InfrastructurePatient Index and Demographics Implementation Strategies

1
InfrastructurePatient Index and Demographics
Implementation Strategies
Yongjian Bao GE Healthcare May 16, 2007
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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

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EHR Drives Need for Patient Identity Management
inter- and intra-Enterprise
Patient Registration
ED Application
PACS
EHR System
Document Repository
Reliable, Accurate Patient Identity is the Key to
Integrate Clinical Applications
Teaching Hospital
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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 Healthcare
  Institution

Solution IHE Patient Identity Integration
Profiles
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• Patient Identity Model

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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 Identifying Traits
Patient identity Record
Patient Identifying Traits
Additional Patient Data Items
Additional Patient Data Items
Additional Patient Data Items
Patient Identity Model
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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
  Domain(s) for Patient Identification and Policy
  for Administration
• Different Organizations Often Have Their Own
  Patient Registries, and therefore Different
  Patient Identity Sources

MAIN HOSPITAL
29764
Patient identity Record
James A. Massie 1956-01-29 Male 171 Zoberlein,
Ishpeming MI 49849
76363
91432
63537
I6381209 Asian CFR James Addison
Patient identity Record
Alice Smith 1974-03-21 Female 123 South Street,
New York NY 10021
Patient identity Record
Mary Jones 1967-09-14 Female 1634 J St, Apt. 214,
Davis CA 95616
Patient identity Record
John Smith 1963-04-23 Male N2378 South St..
Madison WI 53711
I87745833 African American AMT Carl Anderson
I53874747 American Indian AME Dr. John Griffin
I8944747 White ABC Ellen Massie
Patient Identity Source
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Patient Identity in Multiple Sources
AL-6625
29764
US Exam System
ED Application
Physician Office
62627
PACS
Document Repository
EHR System
Document Repository
PACS
Lab Info. System
Teaching Hospital
Community Clinic
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Enterprise MPI
Enterprise MPI
US Exam System
ED Application
Physician Office
PACS
Document Repository
EHR System
Document Repository
PACS
Lab Info. System
Teaching Hospital
Community Clinic
EMPI Patient Identification Domain
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• IHE Patient Administration Management (PAM)
  Integration Profile

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Patient Administration Management Integration
Profile Abstract

• Patient Identity and 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 patient tracking and
  historical events 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
• OptionPackages
• Support a wide range of applicationneeds

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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 resolve patient identity duplicates
• At least one of them must be supported it can
  be defined in national extensions

Patient Identifying Traits in PID Segment
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)
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• IHE Patient Identifier Cross-Referencing (PIX)
  Integration Profile

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Patient Identifier Cross-Referencing Integration
Profile Abstract

• Cross-Mapping of Patient Identity Records of the
  Same Patient from Different Domains
• Specified identifying traits, but left matching
  design open for implementation
• Specified consumer behaviors on receiving PIX
  query responses
• PIX Domain the Scope Support 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 Service
• PIX Query Look-up identifiers in other domains
• PIX Update Notification Subscription to receive
  cross-mapped identifiers when such relationship
  is established or changed
• HL7 2.5 versionsupported since2003 HL7 V3
  support in trial implementationphase

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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 the data fields
  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 2.3.1 and Higher

HL7 V3 Support of ITI-8 Trial Implementation
Supplement Since 2006
Patient Identity Source
Patient Identity Source
ADTA01 ADTA04 ADTA05 ADTA08 ADTA40
Run Patient ID X-Ref Process
Trigger PIX Notification if Any Change in Patient
ID X-Ref Relationship within PIX Manager
ACKAxx
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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 Identifiers from one domain to
  other domains
• Query Name QPD-1IHE 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-referenced to
  the identifier in PIX query request.
• PIX query response may include multiple
  identifiers in the same 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
QBPQ23
MSH\CLINREGWESTCLINHOSPMPIHOSP20050801073
005-0600QBPQ23QBP_Q218699P2.5 QPDQ23Get
Corresponding IDsHL70471111069112234METRO
HOSPITALWEST CLINICSOUTH LAB RCPI
Process PIX Query Request
MSH\HOSPMPIHOSPCLINREGWESTCLIN20050801073
008-0600RSPK23RSP_K231P2.5 MSAAA8699 QA
K111069OKQ23Get Corresponding
IDsHL704711 QPDQ23Get Corresponding
IDsHL70471111069112234METRO
HOSPITALWEST CLINICSOUTH
LAB PID56321AWEST CLINIC66532SOUTH
LABS
RSPK23
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Patient Identifier Cross-Referencing PIX Update
Notification Transaction (ITI-10)

• Implementation Considerations
• Notification transaction is initiated from the
  PIX Manager to PIX Consumer
• PIX Manager needs to provide a method for PIX
  Consumer to subscribe the notification
• Domain(s) of interest
• Network address to send the notification
• The PIX notification 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-refed 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
ADTA31
MSH\HOSPMPIHOSPCLINREGWESTCLIN20050801073
005-0600ADTA31ADT_A058703P2.5 EVNA312005
08010700200508010700 PID56321AWEST
CLINIC66532SOUTH LABS
ACKA31
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PIX and MPI Combined Use in Typical IHE View
PIX Domain
PIX Manager
A87631
Patient ID Domain D
Patient Registration
PACS
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• IHE Patient Demographics Query (PDQ) Integration
  Profile

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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 demographics keys ? patient pick list
• Patient visit info keys ? patient pick list
• Patient identifier key ? 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

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PDQ Model Patient Information Source and Patient
Information Supplier
Patient Demographics Supplier
Patient Demographics Supplier

• A PDQ request is always defined in one Source,
  where patient records are identified in the
  sources 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.

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Specify Patient Identity Source in PDQ Request
Patient Demographics Supplier
Example given in HL7 2.5 HL7 V3 support in
trial implementation since 2006

• PDQ Request QBPQ22 or QBPZV1
• MSH-5 to select Patient Identity Source
• QPD-8 to specify Other Domains from which
  additional Patient ID are requested (optional),
  e.g., Patient ID in XDS Affinity Domain

Patient Demographics Consumer
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Patient Demonstration Query Patient Demographics
Query Transaction (ITI-21)

• Actor Requirements
• Patient demographics supplier Required
• Patient demographics consumer Required
• Query Name QPD-1IHE 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
  ANDed
• Needs to know Sources supported by the Supplier
  Specifying a unknown Source causes error
  condition
• Needs to know 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-21 Trial Implementation
Supplement Since 2006
Patient Demographics Consumer
Patient Demographics Supplier
QBPQ22
Process PDQ Query Request
RSPK22
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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

QBPQ22 or QBPZV1
RCP-1I R RCP-2n - O
RSPK22 or RSPZV2
DSC-1 CP If continuation requested and supplier
has more record to return
Loop
If RSP contains a valid CP
If Consumer wants to receive the next block of
results
Loop
QBPQ22 or QBPZV1
Fetch next continuation block of matched results
Send original query request in a new message w/
DSC echoing CP received in RSP
RSPK22 or RSPZV2
DSC-1 CP If supplier has more record to return.
The CP is a new one
Example given in HL7 2.5 HL7 V3 support in
trial implementation since 2006
else
QCNJ01
ACKQCN
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• Patient Identity Solutions and Implementation
  Strategy

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Patient Identifying Traits Required in IHE
Integration Profiles
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Patient Identity Profiles Implementation
Security Considerations
Patient Record Event
Patient Record Event
Patient Record Event
Patient Record Event
Query Event
Patient Record Event
Query Event
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Patient Identity Profiles Implementation System
Deployment Considerations
Patient Encounter Source
Patient Encounter Consumer
ITI-31
Patient Record Event
Patient Record Event
Patient Demographics Consumer
Patient Demographics Source
ITI-30
Patient Record Event
Patient Record Event
Patient Identity Source
Patient Demographics Supplier
Patient Identifier Cross-Referencing Manager
ITI-8
Query Event
ITI-21
ITI-22
ITI-9
ITI-10
Patient Record Event
Query Event
Patient Demographics Consumer
Patient Identifier Cross-Referencing Consumer
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Implementation Example Using PIX to Cross-Link
Patient Identities across Different Organizations
Longitudinal Record Services
Common Services
Communication Bus
CANADA INFOWAY JURISDICTIONAL INFOSTRUCTURE
Ancillary Data Services
EHR Data Services
DataWarehouse
Registries Data Services
OutbreakMgmt
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging
Laboratory
HealthInformation
ClientRegistry
ProviderRegistry
LocationRegistry
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
TerminologyRegistry
Security Mgmt
Privacy Data
Configuration
HIAL
EHR SCP Standards

• Centricity PACS
• IHE PIX for Client Registry
• IHE XDS /I for Information Exchange
• XDS Consumer
• XDS Source (local repository)

PIX
XDS/i
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Implementation Example Using PDQ to Query
Patient Identities Information
CDX Gateway
RLS
Boston MC

• 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
Courtesy of
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IHE Patient Identity Profiles Summary

• Communication Mechanism HL7 2.x Messages
• Some of these profiles are 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

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Further IHE Documents

• IHE Web site
• http//www.IHE.net
• 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

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Questions?