5 3 hitch-hikers jump into a magic bus Radio Land Profiles Actors Transactions Basic Security ADT 1, 12 Cardio Land Lab Land ADTRad-1,Rad-12Rad-1,Rad-12ADT The ITI Magic Bus CT ATNA EUA XUA PDQPIX XDS NAV DSG PAM
6 3 hitch-hikers jump into a magic bus Radio Profiles Actors Transactions Cardio Lab The ITI Magic Bus CT ATNA EUA XUA PDQPIX XDS NAV DSG PAM PathologyPCCPCD RID PSA PWP SWF PIR …
10 PAM scope Acute care setting Care providers community Admitted & ambulatory Patient identification & demographics Patient Account & Encounter Patient Movement Admitted & ambulatory
11 Patient Identification All patients in PAM must be identified. PID-3 (CX, mandatory, repeatable) = Patient Identifier List Each patient identifier has an assigning authority (CX-4) Each identifier is typed (CX-5 = Identifier Type Code) PE = Living Subject Enterprise Number PI = Patient internal identifier assigned by the HC organization NH = National Health Plan Identifier
12 Encounter extends VisitEncounter extends Visit An interaction between a patient and care provider(s) for the purpose of providing healthcare-related service(s). Healthcare services include health assessment. Examples: inpatient hospital stay, emergency room visit, field visit (e.g., traffic accident), physicians office visit… Encounters may uniquely be identified in PAM: PV1-19 (CX) = Visit Number (CX-5 = VN)
13 Patient Account Assigned by accounting. Records all charges, invoices, payments A Patient Account may be associated with one Encounter, or span several Encounters. Accounts may uniquely be identified in PAM: PID-18 (CX) = Account Number (CX-5 = AN)
14 Movement extends TransferMovement extends Transfer An event describing a change of the situation of the patient in the context of the encounter. Examples: transfers of patient location, change of patient class, new attending doctor, new consulting doctor, new encounter starting, encounter closing Movements may uniquely be identified in PAM: ZBE-1 (EI, repeatable) = Movement Id List
15 Movements are events Patient received at the emergency room Two hours later, the patient is admitted to a ICU After two days, the patient is transferred to a regular bed in Medicine The patient is discharged In emergency ward In ICU In Medicine A04 Movement Id = M0 A06 Movement Id = M1 A02 Movement Id = M2 A03 Movement Id = M3 Movements are events that trigger sub-encounters = periods during which the patient situation is stable
22 ITI-31 is self-contained Encounter, account & movement information Patient identity and demographics (in the context of the encounter) The Patient Encounter Source sends in ITI-31 messages: In addition, ITI-31 also allows the Patient Encounter Source to send messages to the Patient Encounter Consumer for patient identity maintenance in the encounter context, including patient update and identity merge. Thus there is no required grouping for the Patient Encounter Consumer Actor: It may receive all information needed through the only transaction ITI-31.
23 ITI-31 Inpatient/Outpatient This is what the old ménage à trois (ADT, 1, 12) was up to.
24 PAM actors grouping To be able to put patient identity and demographics in its encounter messages of transaction ITI-31, a Patient Encounter Source is required to be grouped with either a Patient Demographics Source or a Patient Demographics Consumer: Patient Encounter Consumer Patient Encounter Source Patient Demographics Source ITI-31 Patient Encounter Consumer Patient Encounter Source Patient Demographics Consumer ITI-31 Patient Demographics Source ITI-30
26 PAM leveraged by domain profiles Domain Profile Order Placer Order Placer ADT Rad-12 Rad-1 Option 1 PAM Patient Demographics Consumer Patient Encounter Consumer Op t I o n 2 Patient Encounter Source Patient Demographics Source
27 Choice of the standard HL7 v2.5 The latest available balloted standard as of June 2005 For consistency with PDQ Extends the length of key data types (e.g. CX for patient identifiers), which is necessary for large affinity domains (assigning authority systematically mentioned) Enables a more expressive error reporting (in ACK messages) than previous versions. Brings built in message profiles, which facilitate the message validation. The PAM supplement uses the message static definitions at: Message level Segment level Data type level
28 Message static definition The applicative acknowledgement message (Original mode acknowledgement of HL7) The ERR segment is present if the receiving application encountered an error while integrating the original message.
29 Segment static definition The Error segment in the acknowledgement message
30 Data Type static definition ERL: Data Type of ERR-2 Example: ERR||MSH^1^9^1^1|200^unsupported message type^HL70357
31 Reminders Pay attention to the data types (Appendix N) Review the examples (Appendix P) Choose the options appropriate to your environment Choose the same options set for a pair of actors
32 Conclusion PAM mandates more fields and subfields, and brings more constraints than ADT, Rad-1 & Rad-12 did. On the other hand, PAM extends widely the capacities of these. It offers a rich set of options to meet the needs of all kinds of healthcare organizations. Not all options are needed for a particular implementation. PAM is a constrainable profile. Each organization must select the appropriate subset.