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Infrastructure—Patient Index and Demographics Implementation Strategies Yongjian Bao GE Healthcare May 16, 2007.

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Presentation on theme: "Infrastructure—Patient Index and Demographics Implementation Strategies Yongjian Bao GE Healthcare May 16, 2007."— Presentation transcript:

1 Infrastructure—Patient Index and Demographics Implementation Strategies
Yongjian Bao GE Healthcare May 16, 2007

2 Why Patient Identity Management
Establishing Reliable Patient Identity is a Critical Infrastructure Component in Health IT Bind clinical data to its subject of care Identity Life-Cycle Management is the Key to Accurate Identification of Patient Ensure consistent patient data across all clinical domains and applications EHR Drives Need for Patient Identity Process Cross Health Enterprises Collect and access to Longitudinal EHR data

3 EHR Drives Needs for Patient Identity Management inter- and intra-Enterprise
US Exam System Physician Office Patient Registration Patient Registration Access Info in EHR Access Info in EHR ED Application Community Clinic Lab Info. System PACS Patient Registration Document Repository Provide Info to EHR EHR PACS Access Info in EHR Provide Info to EHR Provide Info to EHR EHR System Document Repository Reliable, Accurate Patient Identity is the Key to Integrate Clinical Applications Teaching Hospital

4 Patient Identity Problems
Establish Patient Identity Manage Patient Identity Life-Cycle Update / add new attributes, link / merge, end of life, etc. Patient Identification at Point of Care Find Detailed Demographics Information Locate Patient Record in Other Institutions Solution: IHE Patient Identity Integration Profiles

5 Patient Identity Model

6 Patient Identity Model
Patient Identity Record Identifying traits Other data items Patient ID: A Symbol to Uniquely Identify each Record Patient ID Domain: A Namespace issuing unique Patient ID Namespace ID Unique ID / Unique ID Type Identification: A Process to Bind a Patient ID to a Record Patient ID Domain Patient ID Patient Identifying Traits Patient identity Record Patient Identifying Traits Patient Identifying Traits Additional Patient Data Items Additional Patient Data Items Additional Patient Data Items Patient Identity Model

7 Patient Identity Source
Patient Identity Source: a Collection of Records Created from a Patient Identity Model Identified in the Same Domain(s) Administered under the Same Policy A Patient Identity Source Decides Its Own Identifier Domain(s) and Administration Policy Different Organizations Often Have Their Own Patient Registries, and therefore Different Patient Identity Sources MAIN HOSPITAL 29764 Patient identity Record James A. Massie Male 171 Zoberlein, Ishpeming MI 49849 76363 91432 63537 Patient identity Record I Asian CFR James Addison Patient identity Record Alice Smith Female 123 South Street, New York NY 10021 Patient identity Record Mary Jones Female 1634 J St, Apt. 214, Davis CA 95616 John Smith Male N2378 South St.. Madison WI 53711 I African American AMT Carl Anderson I American Indian AME Dr. John Griffin I White ABC Ellen Massie Patient Identity Source

8 Patient Identity in Multiple Sources
AL-6625 29764 US Exam System ED Application Physician Office 62627 PACS Document Repository 29764 EHR System Document Repository PACS Lab Info. System Community Clinic Teaching Hospital

9 EMPI Patient Identification Domain
Enterprise MPI Enterprise MPI US Exam System ED Application Physician Office PACS Document Repository EHR System Document Repository PACS Lab Info. System Community Clinic Teaching Hospital EMPI Patient Identification Domain

10 IHE Patient Administration Management (PAM) Integration Profile

11 Patient Administration Management Integration Profile: Abstract
Patient Identity and Patient Encounter Management for All Clinical Domains Source – Consumer notification messaging model … both in- and outpatient settings Identity life-cycle management … creation, update, merge / link Encounter - movement model … historical events tracking and updating Designed with HL7 2.5 Standard Conformance Profile Structure Static Constraints on message, segment, and data type levels Dynamic Constraints on event level Message control and acknowledgement definition … robust error reporting by leveraging HL7 2.5 Option Packages Support a wide range of application needs Patient Encounter Source ITI-31: Patient Encounter Management Patient Encounter Consumer Patient Demographics Source ITI-30: Patient Identity Feed Patient Demographics Consumer

12 Patient Administration Management Integration Profile: Encounter Movement Model
time Location GG & attending doctor X Emergency & attending doctor U Location BB & attending doctor X A04 A06 A02 A03 Patient received at Emergency room by attending doctor U. (A04 / patient class E). Doctor U admits the patient (A06 / patient class = I), into location BB, referring him to attending Doctor X The patient is moved to location GG (A02Transfer), keeping X for attending doctor. The patient is healed and leaves the hospital (A03: Discharge). Segment ZBE is used in any INSERT event to attach an ID to the movement but does not change the original semantics of the event: ZBE-4 = INSERT. Segment ZBE can be in any CANCEL event, but does not change the original semantics of the event: ZBE-4 = CANCEL. Segment ZBE is used in Z99 trigger to update a current or historical movement: ZBE-4 = UPDATE Movement ID R Start Movement Date/Time End Movement Date/Time O Movement Action Code Historical Movement Indicator Original Event Code C Responsible Ward Code ZBE Segment Definition In some acute care settings, both the billing process and care provision process require precise knowledge of the movements of the inpatient during his or her stay in the hospital. Applications acting as Patient Encounter Supplier or Patient Encounter Consumer, divide the period of the encounter into “sub-encounters” delimited by the Movements. Each of these “sub-encounters” provides a specific context to record and invoice the acts produced within this period. However, if applications on both ends manage sub-encounters, which are periods of time, the messages of transaction ITI-31 communicate Movements as events. Hence, applications manage periods of time, but the messages carry the discrete events that delimit these periods of time. Illustration: 1. Patient received at Emergency room by attending doctor U. (A04 / patient class E). 2. Doctor U admits the patient (A06 / patient class = I), into location BB, referring him to attending Doctor X . 3. The patient is moved to location GG (A02Transfer), keeping X for attending doctor. 4. The patient is healed and leaves the hospital (A03: Discharge). These 4 real world events are expressed with 5 trigger events / messages, two of which occur at the same time (step 2). Here the encounter will be divided into 3 sub-encounters:

13 Patient Administration Management Integration Profile : Actors
Patient Demographics Source Responsible for administering patient identity and maintaining its record (incl. demographics, e.g., name, address, and related persons), and supplying the patient data and their updates to Patient Demographics Consumer Patient Demographics Consumer Uses demographic information provided by the Patient Demographics Source about a patient Patient Encounter Source Responsible for maintaining encounter information about a patient, and supplying the encounter data and their updates to the Patient Encounter Consumer Must be grouped with either Patient Demographics Source or Patient Demographics Consumer Patient Encounter Consumer Uses patient encounter information provided by Patient Encounter Source

14 Patient Identifying Traits in PID Segment
Patient Administration Management: Patient Identity Feed Transaction (ITI-30) Actor Requirements Patient demographics source – Required Patient demographics consumer – Required Patient Identity Management Patient Identifying Traits Messages to notify patient identity life-cycle events: Creation / Update / Duplicates Resolution Base Set of Messages + 2 Options Patient identifying traits defined in base messages Two ways to handle patient identity duplicates At least one of them must be supported … it can be defined in national extensions Patient Identifying Traits in PID Segment PID-3 Patient Identifier List R PID-5 Patient Name R PID-7 Date / Time of Birth CE PID-8 Administrative Sex CE PID-11 Patient Address CE PID-31 Identifier Unknown Indicator CE PID-32 Identifier Reliability Code CE PID-35 Species Code CE PID-36 Breed Code CE Merge Two Patients (A40/A39) Link Patient Information (A24/A24) Unlink Patient Information (A37/A37) Create New Patient (A28/A05) Update Patient Information (A31/A05) Change Patient Identifier List (A47/A30)

15 Patient Administration Management: Patient Encounter Management Transaction (ITI-31)
Actor Requirements Patient encounter source – Required Patient encounter consumer – Required Patient Encounter Management Encounter level events Movement level events Movement identification w/ ZBE segment Update of current and historic event w/ Z99 trigger All events: insert / cancel (if applicable) Base Set of Messages + 5 Options Only base set is required for basic encounter management Both the source and consumer actors can choose any (logically reasonable) combination of options to support their functional needs Historic movement option extends all events in base and optional messages Temporary Patient Transfers Tracking Patient departing – tracking (A09/A33) Patient arriving – tracking (A10/A32) Advanced Encounter Management Change attending doctor (A54/A55) Leave of absence (A21/A52) Return from leave of absence (A22/A53) Move account information (A44) Pending Event Management Pending admit (A14/A27) Pending transfer (A15/A26) Pending discharge (A16/A25) Extend all events in base and optional messages to manage historic movement events by adding ZBE segment Historic Movement Management In-/Outpatient Encounter Management Pre-admit patient (A05/A38) Change outpatient to inpatient (A06) Change inpatient to outpatient (A07) Transfer patient (A02/A12) Basic Encounter Management Admit inpatient (A01/A11) Register outpatient (A04/A11) Discharge patient (A03/A13) Update patient information (A08) Merge Patient Identifier List (A40)

16 IHE Patient Identifier Cross-Referencing (PIX) Integration Profile

17 Patient Identifier Cross-Referencing Integration Profile: Abstract
Cross-Mapping of Patient Identity Records of the Same Patient from Different Domains Specify identifying traits, but leave matching design open for implementation Specify consumer behaviors on receiving PIX query responses PIX Domain … the Scope Supported in PIX Manager Not a real id domain, but a set of cross-mapped id domains PIX Manager provides only ID-cross-mapping services … no identity details HL7 Messages to Access PIX Services PIX Query: Look-up identifiers in other domains PIX Update Notification: Subscription service to receive cross-mapped identifiers and their changes HL7 2.5 version supported since 2003 … HL7 V3 support in trial implementation phase ITI-8: Patient Identity Feed Patient Identity Source Patient Identifier Cross-Referencing Consumer ITI-9: PIX Query ITI-10: PIX Update Notification Patient Identifier Cross-Referencing Manager ITI-9 ITI-10

18 Patient Identifier Cross-Referencing Integration Profile : Actors
Patient Identity Source Responsible for administering patient identity and maintaining its record (incl. demographics, e.g., name, address, and related persons), and feeding the patient identity data and their updates to Patient Identifier Cross-Referencing Manager Patient Identifier Cross-Referencing Consumer Queries Patient Identifier Cross-Referencing Manager for patient’s identifiers in other domains Optionally, subscribes PIX update notification service to receive all changed (new) x-ref relationship of patient identifiers from different domains. Patient Identifier Cross-Referencing Manager Responsible for receiving patient identify feeds from different sources (domains), using them to create / update x-ref relationship of the identity records for the same patient, and maintaining its x-ref relationship repository Serves PIX query request by looking up x-ref identifiers in its repository Serves PIX update notification by sending messages to all subscribers when any change occurred in x-ref relationship of the patient identifiers from the domains of their interest

19 Patient Identifying Traits
Patient Identifier Cross-Referencing : Patient Identity Feed Transaction (ITI-8) Implementation Considerations: Send Patient Identifier in PID-3, always with Patient Identifier Domain information (PID-3.4) If the Identity Source supports multiple Patient Identifiers, list all of them in PID-3 Use ISO OID to identify Patient Identifier Domain if possible … if the identity feed is to Document Registry, this is required. Send detailed demographics … all of the traits IHE required for PIX Manager and more Actor Requirements Patient identity source – Required Patient identifier cross-referencing manager – Required Feed Patient Identity records from different sources to PIX Manager for cross-referencing HL7 Standard: Version and Higher HL7 V3 Support of ITI-8 Trial Implementation Supplement Since 2006 PID-3 Patient Identifier List R PID-5 Patient Name PID-7 Date / Time of Birth R+ PID-8 Administrative Sex PID-11 Patient Address R2 PID-13 Phone Number - Home PID-14 Phone Number - Work PID-16 SSN Number - Patient PID-25 Driver’s License Number Patient Identifying Traits PID-6 Mother’s Maiden Name PIX Manager Document Registry Patient Identity Source Patient Identity Source PIX Manager ADT^A01 ADT^A04 ADT^A05 ADT^A08 ADT^A40 Run Patient ID X-Ref Process Trigger PIX Notification if Any Change in Patient ID X-Ref Relationship within PIX Manager ACK^Axx

20 Patient Identifier Cross-Referencing : PIX Query Transaction (ITI-9)
Actor Requirements Patient identifier Cross-referencing consumer – Required Patient identifier cross-referencing manager – Required Look-up Patient Identifier from one domain to other domains Query Name: QPD-1=“IHE PIX Query” HL7 Immediate Query Mode is Required HL7 Standard: Version 2.5 Implementation Considerations: Specify one patient identifier with domain information (QPD-3) as search key, to look up identifiers of the same patient in other domains – “Domains Returned” Specify Domains Returned in QPD-4 Use ISO OID to specify all patient identifier domain if possible If Domains Returned are not specified, the PIX Manager returns patient identifiers in all domains it knows, which are cross-linked to the identifier in PIX query request. PIX query response may include multiple identifiers in one domain … you SHALL use or ignore them all HL7 V3 Support of ITI-9 Trial Implementation Supplement Since 2006 Patient Identifier Cross-Referencing Consumer Patient Identifier Cross-Referencing Manager QBP^Q23 MSH|^~\&|CLINREG|WESTCLIN|HOSPMPI|HOSP| ||QBP^Q23^QBP_Q21|8699|P|2.5 QPD|Q23^Get Corresponding IDs^HL70471|111069|112234^^^METRO HOSPITAL|^^^WEST CLINIC~^^^SOUTH LAB RCP||I| Process PIX Query Request MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN| ||RSP^K23^RSP_K23|1|P|2.5| MSA|AA|8699| QAK|111069|OK|Q23^Get Corresponding IDs^HL70471|1| QPD|Q23^Get Corresponding IDs^HL70471|111069|112234^^^METRO HOSPITAL|^^^WEST CLINIC~^^^SOUTH LAB| PID|||56321A^^^WEST CLINIC~66532^^^SOUTH LAB||~^^^^^^S| RSP^K23

21 Patient Identifier Cross-Referencing : PIX Update Notification Transaction (ITI-10)
Implementation Considerations: Notification transaction is initiated from the PIX Manager to PIX Consumer Provide a method for PIX Consumer to subscribe the notification Domain(s) of interest Network address to send the notification The PIX notification service is useful for a PIX Consumer which maintains a local cache of patient identifier cross-referencing relationship to avoid frequent PIX queries. Notification may include multiple identifiers in one domain … you SHALLL use or ignore them all Actor Requirements Patient identifier cross-referencing consumer – Optional Patient identifier cross-referencing manager – Required Enable PIX Consumer locally cache (a portion of) x-ref’ed identifiers, mirrored from the PIX Manager HL7 Standard: Version 2.5 HL7 V3 Support of ITI-10 Trial Implementation Supplement Since 2006 Patient Identifier Cross-Referencing Consumer Patient Identifier Cross-Referencing Manager Any Process Resulting in Change in Patient ID X-Ref Relationship ADT^A31 MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN| ||ADT^A31^ADT_A05|8703|P|2.5| EVN|A31| |||| PID|||56321A^^^WEST CLINIC~66532^^^SOUTH LAB||~^^^^^^S| ACK^A31

22 PIX Process Flow: Overview
PIX Domain Patient ID Domain A Patient Registration US Exam System 14355 Patient ID Domain B L-716 Patient ID Feed PIX Manager A87631 Patient ID Feed Patient ID X-Ref Query 35424 14355 Patient ID X-Ref Query Patient Registration L-716 Clinical Information System Patient ID Feed Patient ID Feed Patient ID X-Ref Notification Patient ID X-Ref Notification Patient Registration EHR System 35424 Patient ID Domain C Patient ID Domain D A87631 Patient Registration PACS

23 PIX Process Flow: Query and Notification Examples
PIX Domain Patient ID Domain A Patient Registration US Exam System 14355 S1763 14355 98532 Y-456 L-716 D-776 DF-45 A74630 A87631 35424 63452 23511 Patient ID Domain B L-716 PIX Manager A87631 A: S1763 B: ? D: ? 35424 14355 Patient Registration L-716 A: S1763 B: Y-456 D: A74630 Clinical Information System PIX Query Patient Registration EHR System 35424 Patient ID Domain C Patient ID Domain D A87631 A: 98532 B: DF-45 C: 23511 Patient Registration PIX Notification PACS

24 PIX and MPI: Combined Use in Typical IHE View
PIX Domain Patient ID Domain A Patient Registration US Exam System 14355 Patient Registration Clinical Information System L-716 Patient ID Domain B Patient ID Feed PIX Manager M 35424 A87631 14355 L-716 Patient ID Feed A87631 35424 Patient ID Feed Patient ID Feed Patient ID Feed Patient Registration EHR System 35424 Patient ID Domain C Patient ID Domain D A87631 Patient Registration Master Patient Index (MPI) M Patient ID Domain MPI PACS

25 PIX and MPI: MPI Joins in PIX as One Domain
PIX Domain Patient ID Domain A Patient Registration US Exam System 14355 Patient ID Domain B L-716 Patient ID Feed PIX Manager M 35424 A87631 14355 L-716 A87631 Patient ID Feed 35424 14355 Patient Registration L-716 Clinical Information System Patient ID Feed Patient ID Feed Patient ID Feed Patient Registration EHR System 35424 Patient ID Domain C Patient ID Domain D A87631 Patient Registration Master Patient Index (MPI) M Patient ID Domain MPI PACS

26 IHE Patient Demographics Query (PDQ) Integration Profile

27 Patient Demographics Query Integration Profile: Abstract
PDQ Information Model Query by parameter – patient identifying traits Multiple patient information sources Patient identifiers from other domains Patient Identification at Point of Care Partial identifying traits  patient pick list Patient visit traits  patient pick list Patient identifier  patient record details Acquire Patient Identifier in a Different Domain … an Alternative Way to PIX Typically used in XDS environment to acquire patient identifier in Affinity Domain Standardized HL7 QBP Message Profile Query response continuation protocol HL7 2.5 version Supported since 2003 … HL7 V3 support in trial implementation phase Patient Demographics Consumer ITI-21: Patient Demographics Query Patient Demographics Supplier ITI-22: Patient Demographics and Visit Query

28 Patient Demographics Query Integration Profile: Actors
Patient Demographics Supplier Capable of supplying patient identity information from one or more patient identity sources, and using these data to serve query requests from patient demographics consumer by returning identifiers and demographic information for all patient records matching the search criteria specified in a request. Note that patient demographics supplier does not need to be a patient identity source itself, but can be an actor which can authoritatively provide the same information maintained in a patient identity source. In fact, it can provide the patient demographics information from multiple patient identity sources. Patient Demographics Consumer Requests demographics data of patient(s) matched to a set of search criteria (e.g., patient identifier or partial name) from Patient Demographics Supplier, and uses the returned patient demographics data for its application purposes Patient Demographics Consumer can specify the search criteria in various ways, from a patient identifier in the identification domain used by the patient identity source to exactly locate the target patient record, to an incomplete set of demographics items (e.g., patient’s last name and administrative sex) to request a list of patients for selection.

29 Patient Demographics Query Use Cases
Patient Identity Source ICU nurse queries patient ID and name using the current bed number as search key Physician at office queries a list of patient records with partial patient info as search keys Lab tech queries patient info, and asks the Patient ID in another domain. ICU Bed-site System Physician Office System Lab Information System

30 PDQ Model: Patient Information Source and Patient Information Supplier
Patient Demographics Supplier Patient Demographics Supplier Patient Identity Source A 14355 J-718 RAD-0202 Patient Identity Source B A PDQ request is always defined in one Source, where patient records are identified in the source’s patient identifier domain. The Supplier may know patient identifiers from Other Domains corresponding to its patient records. The Supplier may support multiple Sources – the Consumer must select which source a query to be served.

31 Specify Patient Identity Source in PDQ Request
Patient Demographics Supplier Patient Identity Source A 14355 J-718 Patient Identity Source B 14355 14355 Example given in HL7 2.5 … HL7 V3 since 2008 PDQ Request: QBP^Q22 or QBP^ZV1 MSH-5 to select Patient Identity Source QPD-8 to specify Other Domains from which additional Patient ID are to be returned (optional), e.g., Patient ID in XDS Affinity Domain Patient Demographics Consumer Physician Office System

32 Patient Identifying Traits
Patient Demonstration Query: Patient Demographics Query Transaction (ITI-21) Actor Requirements Patient demographics supplier – Required Patient demographics consumer – Required Query Name: QPD-1=“IHE PDQ Query” HL7 Query Immediate Mode Required HL7 Query Continuation Protocol Supported HL7 Standard: Version 2.5 Implementation Considerations: Specify search keys in QPI-3 – Patient ID or demographics traits as PID/PD1 fields. They are AND’ed List of Sources supported by the Suplier … Specifying a unknown Source in MSH-5 causes error condition List of Other Domains supported in each Source … Specifying a unknown domain causes error condition Requested Patient ID in Other Domains may not be returned in PDQ response. It is not error condition. Return detailed demographics … those required and more IHE neither specifies nor prohibits: additional identifying traits for matching, wildcards matching, repetitions in one PID field HL7 V3 Support of ITI-2 since 2008 PID-3 Patient Identifier List R PID-5 Patient Name PID-7 Date / Time of Birth R2 PID-8 Administrative Sex PID-11 Patient Address PID-18 Patient Account Number Patient Identifying Traits Patient Demographics Consumer Patient Demographics Supplier Use MSH-5 to designate Patient Information Source to search If Patient ID in other domains needed, specify those domains in QPD-8 (only include domains the supplier supports!) Use RCP-3 for incremental responses if desired Copy incoming MSH-5 to MSH-3 in response to indicate the source of patient info. Add requested Patient ID in PID-3 with fully specified domains Return Continuation Pointer if incremental response is in action and there are more results to return QBP^Q22 Process PDQ Query Request RSP^K22

33 Patient Identifying Visit Traits
Patient Demonstration Query: Patient Demographics and Visit Query Transaction (ITI-22) Implementation Considerations: Specify search keys in QPI-3 – Patient ID or demographics traits as PID/PD1/PV1/PV2 fields. They are AND’ed No keys of visit information required for Supplier, but some of the keys recommended. Supplier’s support of these visit key depends on care settings. Consumer needs to know what keys a Supplier supports Return detailed demographics … those required and more All query keys and features in PDQ query supported … as well issues remain Actor Requirements Patient demographics supplier – Optional Patient demographics consumer – Optional Query Name: QPD-1=“IHE PDVQ Query” HL7 Query Immediate Mode Required HL7 Query Continuation Protocol Supported HL7 Standard: Version 2.5 HL7 V3 Support of ITI-22 since 2008 PV1-1 Patient Class R PV1-3 Assigned Patient Location R2 PV1-7 Attending Doctor PV1-8 Referring Doctor PV1-9 Consulting Doctor PV1-10 Hospital Service Patient Identifying Visit Traits PV1-17 Admitting Doctor PV1-19 Visit Number Patient Demographics Consumer Patient Demographics Supplier QBP^ZV1 RSP^ZV2 Process Demographics and Visit Query Request Use MSH-5 to designate Patient Information Source to search If Patient ID in other domains needed, specify those domains in QPD-8 (only include domains the supplier supports!) Use RCP-3 for incremental responses if desired Copy incoming MSH-5 to MSH-3 in response to indicate the source of patient info. Add requested Patient ID in PID-3 with fully specified domains Return Continuation Pointer if incremental response is in action and there are more results to return

34 PDQ: Incremental Query Response Support
Patient Demographics Consumer Patient Demographics Supplier Implementation Considerations: Throughout all interactions in a continuation process, Query Tag (QAK-1) is used to correlate all request/response messages associated with the same query Supplier should declare its time-out policy to terminate a query continuation In continuation, consumer resends the original query request in a new message – new value in MSH-10 QBP^Q22 or QBP^ZV1 RCP-1=“I” – R RCP-2=n - O RSP^K22 or RSP^ZV2 DSC-1= CP If continuation requested and supplier has more record to return Loop [If RSP contains a valid CP] Loop [If RSP contains a valid CP, and Consumer wants to receive the next block of results] QBP^Q22 or QBP^ZV1 Send original query request in a new message w/ DSC echoing CP received in RSP Fetch next continuation block of matched results Use MSH-5 to designate Patient Information Source to search If Patient ID in other domains needed, specify those domains in QPD-8 (only include domains the supplier supports!) Use RCP-3 for incremental responses if desired Copy incoming MSH-5 to MSH-3 in response to indicate the source of patient info. Add requested Patient ID in PID-3 with fully specified domains Return Continuation Pointer if incremental response is in action and there are more results to return RSP^K22 or RSP^ZV2 DSC-1= CP If supplier has more record to return. The CP is a new one Example given in HL7 2.5 … HL7 V3 supported since 2008 [else] QCN^J01 ACK^QCN

35 PDQ Message Example - Request
MSH|^~\&|CLINREG|WESTCLIN|HOSPMPI|HOSP| ||QBP^Q22^QBP_Q21|8799|P|2.5 QPD|Q22^Find Candidates^HL70471|111069| HOSPITAL~^^^SOUTH LAB RCP|I|20^RD

36 PDQ Message Example: Response
MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN| ||RSP^K22^RSP_K21|134410|P|2.5 MSA|AA|8799 QAK|111069|OK|Q22^Find Candidates^HL70471|3 QPD|Q22^Find HOSPITAL~^^^SOUTH LAB| PID|||66785^^^METRO HOSPITAL~66532^^^SOUTH LAB||Smith^John|| |M||C|N2378 South Street^^Madison^WI^53711| QRI|95||MATCHWARE 1.2| PID|||87443^^^METRO HOSPITAL~651189^^^SOUTH LAB||Smith^Jon|| |M||C|124 Second Street^^Madison^WI^53711| QRI|90||MATCHWARE 1.2| PID|||43266^^^METRO HOSPITAL~81209^^^SOUTH LAB||Smithy^John|| |M||C|W11234 Bay Drive^^Lodi^WI^53555| QRI|85||MATCHWARE 1.2|

37 Patient Identity Solutions and Implementation Strategy

38 Patient Identifying Traits Required in IHE Integration Profiles
PID-3 Patient Identifier List R PID-5 Patient Name PID-7 Date / Time of Birth CE PID-8 Administrative Sex PID-11 Patient Address PID-31 Identifier Unknown Indicator PID-32 Identifier Reliability Code PID-35 Species Code PID-36 Breed Code Patient Identifying Traits in PID Segment PAM PID-3 Patient Identifier List R PID-5 Patient Name PID-7 Date / Time of Birth R+ PID-8 Administrative Sex PID-11 Patient Address R2 PID-13 Phone Number - Home PID-14 Phone Number - Work PID-16 SSN Number - Patient PID-25 Driver’s License Number Patient Identifying Traits PID-6 Mother’s Maiden Name PIX PID-3 Patient Identifier List R PID-5 Patient Name PID-7 Date / Time of Birth R2 PID-8 Administrative Sex PID-11 Patient Address PID-18 Patient Account Number Patient Identifying Traits PDQ

39 Patient Identity Profiles Implementation: Security Considerations
ITI-8 ITI-21 ITI-22 Patient Demographics Consumer ITI-30 Patient Encounter Source ITI-31 Patient Encounter Consumer ITI-9 ITI-10 Patient Identifier Cross-Referencing Consumer Patient Demographics Supplier Patient Identifier Cross-Referencing Manager Patient Identity Source Patient Demographics Source Patient Record Patient Record Patient Record Query Event Query Event Patient Record ATNA

40 Patient Identity Profiles Implementation: System Deployment Considerations
Patient Encounter Consumer Patient Encounter Source ITI-31 Patient Record Patient Demographics Consumer Patient Record Patient Demographics Source ITI-30 Patient Demographics Supplier Patient Identifier Cross-Referencing Manager ITI-8 Patient Identity Source Patient Record Query Event Query Event Patient Record ITI-21 ITI-22 ITI-9 ITI-10 Patient Demographics Consumer Patient Identifier Cross-Referencing Consumer ATNA

41 Registries Data & Services Ancillary Data & Services
Implementation Example: Using PIX to Cross-Link Patient Identities across Different Organizations Longitudinal Record Services Common Services Communication Bus CANADA INFOWAY JURISDICTIONAL INFOSTRUCTURE Registries Data & Services Ancillary Data & Services EHR Data & Services Data Warehouse EHR IP HIAL EHR IP Standards Client Registry Outbreak Mgmt PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Provider Registry Location Registry Business Rules EHR Index Message Structures Normalization Rules Terminology Registry Security Mgmt Privacy Data Configuration HIAL EHR SCP Standards PIX XDS/i Centricity PACS IHE PIX for Client Registry IHE XDS /I for Information Exchange XDS Consumer XDS Source (local repository)

42 Clinical Doc Locations Aggregated Lab Results (Local and Remote)
Implementation Example: Using PDQ to Query Patient Identities Information CDX Gateway ISB ISB ISB ISB RLS RLS Boston MC CDX Gateway CHC Repositories BMC XDS Domain Document Registry Cross-Domain Bridge BMC Physician Retrieves Lab Results Centricity sends query to BMC CDX Gateway, which passes it to the MA-SHARE Gateway/ISB & queries RLS for location of local patient records MA-SHARE Gateway retrieves clinical doc locations (metadata) from XDS registry ISB Queries other RHIOs (Indiana Health Information Exchange Aggregated query metadata displayed on EMR Physician selects documents to view Whittier HC South Boston HC GE Centricity Clinical Doc Locations Aggregated Lab Results (Local and Remote) Query Courtesy of

43 IHE Patient Identity Profiles Summary
Communication Mechanism: HL7 2.x Messages Some of these profiles are being adapted to HL7 V3 messages using Web Services (work in progress) Standardized Patient Identifying Traits Standardized Messages for Patient Records Life-Cycle Management Events Standardized Query Messages to Acquire Patient Identity / Demographics Information Defined Cross-Referencing Mechanism to Map Identities across Different Domains

44 Further IHE Documents IHE Web site: Technical Frameworks:
Technical Frameworks: ITI V3.0 Technical Framework Supplements - Trial Implementation July 2005: PAM Integration Profile (Revised Nov. 2006) Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements

45 Cross-Enterprise Information Sharing
XAD Patient Identity Source M US Exam System 14355 Physician Office A87631 Provide & Register Register Retrieve Document Query Document Patient Identity Feed Query Document Retrieve Document Provide & Register Register ED Application Community Clinic Lab Info. System PACS L-716 Document Registry PACS Document Repository EHR System Document Repository Query Document Register Provide & Register Retrieve Document Teaching Hospital XDS Clinical Affinity Domain

46 Questions?


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