Cross-Enterprise Document Sharing (XDS)
Bill Majusrski (

Overview: A patient record constructed as a collection of clinical documents and organized by a document registry is a key component of an electronic health record (EHR). The challenge is to make these documents available to any healthcare professional, regardless of their organizational affiliation, enabling them to make quality healthcare decisions. The goal of this project is to collaborate in developing a standards-based registry infrastructure that will allow healthcare professionals to find and access all pertinent documents of clinical information regarding a patient regardless of the healthcare organization that creates and manage the documents.

Industry Need Addressed: The use of document registries for sharing clinical information intra-organizationally presents unique challenges. Standardized metadata, interfaces and formats are required for interoperability and interchange. The strict adherence to security and privacy policies related to healthcare information must be supported by the technology. Document registries, an emerging technology for indexing documents on a network, provide solutions to many of these challenges. A number of industrial and international standards organizations support current document registry standards.

NIST/ITL Approach: NIST/ITL is collaborating with industry to define standards-based approaches to clinical document registries. We are collaborating on the project 'Integrating the Healthcare Enterprise' (IHE), an industrial effort with a focus on interoperability of healthcare systems. NIST/ITL is a primary author of the IHE Profile: Cross-Enterprise Document Sharing. NIST/ITL has also developed a reference implementation for the XDS profile and a web-based test suite, allowing vendors to determine conformance to the XDS profile. Vendors also use the test suite as an early stage tool for interoperability testing.

The reference implementation is available as an open source project hosted on Source Forge, called IheOs (i.e., IHE Open Source), at The test suite is available at's_Cross-Enterprise_Document_Sharing.

Impact: The ability for healthcare professionals to access relevant clinical information will greatly improve the quality of care decisions and reduce the cost of healthcare in the US. Standardized clinical document registries can help move the healthcare industry forward in achieving this goal.