Tuesday, January 26, 2016

IHE day 2: testing XCPD

Our night out in Cleveland at the
House of Blues
It is day 2 at the IHE connectathon at the HIMSS global center for Health Innovation in Cleveland and the monitors have cleared 1158 tests so far, amazing.... I have started to test XCPD profile implementations (Cross Community Patient Discovery). This is a critical feature in case there is no central registry in place for an EMR to go to, such as a public or even private Health Information Exchange (HIE), which is used to register the patients and the documents as well as images which are available for these patients. 

A typical use case of the XCPD profile implementation would be of a retiree who is in Florida in the winter, gets lab work and potentially imaging done at the local hospital, and upon returning back to the North, to spend the summer close to his or her family, needs to provide access to this information.

We call these geographical areas that are connected “local communities”, which has a gateway that can be queried using patient information such as name, sex, birthdate, gender, address, etc. An EMR would talk with the local gateway who would talk with the remote gateway, and upon successful “discovery” of the patient, a query for the applicable documents and images can be done and they can be retrieved, for example by the primary physician. This is a good alternative to the architecture that requires multiple HIE’s, which were kind of a mixed success: some states have abandoned these due to lack of a sustainable business model, and therefore, ad-hoc discoveries using these community gateways might become the standard way for cross-enterprise information exchange.

Testing and validating these transactions is somewhat of a puzzle as you need to dig into the log files and search for the applicable XML coded tags for the appropriate returns, but it is exciting to see the support of this by the major EMR vendors who are present. It shows their commitment to true interoperability.