cross domain patient identity management eric heflin dir of standards and interoperability/medicity
TRANSCRIPT
Cross Domain Patient Identity Management
Eric HeflinDir of Standards and Interoperability/Medicity
Audience/Scope
• Agenda– Introduction– Terms Used– The Patient ID Problem– The IHE Solution– For More Information
Audience/Scope
• Audience– Senior healthcare IT technical executives– Architects– Implementers seeking a broad overview
• Scope– Broad context and guidance about the use of IHE
standard profiles for patient identifier management across organizational boundaries
• Purpose– Provide reusable educational content
IHE PATIENT IDENTITY MANAGEMENT INTRODUCTION
Introduction
• IHE has created six standards (profiles) for patient identifier management
• Some profiles target patients inside an enterprise• Other profiles target patients across enterprises• This presentation introduces and compares these five
of these six profiles (XCPD is covered elsewhere)• <why did we group these together, perhaps have a
diagram showing the interplay between the profiles>
Terms Used
• Patient Identifier: A value controlled and assigned by a single assigning authority (hospital, group of related practices, national health authority, etc.). Note that the same patient can have multiple identifier inside a single domain
• Assigning authority: • XDS Affinity Domain: <get from Charles>• Others?
What Problem is Being Solved?
• Problem statement: • How can we correctly identify patients across
organizational boundaries (with different identifiers in different systems) to accommodate the exchange of health information using a standards-based approach with a high degree of assurance that the information is about the correct patient?
IHE Approach
IHE has created six mechanisms, or “profiles”, designed to solve this problem
• PIX – HL7 2.x Patient Identifier Cross Reference• PIXv3 – HL7 3.x Patient Identifier Cross Reference• PDQ – HL7 2.x Patient Demographic Query• PDQv3 – HL7 2.x Patient Demographic Query• *XCPD – Cross Community Patient Discovery• PAM – Patient Administration Manaement
*XCPD is discussed in another IHE presentation
PATIENT IDENTITY CROSS-REFERENCING (PIX)
PIX Introduction
• The PIX profile supports the cross-referencing of patient identifiers from multiple Patient Identifier Domains. These cross-referenced patient identifiers can then be used by “identity consumer” systems to correlate information about a single patient from sources that “know” the patient by different identifiers. This allows a clinician to have more complete view of the patient information.
• This integration profile does not define any specific enterprise policies or cross-referencing algorithms
PIX Introduction
The Patient Identifier Cross Referencing (PIX) Integration Profile supports two domains:
1. A Patient Identifier Domain is defined as a single system or a set of interconnected systems that all share a common identification scheme (an identifier and an assignment process to a patient) and issuing authority for patient identifiers.
2. The Patient Identifier Cross-reference Domain embodies the following assumptions about agreement within the group of individual Identifier Domains:– They have agreed to a set of policies that describe how patient
identities will be cross-referenced across participating domains;– They have agreed to a set of processes for administering these
policies;– They have agreed to an administration authority for managing
these processes and policies.
PIX Introduction
The Patient Identifier Cross-referencing Integration Profile (PIX) is targeted at healthcare enterprises of a broad range of sizes (hospital, a clinic, a physician office, etc.). It supports the cross-referencing of patient identifiers from multiple Patient Identifier Domains via the following interactions:
1. The transmission of patient identity information from an identity source to the Patient Identifier Cross-reference Manager.
2. The ability to access the list(s) of cross-referenced patient identifiers either via a query / response or via update notification.
PIX Use Cases
1. Use Case: Multiple Identifier Domains within a Single Facility / Enterprise
2. Use Case: Multiple ID Domains Across Cooperating Enterprise
PIX Transaction Diagram
PIX Actors
PIX Actors, Transactions, and Options
• Actors– Patient Identity Source – will describe each of the
below– Patient Identifier Cross-reference Consumer– Patient Identifier Cross-reference Manager
• Transactions– Patient Identity Feed [ITI-8]– PIX Query [ITI-9]– PIX Update Notification [ITI-10]
• Options– PIX Update Notification
PIX to eMPI Relationship
• PIX is compatible with enterprise master patient index systems (eMPI)
• Supports both “federated” and “master” topologies
• An HL7 v2 ADT stream can act as the Patient Identity Source Actor
• The eMPI query function can act as the Patient Identifier Cross-reference Manager actor
PIX Definition
• PIX = Patient Identifier Cross Referencing
• Definition: Allows a patient identifier assigned by one assigning authority to establish and maintain an identifier relationship assigned by another assigning authority
• Status: “Final Text”• <review wiki page def text>
• PIX v2 vs. PIX v3• Identical purpose, different underlying
standards• HL7 v2 messaging is used for PIX v2• HL7 v3 messaging is used for PIX v3
IHE Profile Grouping
• Each actor implementing PIX shall be grouped with the Time Client Actor
• Required to manage and resolve conflicts in multiple updates
PIX Workflow(s)
• List one or more typical workflows• Should be a less technical diagram, like
the appendix, not a UML sequence diagram
PIX Security and Privacy
• Describe how security and privacy are implemented for this profile
PDQ
• PDQ = Patient Demographic Query• PDQ is designed to allow for a query
across domains using, as the name implies, demographic information
• Status: Final Text?• Other topics…
PDQ Use Case
• Use case
PDQ Transaction Diagram
• Insert transaction diagram from ITI TF
PDQ
• List and define each PDQ actor• List each PDQ transaction
PDQ Options
• List and define each PDQ option
PDQ Workflow(s)
• List one or more typical workflows
PDQ Security and Privacy
• Describe how security and privacy are implemented for this profile
PDQ Typical Architecture
• Simplistic architectural diagram
XCPD
• <covered by karen, sync up with her>• XCPD = Cross Community Patient Discovery• XCDP is designed …• XCPD is different than PDQ in the following
ways…– Async, optimized, reverse query, etc.
• Used for the Nationwide Health Information Network Exchange 2010 Patient Discovery Production Specification
XCPD Maturity
• Relatively new profile, just entering first year of “Trial Implementation” status
• Deployed by NHIN Exchange participants
• Will be demonstrated for the firs time at the 2011 IHE Connectathon?
XCPD Use Case
• Use case
XCPD Transaction Diagram
• Insert transaction diagram from ITI TF
XCPD Actors
• List and define each XCPD actor• List each XCPD transaction
XCPD Options
• List and define each XCPD option
XCPD Workflow(s)
• List one or more typical workflows
XCPD Security and Privacy
• Describe how security and privacy are implemented for this profile
Typical XCPD Architecture
• Simplistic diagram
Patient Administration
• Repeat the above for PAM
References
• For more information on this topic, please see:– IHE content
• Other topics??
August 18, 2005
IHE Technical Webinar
44
IHE ITI Integration Profile XDS: Clinical Information Sharing in
RHIO
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Query Document Retrieve
Document
Provide & Register
Register
Provide & Register
Register
Retrieve Document
Query Document
Document RegistryDocument
Repository
Document Repository
ED Application
In order to publish or query clinical documents in XDS Affinity Domain (XAD), applications need to look-up XAD Patient ID using their local patient information,
e.g., Patient ID in local domain and demographics
August 18, 2005
IHE Technical Webinar
45
Look-Up XDS Affinity Domain Patient ID with Local PIX
Service
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Document RegistryDocument
Repository
Document Repository
ED Application
A87631
M8354673993
14355
L-716
M8354673993
Patient Identity Feed
Patient Identity Feed
Patient Identity Feed
Patient Identity Feed
Patient Identity Feed
PIX QueryPIX Query
August 18, 2005
IHE Technical Webinar
46
Look-Up XDS Affinity Domain Patient ID with Affinity Domain
PIX Service
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Document RegistryDocument
Repository
Document Repository
ED Application
14355M8354673993
L-716
A87631Patient Identity Feed
Patient Identity Feed
PIX Query
PIX Query
Patient Identity Feed
M8354673993
A8763114355L-716
August 18, 2005
IHE Technical Webinar
47
Query Affinity Domain PDQ Service for XDS Affinity Domain
Patient ID
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Document RegistryDocument
Repository
Document Repository
ED Application
PDQ Query to Acquire XAD Patient ID
PDQ Query to Acquire XAD Patient ID
Patient Demographics Supplier
August 18, 2005
IHE Technical Webinar
48
IHE IT Infrastructure Integration Profiles Provide a Solid Foundation for EHR
Management Cross-enterprise Patient Health Information Management Architectural Principles:
• A Patient Information Source administers patient records (demographics) and manages a Patient Identification Domain to identify these patient records on that domain
• Patient ID is assigned / maintained within a managed Patient Identification Domain
• Search patient records (in a patient information source)
→ PDQ Integration Profile• Look-up Patient ID in federated domains
→ PIX Integration Profile• Locate healthcare information (documents or
services)
→ XDS Integration Profile
IHE Technical Webinar
49August 18, 2005
IHE PIX / PDQ Profiles Implementation Considerations
Patient Registration
Patient Registration
Patient Registration
Patient Registration
Master Patient ID Domain
Administration and Service Functions
PIX Notification Service
PIX Query Service
PDQ Service
Enhanced PDQ Service
MPI Service
Patient Identity Source
HL7HL7
Service defined in IHE Technical Framework
Service out of IHE scope
Pati
en
t Id
en
tity
Feed
Serv
ice
August 18, 2005
IHE Technical Webinar
50
IHE ITI Integration Profile XDS: Clinical Information Sharing in
RHIO
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Query Document Retrieve
Document
Provide & Register
Register
Provide & Register
Register
Retrieve Document
Query Document
Document RegistryDocument
Repository
Document Repository
ED Application
In order to publish or query clinical documents in XDS Affinity Domain (XAD), applications need to look-up XAD Patient ID using their local patient information,
e.g., Patient ID in local domain and demographics
August 18, 2005
IHE Technical Webinar
51
Look-Up XDS Affinity Domain Patient ID with Local PIX
Service
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Document RegistryDocument
Repository
Document Repository
ED Application
A87631
M8354673993
14355
L-716
M8354673993
Patient Identity Feed
Patient Identity Feed
Patient Identity Feed
Patient Identity Feed
Patient Identity Feed
PIX QueryPIX Query
August 18, 2005
IHE Technical Webinar
52
Look-Up XDS Affinity Domain Patient ID with Affinity Domain
PIX Service
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Document RegistryDocument
Repository
Document Repository
ED Application
14355M8354673993
L-716
A87631Patient Identity Feed
Patient Identity Feed
PIX Query
PIX Query
Patient Identity Feed
M8354673993
A8763114355L-716
August 18, 2005
IHE Technical Webinar
53
Query Affinity Domain PDQ Service for XDS Affinity Domain
Patient ID
US Exam System
14355
Physician Office
EHR System
A87631
Teaching Hospital
XDS Clinical Affinity Domain
Community Clinic
Lab Info. System
PACS
L-716
PACS
XAD Patient Identity SourceM8354673993
Retrieve DocumentProvide & Register
RegisterQuery Document
Patient Identity Feed
Document RegistryDocument
Repository
Document Repository
ED Application
PDQ Query to Acquire XAD Patient ID
PDQ Query to Acquire XAD Patient ID
Patient Demographics Supplier
August 18, 2005
IHE Technical Webinar
54
IHE IT Infrastructure Integration Profiles Provide a Solid Foundation for EHR
Management Cross-enterprise Patient Health Information Management Architectural Principles:
• A Patient Information Source administers patient records (demographics) and manages a Patient Identification Domain to identify these patient records on that domain
• Patient ID is assigned / maintained within a managed Patient Identification Domain
• Search patient records (in a patient information source)
→ PDQ Integration Profile• Look-up Patient ID in federated domains
→ PIX Integration Profile• Locate healthcare information (documents or
services)
→ XDS Integration Profile
IHE Technical Webinar
55August 18, 2005
IHE PIX / PDQ Profiles Implementation Considerations
Patient Registration
Patient Registration
Patient Registration
Patient Registration
Master Patient ID Domain
Administration and Service Functions
PIX Notification Service
PIX Query Service
PDQ Service
Enhanced PDQ Service
MPI Service
Patient Identity Source
HL7HL7
Service defined in IHE Technical Framework
Service out of IHE scope
Pati
en
t Id
en
tity
Feed
Serv
ice