2 Msg Transport HL7 Minimum Lower Layer Protocol (MLLP) over TCP/IP (behind the firewall) Note: This is new to the IHE PCD not IHE ITI test tooling, test scripts, etc. Page 23

24 Transaction vs. Option Heuristics Question: Should PCD-01 / WS* be a new transaction or an option? What Changed? Optionality? Function / Content Syntax / Encoding / Format Transport Topology Application Architecture Security Sending Actor Receiving Actor DEC vs. ACM, HL7 ER or XML. MLLP, WS* LAN, WAN, wlan Messaging, Services TLS, WS-BSP, Often can select one Often supports all New Transaction? Optionality? Different Content / Function Yes Multiple differences - Yes Only different Transport or Format - No Sending Actor Yes Receiving Actor Yes / All / Maybe (case-by-case basis) Page 24

25 IHE and Continua WAN V1.5 Security Guidelines Requirement Guidelines WAN HITSP IHE Data Confidentiality WS-I BSP v1.0 TLS protocol v1.0 (RFC 2246) AES cipher (RFC 3268) Data Integrity WS-I BSP v1.0 TLS protocol v1.0 (RFC 2246) SHA1 hash (RFC 3174) Authorization Information Exchange Auditing WS-I BSP v1.0 WS-Security Header Only SAML v2.0 token M O M O M Consistent with IHE XUA IHE ATNA Auditing Section 3.20, ITI-TF6-Vol2a mv2 1 M Mandatory shall R Recommended O Optional Guideline is aligned with IHE and HITSP mv2 1 IHE ATNA Auditing may become mandatory in a later version, e.g. V2 Page 25

26 Continua Standards Framework ISO/IEEE Std xx Device Specializations Which devices for Daegu 10? Device Specializations Pulse Oximeter Blood Pressure Monitor Thermometer Weighing Scale Glucose Meter Insulin Pump Peak Expiratory Flow Cardiovascular Fitness Strength Fitness Activity Hub Medication Monitor -104xx other specializations USB Personal Healthcare Device ISO/IEEE Std Optimized Exchange Protocol Bluetooth Health Device Profile Transport Zigbee Health Care Profile also considering BT-LE, Serial, IrDA Data Exchange Protocol Page 26

27 IHE PCD Profile Development Current Profiles: Enterprise sharing of Patient Care Data (DEC) Patient Identity Binding to Device Data (PIB) Subscribe to Patient Data (SPD) Rosetta Terminology Mapping Project (RTM) Daegu 10 PCD Alarm Communication Management (ACM) Point-of-care Infusion Verification (PIV) Implantable Device Cardiac Observations Reporting (IDCO) Work in Process: Device Point-of-care Integration (DPI) Medical Equipment Management (MEM) Waveform Communication Management (WCM) Event Communication (EC) [for non-alarm events] Patient-Device Association (PDA) Daegu 10 Initial device classes vital signs / physiological monitors, infusion pumps and ventilators Page 27

28 Profiles simplify development! All implementation detail in vol. 2! Page 28

29 PCD Published Profiles DEC Profile Device to Enterprise Communication Trial Implementation Page 29

30 DEC Profile Mapping Model ISO/IEEE Domain Information Model and Nomenclature mapped to HL7 (v2.6) Observation Report ISO/IEEE Data Types mapped to HL7 Data Types Mapping preserves measurement context for complex devices. Page 30

31 Device Enterprise Communication (DEC) Data Observation Customer (DOC) EHR, CDR, CDSS PCD-01: Communicate Device Data Device Observation Reporter (DOR) Map Device Data to Consistent Syntax and Semantics Device Monitor, Ventilator, Infusion Pump Page 31

32 IHE PCD DEC & SPD DEC fire hose DEC filter criteria DEC filtered Page 32

33 Measurement Context is Complex Clinical example but the problem exists for home contexts. Page 33

34 PCD-01 Measurement Context n IEEE Domain Information Model Defines Device Context IEEE PHD simpler but follows same strategy. Page 34

35 PCD-01 Measurement Context Medical Device System (MDS) 0..* 1 1 Virtual Medical Device (VMD) * 1 Channel (Chan) * 1 * Metric Numeric Enumeration Subject Medical: Containment Tree Hierarchical Level <mds> <vmd> <chan> <parametric instance> Mapping preserves measurement context Examples OBX-4 Virtual (Medical) <VS Mon> <PulsOxim> <Oxim> Ordinal Virtual (Medical) <VS Mon> <PulsOxim> <Ptach> Ordinal Virtual (Medical) <VS Mon> <ECG> <Ctach> Ordinal Recommend that Ordinal value is unique among entire set <Spo2> 1 <PR> 2 <HR> 3 Page 35

36 PCD-01 Message Example MSH ^~\& INFO_SRC_PHILIPS^ACDE ABCD^EUI ORU^R01^ORU_R01 PMS P 2.5 NE AL 8859/1 PID AB60001^^^Philips Medical^PI Brooks^Albert^^^^^L M PV1 I UNIT_1^^Bed1 OBR 1 PMS ^INFO_SRC_PHILIPS^ACDE ABCD^EUI-64 PMS ^INFO_SRC_PHILIPS^ACDE ABCD^EUI ^MDC_DEV_METER_PHYSIO_MULTI_PARAM_MDS^MDC OBX 1 ST ^MDC_ECG_STAT_ECT^MDC "" F OBX 2 ST ^MDC_ECG_STAT_RHY^MDC Sinus Rhythm F OBX 3 NM ^MDC_PULS_OXIM_SAT_O2^MDC ^MDC_DIM_PERCENT^MDC F OBX 4 NM ^MDC_ECG_HEART_RATE^MDC ^MDC_DIM_BEAT_PER_MIN^MDC F OBX 5 NM ^MDC_PRESS_BLD_ART_ABP_SYS^MDC ^MDC_DIM_MMHG^MDC F OBX 6 NM ^MDC_PRESS_BLD_ART_ABP_DIA^MDC ^MDC_DIM_MMHG^MDC F OBX 7 NM ^MDC_PRESS_BLD_ART_ABP_MEAN^MDC ^MDC_DIM_MMHG^MDC F OBX 8 NM ^MDC_ECG_V_P_C_CNT^MDC ^MDC_DIM_BEAT_PER_MIN^MDC F OBX 9 NM ^MDC_PRESS_BLD_ART_PULM_SYS^MDC ^MDC_DIM_MMHG^MDC F OBX 10 NM ^MDC_PRESS_BLD_ART_PULM_DIA^MDC ^MDC_DIM_MMHG^MDC F OBX 11 NM ^MDC_PRESS_BLD_ART_PULM_MEAN^MDC ^MDC_DIM_MMHG^MDC F OBX 12 NM ^MDC_PLETH_PULS_RATE^MDC ^MDC_DIM_BEAT_PER_MIN^MDC F OBX 13 NM ^MDC_PRESS_BLD_ATR_LEFT_MEAN^MDC ^MDC_DIM_MMHG^MDC F OBX 14 NM ^MDC_PRESS_BLD_VEN_CENT_MEAN^MDC ^MDC_DIM_MMHG^MDC F Note: Extensive message examples on the PCD FTP Site: ftp://ftp.ihe.net/patient_care_devices/connectathonsincludingprocessandtesting Page 36

37 PCD-01 WAN Example CommunicatePCDData.xml <?xml version="1.0" encoding="utf-8"?> <soapenv:envelope xmlns:soapenv=" <soapenv:header xmlns:wsa=" <wsa:to soapenv:mustunderstand="true"> </wsa:to> <wsa:from soapenv:mustunderstand="true"> <wsa:address> </wsa:address> </wsa:from> <wsa:messageid soapenv:mustunderstand="true"> urn:uuid:a d1a </wsa:messageid> <wsa:action soapenv:mustunderstand="true"> urn:ihe:pcd:2010:communicatepcddata </wsa:action> </soapenv:header> <soapenv:body> <CommunicatePCDData xmlns="urn:ihe:pcd:dec:2010"> MSH ^~\& AcmeInc^ACDE ABCD^EUI ORU^R01^ORU_R01 MSGID1234 P 2.6 NE AL IHE PCD ORU- R ^HL7^ n.m^HL7 PID ^^^Imaginary Hospital^PI Doe^John^Joseph^^^^L^A M OBR 1 AB12345^AcmeAHDInc^ACDE ABCD^EUI-64 CD12345^AcmeAHDInc^ACDE ABCD^EUI ^MDC_DEV_SPEC_PROFILE_BP^MDC OBX ^MDC_DEV_SPEC_PROFILE_BP^MDC 1 R ABCDEF^EUI-64 OBX ^MDC_PRESS_BLD_NONINV^MDC R OBX 3 NM ^MDC_PRESS_BLD_NONINV_SYS^MDC ^MDC_DIM_MMHG^MDC R OBX 4 NM ^MDC_PRESS_BLD_NONINV_DIA^MDC ^MDC_DIM_MMHG^MDC R OBX 5 NM ^MDC_PRESS_BLD_NONINV_MEAN^MDC ^MDC_DIM_MMHG^MDC R </CommunicatePCDData> </soapenv:body> </soapenv:envelope> Note: Example from CP-PCD-WAN-[T]Transport-WS-pss.1b.doc Page 37

38 PCD Published Profiles RTM Profile Rosetta Terminology Mapping Trial Implementation Page 38

39 Rosetta for Semantic Interoperability Page 39

40 Rosetta for Semantic Interoperability Vendor Semantics Vendor A Vendor B Vendor C ISO/IEEE Semantic Standards Vendor Terms RTM 1400 rows Harmonized Terms hrtm 440 terms Open consensus process Observation identifiers and co-constraints New terms incorporated into standards hrtm used for conformance testing IHE PCD Technical Framework Content HL7 V2 Messages HL7 V3 CDA/CCD PnP Comm Page 40

41 Harmonized Rosetta (hrtm) Specifies for each IEEE REFID observation identifier: the MDC and UCUM units-of-measure includes dimensional analysis to ensure correct units-math enumerated values and measurement sites numeric codes, where appropriate An extract from the hrtm is shown below: Group REFID DIM UOM_MDC UOM_UCUM CVS_ECG_HR MDC_ECG_HEART_RATE T-1 MDC_DIM_BEAT_PER_MIN {beat}/min {beats}/min 1/min /min CVS_ECG_ST MDC_ECG_AMPL_ST_I ML2I-1T-3 ML2I-1T-3 MDC_DIM_MILLI_VOLT MDC_DIM_MICRO_VOLT MDC_DIM_MILLI_M# mv uv mm# (added by scripting rule) (voted off-the-island ) GASMON_AA_ENFL MDC_CONC_ENFL_ET L3L-3 LMT-2L-2 LMT-2L-2 MDC_DIM_VOL_PERCENT MDC_DIM_KILO_PASCAL MDC_DIM_MMHG %{vol} kpa mm[hg] Page 41

42 RTM & hrtm Highlights Unified semantics and semantic model are essential prerequisites for safe and effective interoperability between devices and systems. The hrtm rigorously defines what may be sent and informs recipients of what they may expect to receive. For each observation identifier, the hrtm specifies the units-of-measure, enumerated values, measurement sites and other co-constraints. The hrtm is based on the ISO/IEEE standards and leverages and extends that work by using an open consensus process. The hrtm is publicly available for IHE PCD clinical devices and will be available shortly for IEEE personal health devices. The hrtm supports message conformance testing frameworks that can be used for both clinical and personal health devices. Page 42

43 Rosetta Release 3m Review Release files in Attachments PHD Terms to be added in July 10! Page 43

44 Connectathon Test Scripts (Review Scripts on FTP Site) Page 44

45 Patient-Device ID Binding (PIB) How should this be handled over the WAN interface? Not currently defined in Continua / IHE nor in previous U.S. HITSP work. ITI-PDQ ITI-PAM Adding ITI-31 PEC Note: This is currently an option to DEC for coordinating authenticated patient IDs. Page 45

46 IT Infrastructure Domain (ITI) Supports profiles which supply necessary infrastructure for sharing healthcare information. IT Infrastructure domain began in 2003 and now has 27 profiles that it supports. Key ITI profiles HIMSS 10 Showcase in Atlanta: Information Exchange: XDS.b, XDM, XDS-SD, RFD Security: ATNA, CT, XUA, BPPC Identity Management: PIX, PDQ (HL7 V2 & V3) Page 46

47 Categories of Healthcare Communication Services HIEs and RHIOs e.g. access last 6 mo. historical labs & encounter summaries Source persisted and attested health records Document Sharing e.g. get current list of allergies or med list from source Specific info snapshot provided on demand Dynamic Information Access Hospitals e.g. order lab test, track status and receive results 2 or more entities synchronize a task Workflow Management Patient and Provider Identity Management Security/Privacy Page 47

48 ITI Profiles Information Exchange Cross-Enterprise Document Sharing - b (XDS.b) Cross-Enterprise Sharing of Scanned Documents (XDS-SD) Cross Community Access (XCA) Document Metadata Subscription (DSUB) Multi-Patient Queries Cross-Enterprise Document Media Exchange (XDM) Cross-Enterprise Document Reliable Interchange (XDR) Notification of Document Availability (NAV) Retrieve Form for Data Capture (RFD) Retrieve Information for Display (RID) Patient Synchronized Applications (PSA) Terminology Sharing Value Sets colored text designates 2009 new profiles Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010 Page 48

49 ITI Profiles (Continued) Identify Management Patient Identifier Cross-Referencing (PIX) Patient Demographics Query (PDQ) Patient Identifier Cross-Referencing HL7 V3 (PIX V3) Patient Demographics Query HL7 V3 (PDQ V3) Patient Administration Management (PAM) Pediatric Demographics Option Cross-Community Patient Discovery (XCPD) Security/Privacy Cross-Enterprise User Assertion (XUA) Basic Patient Privacy Consents (BPPC) Enterprise User Authentication (EUA) Consistent Time (CT) Audit Trail and Node Authentication (ATNA) Personnel White Pages (PWP) Document Digital Signature (DSG) colored text designates 2009 new profiles Designates profiles being demonstrated at HIMSS Interoperability Showcase 2010 Page 49

50 ITI Profiles (Review Sections in ITI TF v2) Page 50

51 eworkshop Agenda Connectathon Overview & Workshop Review Technical Profile Overview Connectathon Testing Support Showcase Testing & Preparation Next steps HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 51

52 IHE-PCD Tooling Support Information wiki.ihe.net/index.php?title=pcd_tools wiki.ihe.net/index.php?title=pcd_testing All tools are open & free! All tools are works in progress beware Messaging Workbench (from U.S. VA) is very useful but challenging to use Page 52

53 NIST Test Tools See NIST HIMSS 10 Presentation NIST_HIMSS-2010-Showcase_r1.pdf See NIST IHE-HL7 Message validator Page 53

54 Medical Device Communication NIST Test Effort Page 54

55 Validation Operational Process: Origin of Test Assertions HL7 v2 Standard Message Definition IHE TF Message Transaction Constraints Conformance Profile (XML) HL7 v2 Standard Value Sets IHE TF Message Transaction Value Set Constraints Table Library (XML) Validation Engine ISO/IEEE Nomenclature Harmonized Rosetta Terminology Mapping Constraints Validation Context File (XML) IHE-PCD TF Message Transaction Test Assertions Test Case Specific Test Assertions Validation Assertions Context File (XML) Page 55

56 Test Environments Instance Testing Conformance (e.g., against HL7 V2.x or CDA) Implementation conforms to Spec. on which it is based Isolated System Testing Includes Instance Testing Activities Protocol Conformance Functional Behavior Conformance Features and Operational behavior correspond to Specs. Peer-to-Peer System Testing Includes Isolated System Testing Activities Interoperability Testing Testing complete application environment May include interacting w/ Database, using Network Communications, or interacting w/ other hardware, apps, or systems if appropriate Page 56

57 NIST Tools: Instance System Test Environment Conformance Testing of an HL7 V2 Message HL7 V2 Message Validation Services Report Test Artifacts Conformance Profile HL7 Tables Device Test Agents ISO/IEEE 11073/Rosetta Terminology Test Management HL7 V2 Message Validation Test Case Test Execution Test Harness (Java Code) Web Application Client Results HL7 V2 Message Validation Report HL7 V2 Message User Registry/ Repository Page 57

58 NIST Tools: Isolated System Test Environment IHE-PCD Testing using a Web Application Client Services HL7 V2 HL7 V2 Message Message Validation Generation IHE-PCD IHE-PCD DOC DOR/DOF Test Agent Test Agent IHE-PCD IHE-PCD IOC IOR Test Agent Test Agent IHE-PCD IHE-PCD AM AR Test Agent Test Agent Test Management IHE-PCD Client Test Scenario Test Execution Test Harness (Java Code) Web Application Client Results HL7 V2 Message Validation Reports Vendor IHE-PCD IDCC Test Agent IHE-PCD IDCR Test Agent Report Router/Logger/Proxy System Under Test Page 58

59 NIST Tools: Peer-2-Peer Test Environment A Framework for Building Test Systems an SOA Approach Services Test Management Test Data Generation Validation Test Agent Test Description Results User Test Artifacts Report Evaluation Agent Time Test Harness Test Execution Test Analyzer Facilitator Logging Security Log Analyzer Proxy Specialized Validation Aggregated Services System Under Test Monitor External Services Other Services Router/Logger/Proxy System Under Test Page 59

60 NIST Links Determining timing of availability of NIST tools for PHD PCD-01 & WS-I testing NIST Tool Sites: MDC Testing Web site: IHE-PCD Pre-Connectathon Web site: IHE-PCD Connectathon Web site: HL7WebCon/ Page 60

61 eworkshop Agenda Connectathon Overview & Workshop Review Technical Profile Overview Connectathon Testing Support Showcase Testing & Preparation Next steps HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 61

62 IHE Standards Adoption Process Develop technical specifications Identify available standards ( standards (e.g. e.g. HL7, DICOM, IEEE, IETF) Testing at Connectathons IHE Demonstrations Products with IHE Document Use Case Requirements Improved safety, quality & efficiency! Easy to integrate products 62 Page 62

63 Showcase shows Clinical Application Page 63

64 Develop & Present Real-World Use Explain to attendees how your systems support interoperability! Page 64

65 Develop Showcase Topology Page 65

66 eworkshop Agenda Connectathon Overview & Workshop Review Technical Profile Overview Connectathon Testing Support Showcase Testing & Preparation Next steps HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 66

67 Steps leading to Daegu 10 Start weekly discussions Resolve technical issues Finish Recruitment (3x3 testing) Finalize Rosetta requirements <many other issues will arise!> Pre-Connectathon Testing Virtual Connectathon Testing Connectathon! Page 67

68 Q & A Todd Cooper President Breakthrough San Diego America s Finest City (e) t.cooper@ieee.org (v) (s) ToddCooperX73 HIMSS Page CE-IT Symposium Plug-and-Play Solutions Foundry, Page Inc. 68

69 Extra Slides Page 69