Cross-enterprise Cross-enterprise Document WorkflowDocument Workflow

(XDW)(XDW)

IT Infrastructure Technical CommitteeIT Infrastructure Technical CommitteeEditors: Luca Zalunardo, Arianna Cocchiglia, Arsenal.ITEditors: Luca Zalunardo, Arianna Cocchiglia, Arsenal.IT

XDW - IntroductionXDW - Introduction

The Cross-Enterprise Document Workflow (XDW) profile enables participants in a The Cross-Enterprise Document Workflow (XDW) profile enables participants in a multi-organizationalmulti-organizational environment environment to manage and track the tasks related to patient-to manage and track the tasks related to patient-centric workflows centric workflows as they coordinate their activities:as they coordinate their activities:

No central controllerNo central controllerNo central schedulerNo central schedulerDecisions are made by the “edges” (providers, doctors, nurses, etc)Decisions are made by the “edges” (providers, doctors, nurses, etc)XDW coordinates these activitiesXDW coordinates these activities

Under Second Public Comment until August 26th 2011Under Second Public Comment until August 26th 2011

Necessity:Necessity:

• Many regional and national projects aim at Many regional and national projects aim at digitizing clinical processes (paperless) and digitizing clinical processes (paperless) and enhancing care coordination. enhancing care coordination.

• All expect to manage workflows beyond a single All expect to manage workflows beyond a single organization:organization:

For example: eReferral workflowsFor example: eReferral workflows

Flexible nature and processes for these workflowsFlexible nature and processes for these workflows

Clinical, economic, social and organizational impactClinical, economic, social and organizational impact

XDW - NecessityXDW - Necessity

XDW - Key Design Elements XDW - Key Design Elements

Key XDW design elements:Key XDW design elements:• Provides a common, workflow-independent approach to interoperability Provides a common, workflow-independent approach to interoperability • Enables the support of a wide range a specific workflow “content”Enables the support of a wide range a specific workflow “content”• Designed to support the complexity of health services delivery with flexibility to adapt Designed to support the complexity of health services delivery with flexibility to adapt • Provides the means to associate documents to a broad range of workflowsProvides the means to associate documents to a broad range of workflows• Easy to deploy: no addt’l centralized infrastructure . Scales to regions & nations.Easy to deploy: no addt’l centralized infrastructure . Scales to regions & nations.• Builds upon the secured sharing of health documents provided by other IHE profiles Builds upon the secured sharing of health documents provided by other IHE profiles

(e.g. XDS, ATNA, BPPC, etc.)(e.g. XDS, ATNA, BPPC, etc.)

XDW - Key Elements XDW - Key Elements

Workflow Document in XDW:Workflow Document in XDW:

• Specified by XDW is generic across specific workflow contentSpecified by XDW is generic across specific workflow content

• Manages workflow specific status with relationship to input/output documentsManages workflow specific status with relationship to input/output documents

• Tracking the current/past steps of the workflow and engaged health care entitiesTracking the current/past steps of the workflow and engaged health care entities

• Workflow driven/enforced by the XDW actors, infrastructure provides transparencyWorkflow driven/enforced by the XDW actors, infrastructure provides transparency

Structure of the step in the Structure of the step in the XDW Workflow DocumentXDW Workflow Document

Workflow Document Structure:Workflow Document Structure:• Overall workflow contextOverall workflow context• Task level InformationTask level Information

Task Task describes an activity that is planned or describes an activity that is planned or has been accomplished. Attributes of the has been accomplished. Attributes of the task:task:

• TypeType• OwnerOwner• Current Status Current Status (created, in-progress, completed, etc.)(created, in-progress, completed, etc.)

• References to documents used for input or References to documents used for input or produced as outputproduced as output

• The The Task Event History Task Event History tracks the past tracks the past Task Task EventsEvents, up to the present state, up to the present state

Use Case: an example of Use Case: an example of eReferral workfloweReferral workflow

Task B: ReferredTask B: ReferredSS

ttaattuuss 11:: IInn PPrrooggrreessss

Task A: RequestedTask A: RequestedStatus 1: CompletedStatus 1: Completed

2a-2a-Admission of Admission of the patientthe patient

2b- Start of 2b- Start of the the

ConsultationConsultation

3 – End of the 3 – End of the consultation and consultation and creation of the creation of the clinical reportclinical report

4 – Possible 4 – Possible notification to the notification to the

GPGP

1-Visit and 1-Visit and production of production of

eReferraleReferral

The workflow within the organization is encapsulated into a single XDW step

Task B: ReferredTask B: ReferredSS

ttaattuuss 22:: CCoommpplleetteedd

XDW

Evolutionof sharedWorkflowDocument

XDW

Evolutionof sharedWorkflowDocument

WorkflowDescriptionWorkflowDescription

Use Case: an example of eReferral workflow(2)Use Case: an example of eReferral workflow(2)

Selected Standards & SystemsSelected Standards & Systems

• XDW Supplement introduces a XDW Supplement introduces a new content profile new content profile for for a workflow management documenta workflow management document

• OASIS Human Task for task structure and encodingOASIS Human Task for task structure and encoding

• HL7 CDA for patient and provider description HL7 CDA for patient and provider description

• No new transaction No new transaction are introduced. Leverages existing are introduced. Leverages existing ITI IHE Profiles: ITI IHE Profiles: XDS.b, DSUB, XCA, XDR, XDM, BPPC, ATNA, XDS.b, DSUB, XCA, XDR, XDM, BPPC, ATNA,

• No XDS Metadata extensionNo XDS Metadata extension, but specific rules about , but specific rules about XDS Metadata content for the registry entry XDS Metadata content for the registry entry associated to the XDW Workflow Documentassociated to the XDW Workflow Document

XDW profile – 2010/2011 programXDW profile – 2010/2011 program

MilestonesMilestones• IHE Planning Committee: Selected October 2010• IHE Technical Committee: First Public Comment: June 3rd – July 3rd 2011

• IHE Technical Committee: Second Public CommentIHE Technical Committee: Second Public Comment– Until August 26Until August 26thth 2011 2011– Comment Resolution – Sept 2011Comment Resolution – Sept 2011

• Trial Implementation Profile Specification available: Trial Implementation Profile Specification available: September 2011September 2011

Ready for implementationReady for implementation• XDW testing:XDW testing:

Pilot implementation January 2012 (Chicago - North America)Pilot implementation January 2012 (Chicago - North America)European Connect-a-thon May 2012 (Bern - Switzerland)European Connect-a-thon May 2012 (Bern - Switzerland)

DiscussionDiscussion

The objective The objective of this profile is:of this profile is:

• The standardization of the workflows’ management The standardization of the workflows’ management transactions and the associated workflow tracking transactions and the associated workflow tracking structure linked with clinical eventsstructure linked with clinical events

• The creation of a The creation of a document structure document structure able to respond to able to respond to the present and possibly to extend to future requirementsthe present and possibly to extend to future requirements

• This profile proposal benefits many domains. So it This profile proposal benefits many domains. So it increases the consistency of increases the consistency of workflow interoperability workflow interoperability and the skill to solve the requests of the various care and the skill to solve the requests of the various care areas. It will avoid that different competing solutions are areas. It will avoid that different competing solutions are developed in the different IHE domains.developed in the different IHE domains.

DiscussionDiscussion

The value statement The value statement of this profile is:of this profile is:• Provides a platform upon which a wide range of specific Provides a platform upon which a wide range of specific

workflows can be defined workflows can be defined with minimal specification and with minimal specification and implementation effortsimplementation efforts (e.g., Medical Referrals Workflow, (e.g., Medical Referrals Workflow, Prescriptions Workflow, Home Care Workflow). Prescriptions Workflow, Home Care Workflow).

• Increases the consistency of workflow interoperability, and Increases the consistency of workflow interoperability, and enables the development of interoperable workflow enables the development of interoperable workflow management applications where management applications where workflow-specific workflow-specific customization is minimized customization is minimized

• Facilitates the integration of multi-organizational workflows Facilitates the integration of multi-organizational workflows with the variety of existing workflow management systems with the variety of existing workflow management systems used within the participating organizations (peer-to-peer)used within the participating organizations (peer-to-peer)