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Standards & Testing Infrastructure

HIT: Standards and Testing Infrastructure


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 manages the documents.

Industry Need Addressed

It started with a focus on document registries targeting sharing within a localized community. It has expanded to a collection of 17 interoperability profiles all focused on standardized metadata and interfaces needed 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 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 test suite for the XDS and related profiles, allowing vendors to determine conformance to the profiles. The test suite is also used in validation steps of interoperability testing.

The reference implementation is available as an open source project hosted on Source Forge and BitBucket, called IheOs (i.e., IHE Open Source). Links to these resources are maintained at


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.

Created July 8, 2015, Updated August 25, 2016