Exchanging Imaging Documents Outside a Specific Health Information Exchange Domain

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Type Standard Implementation/Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard
Final
Production
Feedback Requested
No
Free
No
Implementation Specification
Final
Pilot
Rating 1
No
Free
Yes
Implementation Specification
Final
Production
Rating 4
No
Free
Yes
Limitations, Dependencies, and Preconditions for Consideration Applicable Security Patterns for Consideration
  • IHE-PIX and IHE-XCPD are used for the purposes of patient matching and to support this interoperability need.
  • See IHE projects in the Interoperability Proving Ground.
  • Secure Message Router – securely route and enforce policy on inbound and outbound messages without interruption of delivery.
  • Authentication Enforcer – centralized authentication processes.
  • Authorization Enforcer – specifies access control policies.
  • Credential Tokenizer – encapsulate credentials as a security token for reuse  (e.g., – SAML, Kerberos).

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As a member of the Direct Project Workgroup, I would like to highlight work in progress to make the Direct Protocol feasible for image exchange and DICOM study exchange.  The workgroup is testing the concept of message fragmentation (defined in RFC2046 section 5.2.2).  This technique when combined with the Trust, Encryption, and Delivery notification standards of the Direct Protocol create an opportunity to eliminate the SMTP limit of 10 MB for message size and also eliminate the need for expensive persistent connections between parties.  With Direct, any party with a Direct Address can immediately inter-operate with any other party with a Direct Address.  This cost reduction should lead to more widespread Image Exchange.

Bruce Schreiber

CTO MaxMD