Cross-Community Patient Identification (XCPI)

1. Cross-Community Patient Identification (XCPI) Brief Profile Proposal for 2008/09 presented to the IT Infrastructure Planning Committee Karen Witting October 1, 2008

2. The Problem • What problem is this profile proposal hoping to address? • The XCA profile requires that the Patient Identifier be known and the community of interest be known but does not specify an IHE recognized mechanism for doing this. • Identify any existing IHE profile gaps/overlaps that this proposal will improve upon • XCA • What is the market readiness for this IHE profile proposal? • U.S. NHIN project has specified a solution for the problem • Austria is said to have a different solution • Many other countries looking to implement XCA and considering a variety of mechanisms • What is the risk of this proposal not being undertaken this cycle? • Every region/country defines its own solution. These custom built solutions are more expensive and cannot be tested at connectathons. This results in higher cost for all countries, who must pay for a one-of-a-kind solution and less reliable solutions, since they cannot be tested a connectathons.

3. Use Case • Karen is on vacation in Reno, Nevada and becomes ill • Karen visits a clinic where she is diagnosed with pneumonia and sent to the local hospital • Karen is admitted to the hospital and receives inpatient treatment for 5 days • Karen returns home to New York and visits her primary care physician to follow-up on her illness. The physician’s electronic medical records system communicates with the community’s Initiating Gateway to request Karen’s records from Reno. To satisfy this request the Initiating Gateway has the following problems (in addition to security/privacy which is not addressed here): • Which of the several communities in Nevada contain Karen’s records from the visit to the clinic – which has the first chest X-ray which diagnosed pneumonia and what is Karen’s patient identifier within that community. • Which of the several communities in Nevada contain Karen’s records from her hospital stay and what is Karen’s patient identifier within that community. • Having answered the above questions the Initiating Gateway is able to use XCA to retrieve the records and supply them to the physician’s electronic medial records system for review by Karen’s primary care physician

4. Proposed Standards & Systems • What standards and/or systems should be considered in addressing this proposal? • HL7 V2 Messaging • HL7 V3 Messaging • PIX (V2, V3) • PDQ (V2, V3) • Entity Identification Service Functional Model from HSSP

5. Discussion • What level of effort do you foresee in developing this profile? • Medium • Is there someone who is willing to act as profile editor? Please provide the name, organization, email • Karen Witting • ITI White Paper “Cross-Community Information Exchange” includes a technical discussion of the XCA gap. The white paper is waiting for publication to http://www.ihe.net/Technical_Framework/index.cfm#IT but is available in the meantime at ftp://ftp.ihe.net/IT_Infrastructure/TF_Maintenance-2007-2008/TF/CommitteeVersions/9_26_release/IHE_ITI_TF_White_Paper_Cross_Community_2008-09-25.doc