PAM

1. PAM François Macary – AGFA HES

2. Patient Administration Management • Where does PAM come from • PAM scope • PAM actors, transactions and options • Actors grouping • Choice of HL7 2.5 • Message profiles • Reminders and conclusion

3. Radio Land Cardio Land Lab Land ADT ADT Rad-1, Rad-12 Rad-1, Rad-12 The ITI Magic Bus 3 hitch-hikers jump into a magic bus Profiles Basic Security Actors ADT 1, 12 Transactions CT

4. The Mahabharata

5. Radio Land Cardio Land Lab Land ADT ADT Rad-1, Rad-12 Rad-1, Rad-12 The ITI Magic Bus 3 hitch-hikers jump into a magic bus Profiles Basic Security Actors ADT 1, 12 Transactions PDQ PIX XDS NAV DSG ATNA PAM CT EUA XUA

6. The ITI Magic Bus 3 hitch-hikers jump into a magic bus Lab Radio Cardio Pathology PCC PCD SWF PIR … Profiles Actors Transactions PDQ PIX XDS NAV DSG RID PSA ATNA PWP PAM CT EUA XUA

7. Future rearrangement in ITI PIX Patient Identity Source ITI-9 Patient Identity Feed (HL7 2.3.1) Patient Identifier Cross-reference Manager ITI-9 Patient Identifier Cross-reference Consumer ITI-10

8. PAM Patient Demographics Source ITI-030 Patient Identity Feed (HL7 2.5) Opt ion 2 Patient Demographics Consumer Future rearrangement in ITI PIX Patient Identity Source ITI-9 Patient Identity Feed (HL7 2.3.1) Patient Identifier Cross-reference Manager Option 1 ITI-9 Patient Identifier Cross-reference Consumer ITI-10

9. PAM & PDQ: The push-pull brothers PAM PDQ Patient Demographics Source Patient Encounter Source Patient Demographics Source ITI-021 Demographics Query ITI-022 Demographics & Visit Query ITI-030 Patient Identity Feed ITI-031 Patient Encounter Management Patient Demographics Consumer Patient EncounterConsumer Patient Demographics Consumer HL7 v2.5

10. PAM scope Acute care setting Care providers community Admitted & ambulatory Admitted & ambulatory Patient identification & demographics Patient Account & Encounter Patient Movement

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 “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), physician’s 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 “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. A04 Movement Id = M0 A06 Movement Id = M1 A02 Movement Id = M2 A03 Movement Id = M3 In emergency ward In ICU In Medicine 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 Movements are events that trigger sub-encounters = periods during which the patient situation is stable

16. PAM fulfills these purposes • Create, update, merge, link, unlink, delete patient identities • Opens, moves, closes patient accounts • Opens, updates, closes patient encounters • Creates, updates, cancels patient movements

17. Actors pairs Options Patient Demographics Source & Consumer ITI 030 Merge Link / Unlink PAM Actors / Transactions / Options Patient Demographics Source Patient Demographics Consumer ITI-030 Patient Identity Feed Patient Encounter Source Patient EncounterConsumer ITI-031 Patient Encounter Management Patient Encounter Source & Consumer ITI 031 Inpatient / Outpatient Encounter Management Pending Event Management Advanced Encounter Management Temporary Patient Transfer Tracking Historic Movement

18. The mandatory options for France In the acute care setting environment Actors pairs Options Patient Demographics Source & Consumer ITI 030 Merge Patient Encounter Source & Consumer ITI 031 Inpatient / Outpatient Encounter Management Advanced Encounter Management Historic Movement

19. The mandatory options for France In the pure ambulatory environment Actors pairs Options Patient Demographics Source & Consumer ITI 030

20. ITI-30 message sets

21. ITI-31 basic subset

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: ITI-31 Patient Demographics Source Patient Encounter Source Patient Encounter Consumer Patient Demographics Source ITI-30 ITI-31 Patient Demographics Consumer Patient Encounter Source Patient Encounter Consumer

25. PAM Patient Demographics Consumer ITI-030 Patient Identity Feed Patient Encounter Consumer ITI-031 Patient Encounter Management Patient Demographics Source Patient Encounter Source PAM leveraged by other ITI profiles PDQ Patient Demographics Source ITI-021 Demographics Query ITI-022 Demographics & Visit Query Patient Demographics Consumer

26. PAM Patient Demographics Source Patient Demographics Consumer Op t I o n 2 Patient Encounter Source Patient Encounter Consumer PAM leveraged by domain profiles Domain Profile ADT Rad-1 Rad-12 Order Placer Option 1

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.