1. Cross-Community Patient Identification (XCPI) Brief Profile Proposal for 2009 presented to the IT Infrastructure Technical Committee Karen Witting November 18, 2008

2. IT Infrastructure Planning Committee The Problem What problem is this profile proposal hoping to address?What problem is this profile proposal hoping to address? –The XCA profile requires that the Patient Identifier be known and the community of interest be known but does not specify an IHE recognized mechanism for doing this. Identify any existing IHE profile gaps/overlaps that this proposal will improve uponIdentify any existing IHE profile gaps/overlaps that this proposal will improve upon –XCA What is the market readiness for this IHE profile proposal?What is the market readiness for this IHE profile proposal? –U.S. NHIN project has specified a solution for the problem –Austria is said to have a different solution –Many other countries looking to implement XCA and considering a variety of mechanisms What is the risk of this proposal not being undertaken this cycle?What is the risk of this proposal not being undertaken this cycle? –Every region/country defines its own solution. These custom built solutions are more expensive and cannot be tested at connectathons. This results in higher cost for all countries, who must pay for a one-of-a-kind solution and less reliable solutions, since they cannot be tested a connectathons.

3. IT Infrastructure Planning Committee Use Case Karen is on vacation in Reno, Nevada and becomes illKaren is on vacation in Reno, Nevada and becomes ill Karen visits a clinic where she is diagnosed with pneumonia and sent to the local hospitalKaren visits a clinic where she is diagnosed with pneumonia and sent to the local hospital Karen is admitted to the hospital and receives inpatient treatment for 5 daysKaren is admitted to the hospital and receives inpatient treatment for 5 days Karen returns home to New York and visits her primary care physician to follow-up on her illness. The physician’s electronic medical records system communicates with the community’s Initiating Gateway to request Karen’s records from Reno. To satisfy this request the Initiating Gateway has the following problems (in addition to security/privacy which is not addressed here) :Karen returns home to New York and visits her primary care physician to follow-up on her illness. The physician’s electronic medical records system communicates with the community’s Initiating Gateway to request Karen’s records from Reno. To satisfy this request the Initiating Gateway has the following problems (in addition to security/privacy which is not addressed here) : –Which of the several communities in Nevada contain Karen’s records from the visit to the clinic – which has the first chest X-ray which diagnosed pneumonia and what is Karen’s patient identifier within that community. –Which of the several communities in Nevada contain Karen’s records from her hospital stay and what is Karen’s patient identifier within that community. –Having answered the above questions the Initiating Gateway is able to use XCA to retrieve the records and supply them to the physician’s electronic medial records system for review by Karen’s primary care physician

4. IT Infrastructure Planning Committee Proposed Standards & Systems What standards and/or systems should be considered in addressing this proposal?What standards and/or systems should be considered in addressing this proposal? –HL7 V2 Messaging –HL7 V3 Messaging –PIX (V2, V3) –PDQ (V2, V3) –Entity Identification Service Functional Model from HSSP

5. IT Infrastructure Planning Committee Discussion What level of effort do you foresee in developing this profile?What level of effort do you foresee in developing this profile? –Medium Is there someone who is willing to act as profile editor? Please provide the name, organization, emailIs there someone who is willing to act as profile editor? Please provide the name, organization, email –Karen Witting ITI White Paper “Cross-Community Information Exchange” includes a technical discussion of the XCA gap. The white paper is waiting for publication to http://www.ihe.net/Technical_Framework/index.cfm#IT but is available in the meantime at ftp://ftp.ihe.net/IT_Infrastructure/TF_Maintenance-2007- 2008/TF/CommitteeVersions/9_26_release/IHE_ITI_TF_White_Paper_ Cross_Community_2008-09-25.docITI White Paper “Cross-Community Information Exchange” includes a technical discussion of the XCA gap. The white paper is waiting for publication to http://www.ihe.net/Technical_Framework/index.cfm#IT but is available in the meantime at ftp://ftp.ihe.net/IT_Infrastructure/TF_Maintenance-2007- 2008/TF/CommitteeVersions/9_26_release/IHE_ITI_TF_White_Paper_ Cross_Community_2008-09-25.dochttp://www.ihe.net/Technical_Framework/index.cfm#IT

6. IT Infrastructure Planning Committee Existing solutions Share patient identifiers Both communities use the same patient identification domain so no cross referencing is needed. Patient locations are identified when a query results in no matching records. Use top-most PIX All communities feed local patient identifiers to a top-most PIX which provides cross-referencing. Use PDQ interactions Communities send a PDQ Query to communities of interest and make assumptions based upon response – many unanswered questions with this approach Home grown variation

7. IT Infrastructure Planning Committee Topmost PIX Server XDS Registry Initiating Gateway Document Consumer Meta-Community using existing IHE Profiles XDS Registry XDS Repository Patient Identity Source Patient Identity Source Patient Identity Source (1) (3) (2) XDS Registry (4) (5) XDS Repository (6) Meta-Community Community A Community B Community C Responding Gateway Responding Gateway

8. IT Infrastructure Planning Committee Do you know Karen Witting? Yes, she is ID 44398402 in domain 88.693.222.4 No Maybe When to ask? What side-effects from asking? XCA Gateway for community A XCA Gateway for community B What if A doesn’t agree with match? What if demographics change after match? What if later Karen shows up in B? How and when is this resolved?