Cross Domain Patient Identity Management Eric Heflin Dir of Standards and Interoperability/Medicity

Audience/Scope Audience –Senior Healthcare IT Technical Executives –Implementation Architects –Implementers seeking an overview Scope –Broad context and guidance about the use of IHE standard profiles for patient identity management

Definitions Patient Identifier: A value controlled and assigned by a single assigning authority (hospital, group of related practices, national health authority, etc.). Assigning authority: XDS Affinity Domain:

What Problem is Being Solved? Problem statements: How can we accommodate exchange of health information across organizational boundaries requiring identification of the same patient in different systems with different IDs using a standards-based approach? Assurance that health information is about the correct patient via correct identification of the patient of interest

IHE Approach IHE has created several mechanisms, or “profiles”, designed to solve this problem PIX, PIXv3, PDQ, PDQv3, XCPD, PAM

PIX Definition PIX = Patient Identifier Cross Referencing Definition: Allows a patient identifier assigned by one assigning authority to establish and maintain an identifier relationship assigned by another assigning authority Status: “Final Text”

PIX v2 vs. PIX v3 Identical purpose, different underlying standards HL7 v2 messaging is used for PIX v2 HL7 v3 messaging is used for PIX v3

PIX Use Case Use case

PIX Transaction Diagram Insert transaction diagram from ITI TF

PIX Actors List each PIX actor List each PIX transaction

PIX Options List and define each PIX option

PIX Workflow(s) List one or more typical workflows Should be a less technical diagram, like the appendix, not a UML sequence diagram

PIX Security and Privacy Describe how security and privacy are implemented for this profile

PDQ PDQ = Patient Demographic Query PDQ is designed to allow for a query across domains using, as the name implies, demographic information Status: Final Text? Other topics…

PDQ Use Case Use case

PDQ Transaction Diagram Insert transaction diagram from ITI TF

PDQ List and define each PDQ actor List each PDQ transaction

PDQ Options List and define each PDQ option

PDQ Workflow(s) List one or more typical workflows

PDQ Security and Privacy Describe how security and privacy are implemented for this profile

PDQ Typical Architecture Simplistic architectural diagram

XCPD XCPD = Cross Community Patient Discovery XCDP is designed … XCPD is different than PDQ in the following ways… –Async, optimized, reverse query, etc. Used for the Nationwide Health Information Network Exchange 2010 Patient Discovery Production Specification

XCPD Maturity Relatively new profile, just entering first year of “Trial Implementation” status Deployed by NHIN Exchange participants Will be demonstrated for the firs time at the 2011 IHE Connectathon?

XCPD Use Case Use case

XCPD Transaction Diagram Insert transaction diagram from ITI TF

XCPD Actors List and define each XCPD actor List each XCPD transaction

XCPD Options List and define each XCPD option

XCPD Workflow(s) List one or more typical workflows

XCPD Security and Privacy Describe how security and privacy are implemented for this profile

Typical XCPD Architecture Simplistic diagram

Patient Administration Repeat the above for PAM

References For more information on this topic, please see: –IHE content

Other topics??

August 18, 2005 IHE Technical Webinar 35 IHE ITI Integration Profile XDS: Clinical Information Sharing in RHIO US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Query Documen t Retrieve Document Provide & Register Register Provide & Register Register Retrieve Document Query Documen t Document Registry Document Repository ED Application In order to publish or query clinical documents in XDS Affinity Domain (XAD), applications need to look-up XAD Patient ID using their local patient information, e.g., Patient ID in local domain and demographics

August 18, 2005 IHE Technical Webinar 36 Look-Up XDS Affinity Domain Patient ID with Local PIX Service US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application A87631 M L-716 M Patient Identity Feed PIX Query

August 18, 2005 IHE Technical Webinar 37 Look-Up XDS Affinity Domain Patient ID with Affinity Domain PIX Service US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application M L-716 A87631 Patient Identity Feed PIX Query Patient Identity Feed M A L-716

August 18, 2005 IHE Technical Webinar 38 Query Affinity Domain PDQ Service for XDS Affinity Domain Patient ID US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application PDQ Query to Acquire XAD Patient ID Patient Demographics Supplier

August 18, 2005 IHE Technical Webinar 39 IHE IT Infrastructure Integration Profiles Provide a Solid Foundation for EHR Management Cross-enterprise Patient Health Information Management Architectural Principles: A Patient Information Source administers patient records (demographics) and manages a Patient Identification Domain to identify these patient records on that domain Patient ID is assigned / maintained within a managed Patient Identification Domain Search patient records (in a patient information source) → PDQ Integration Profile Look-up Patient ID in federated domains → PIX Integration Profile Locate healthcare information (documents or services) → XDS Integration Profile

August 18, 2005 IHE Technical Webinar 40 IHE PIX / PDQ Profiles Implementation Considerations Master Patient ID Domain Administration and Service Functions PIX Notification Service PIX Query Service PDQ Service Enhanced PDQ Service MPI Service Patient Identity Source HL7 Service defined in IHE Technical Framework Service out of IHE scope Patient Identity Feed Service

August 18, 2005 IHE Technical Webinar 41 IHE ITI Integration Profile XDS: Clinical Information Sharing in RHIO US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Query Documen t Retrieve Document Provide & Register Register Provide & Register Register Retrieve Document Query Documen t Document Registry Document Repository ED Application In order to publish or query clinical documents in XDS Affinity Domain (XAD), applications need to look-up XAD Patient ID using their local patient information, e.g., Patient ID in local domain and demographics

August 18, 2005 IHE Technical Webinar 42 Look-Up XDS Affinity Domain Patient ID with Local PIX Service US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application A87631 M L-716 M Patient Identity Feed PIX Query

August 18, 2005 IHE Technical Webinar 43 Look-Up XDS Affinity Domain Patient ID with Affinity Domain PIX Service US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application M L-716 A87631 Patient Identity Feed PIX Query Patient Identity Feed M A L-716

August 18, 2005 IHE Technical Webinar 44 Query Affinity Domain PDQ Service for XDS Affinity Domain Patient ID US Exam System Physician Office EHR System A87631 Teaching Hospital XDS Clinical Affinity Domain Community Clinic Lab Info. System PACS L-716 PACS XAD Patient Identity Source M Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application PDQ Query to Acquire XAD Patient ID Patient Demographics Supplier

August 18, 2005 IHE Technical Webinar 45 IHE IT Infrastructure Integration Profiles Provide a Solid Foundation for EHR Management Cross-enterprise Patient Health Information Management Architectural Principles: A Patient Information Source administers patient records (demographics) and manages a Patient Identification Domain to identify these patient records on that domain Patient ID is assigned / maintained within a managed Patient Identification Domain Search patient records (in a patient information source) → PDQ Integration Profile Look-up Patient ID in federated domains → PIX Integration Profile Locate healthcare information (documents or services) → XDS Integration Profile

August 18, 2005 IHE Technical Webinar 46 IHE PIX / PDQ Profiles Implementation Considerations Master Patient ID Domain Administration and Service Functions PIX Notification Service PIX Query Service PDQ Service Enhanced PDQ Service MPI Service Patient Identity Source HL7 Service defined in IHE Technical Framework Service out of IHE scope Patient Identity Feed Service