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Bye bye IHE XDS and CDA.

Publication date: Sep 01, 2021

IHE XDS.b has reached the end of its life cycle - requirements in healthcare have moved beyond the mere exchange of documents, and the underlying technology is getting to be too old. We're no longer offering IHE XDS.b courses. There is a future in hybrid architectures which support document-based exchanges as well as other workflows.

When it comes to interoperability standards training courses act as the proverbial canary in the coalmine: when demand for training in a standard drops, this implies that the number of new projects using that standard is dwindling. If in cunjunction with a drop in interest in training courses one sees a drop in the number of volunteers working on a standard, and a drop in the number of (open source / commercial) tools that support the use and/or development of that standard, then this is a sure sign that usage is in decline.

CDA and CDA training courses

We've experienced a sharp decline for HL7 version 3 training courses in the past, and demand for CDA courses suddenly plummeted about 7 years ago. Some (national/regional) projects have heavily invested in CDA, and they still produce new CDA implementation guides. That's just a few countries however (e.g. Austria, Saudi Arabia). Others (e.g. the US) still use CDA, whilst working on porting the current CDA capabilities to FHIR documents.

For the reasons above we've decided to no longer offer any CDA training courses. The 'clinical document' principles (a suitable option for some healthcare data exchange scenarios) will be covered as part of our FHIR training course. As already indicated in a blogpost from 2015 the future of (the principles underlying) CDA will be based on FHIR.

IHE XDS and XDS training courses

IHE XDS.b (the second/current iteration of the IHE XDS workflow profile) was created in 2005. Many healthcare organizations were working on their intial architecture to exchange summary information with other organizations, and as such IHE XDS offered a good solution. XDS.b is used all over the world and it will be used for some time to come. The following two key issues have arisen over the past few years:
  1. No longer fit for todays requirements: the healthcare sector has moved on, partly because of (national) legislation or incentives (e.g. European GDPR, US Cures Act) - the requirement nowadays is to move beyond the exchange of (static) documents, and to combine such exchanges with the support for non-document based workflows (e.g. electronic order management, scheduling) which require the exchange of structured transactional data. IHE have tried to enhance XDS with 'on demand documents' and XDW-workflow support, but to me these are symptoms of 'if all you support is documents, everything must be a document'. Grouping data in a document is a powerful exchange mechanism, but there's more than just that.
  2. Old technology stack: XDS.b uses an old technology stack dating back to the 2000s (WebServices/WS-*, ebRIM as a standard to express document metadata). Now that's fine for powerful back-end systems, but not so nice if one wishes to create light-weigth web based applications.

To use the udnerlying architectural model of XDS (document exchange, based on a registry with document metadata) effectively, XDS will need to be upgraded to

  • Use a more modern technology stack (FHIR/REST based, see my XDS.c blogpost from 2016). IHE has published the MHD profile, as well as the MHDS meta-profile to accomplish this update, but they haven't gone as far as stating that this will be the next version of XDS.
  • To better allow for the XDS architectural model to be mixed with non-document based exchanges. The switch to FHIR/REST (as per MHD/MHDS) will certainly make such mixed architectural models easier to implement.

For the reasons above we've decided to no longer offer any IHE XDS.b training courses. The XDS document exchange principles (a suitable option for some healthcare data exchange scenarios) will be covered as part of our FHIR training course. We expect MHD and MHDS gain more traction, and we'll introduce a new training course to cover these profiles as implementation picks up.

-Rene

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About Ringholm bv

Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
See https://www.ringholm.com for additional information.
Rene's Column (English) Rene is the Tutor-in-chief of Ringholm.
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