The ability to go peer to peer to collect the image or clinical document is
a key function of the IHE XDS model, however it allows for offsite storage
as well. IHE may have started life as a US radiology integration system but
it is a lot more versatile now.

I agree in general with the point of minimising any central infrastructure
required for communication, however we have to accept that some will be
required eg. The internet,  Identity services for patients, provider
directories and referral management infrastructure for some referral
situations and requirements, security management etc.  We cant remain total
individualists! If we do we wont need to communicate. 

Regards

Peter MacIsaac
MacIsaac Informatics

Consulting in Health Informatics, Terminology & Data management and Health
Policy.

[EMAIL PROTECTED] 

0411403462 (mobile)
61611327 (office)
peter_macisaac (skype)

8 Ewart St. Yarralumla 2600

"We trained hard, but it seemed every time we were beginning to form up into
teams, we would be reorganised. I was to learn later in life that we tend to
meet any new situation by reorganising, and a wonderful method it can be for
creation the illusion of progress while producing confusion, inefficiency
and demoralisation." 

- From Pertonii Arbitri AD 66, attributed to Gaius Petronus, a Roman General
who later committed suicide. 


-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Andrew N. Shrosbree
Sent: Wednesday, 10 May 2006 5:01 PM
To: [EMAIL PROTECTED]; General Practice Computing Group Talk
Subject: Re: [GPCG_TALK] IHE and XDS - sharing of documents and

What I find appealing is that when the user needs the image, they establish
a direct peer-to-peer connection that does not have to go through an
intermediary gateway.


Tim Churches wrote: 

        Andrew N. Shrosbree <[EMAIL PROTECTED]>
<mailto:[EMAIL PROTECTED]>  wrote:
          

                Gavan,
                
                Your question regarding whether it is appropriate to use a
US-centric 
                radiology model is very pertinent. The IHE model is, IMO,
excellent for 
                handling the kind of huge blocks of data inherent in the
retrieval of 
                images. Having only a 'manifest' stored centrally makes the
process 
                extremely efficient. 
                    

        
        In what way does having a central "manifest" make the process
extremely, or even more efficient? The actual (large) image files still need
to be sent or retreived from provider to client (or v-v). The only
difference is that in the IHE model the recipient polls the central
"manifest" Web service to see if anything is waiting to be picked up by it,
whereas in the direct Web service model which we have been discussing, the
sender tries to send directly to the recipient and if the recicient is not
contactable, teh sender tries again later and/or takes alternative action
(eg if the information is urgent).
        
        As has been discussed, the overhead of resending iff (if and only
if) a recipient Web service is offline is not likely to be any more than the
overhead of everyone having to constantly poll a central "manifest" service
or clearinghouse. Plus it avoids the very significant central point of
failure which a "manifest" service represents. And as Gavin points out, the
IHE model of a central manifest doesn't help when more complex interactions
between Web services are involved, rather than just "Here's Mrs Blogg's
chest xray".
        
        Tim C
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-- 
Andrew N. Shrosbree B.Sc, B.Ec
Technical Director
ArgusConnect Pty Ltd
http://www.argusconnect.com.au
Suite 4, Greenhill Centre, Mt Helen
Victoria, Australia
Tel: +61 (0)3 5335 2214
Mob: +61 (0)415 645 291
Skype: andrewshroz



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