Infrastructure Patient Index and Demographics Implementation Strategies

1. Infrastructure—Patient Index and Demographics Implementation Strategies

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 Need for Patient Identity Management inter- and intra-Enterprise

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 Healthcare Institution

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

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 Domain(s) for Patient Identification and Policy for Administration Different Organizations Often Have Their Own Patient Registries, and therefore Different Patient Identity Sources

8. Patient Identity in Multiple Sources

9. Enterprise MPI

10. IHE Patient Administration Management (PAM) Integration Profile

11. 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

12. 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

13. IHE Patient Identifier Cross-Referencing (PIX) Integration Profile

14. 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

15. Patient Identifier Cross-Referencing : Patient Identity Feed Transaction (ITI-8) 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

16. 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-1=“IHE PIX Query” HL7 Immediate Query Mode is Required HL7 Standard: Version 2.5

17. Patient Identifier Cross-Referencing : PIX Update Notification Transaction (ITI-10) 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

18. PIX and MPI: Combined Use in Typical IHE View

19. IHE Patient Demographics Query (PDQ) Integration Profile

20. 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

21. PDQ Model: Patient Information Source and Patient Information Supplier 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.

22. Specify Patient Identity Source in PDQ Request

23. 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 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 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

24. PDQ: Incremental Query Response Support 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 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

25. Patient Identity Solutions and Implementation Strategy

26. Patient Identifying Traits Required in IHE Integration Profiles

27. Patient Identity Profiles Implementation: Security Considerations

28. Patient Identity Profiles Implementation: System Deployment Considerations

29. Implementation Example: Using PIX to Cross-Link Patient Identities across Different Organizations

30. Implementation Example: Using PDQ to Query Patient Identities Information 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

31. 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

32. 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