1. Connectathon Patient Identifiers
Steve Moore
Lynn Felhofer

2. Connectathon Patient IDs – 2 areas of concern
This presentation explains the use of Patient IDs at the Connectathon:
In departmental workflow tests: SWF, CATH, ECHO, STRESS – Slides 3-5
In XDS tests – Slides 6-16

3. Patient IDs in Departmental Workflow tests3 3

4. Patient Identifiers: IHE, Department
IHE manages identifiers in the departmental workflows through SWF, Cath and other workflow profiles
An ADT system is the source of patient identifiers
Emergency, unidentified patients have special cases
This is not the ID that is used in XDS (XDS.a, XDS.b) 4 4

5. Identifiers: Connectathon, Department
For Departmental workflow tests
We do not always have enough ADT systems to make things work smoothly
Connectathon management supplements the participant ADT systems with a separate application (RIS Mall) that generates ADT messages with identifiers used for departmental workflow
These are Connectathon tests, not Demonstration choices

6. Patient IDs in XDS.a & XDS.b tests6 6

7. Identifiers: XDS Affinity Domain
An XDS Affinity Domain requires a unique patient identifier
IHE gives these choices (but does not mandate)
PIX
PDQ
Other
Affinity Domains are free to choose, and they can choose “other”

8. Meta Data vs Document
XDS requires that the Patient ID in a document’s XDS meta-data be the value known by the Affinity Domain
Documents themselves are not required to use that ID within their content
In fact, documents may have internal, department identifiers inside the document and never reference the Affinity Domain Patient ID

9. Identifiers: Connectathon, Affinity Domain
In theory, each XDS Registry would warrant a separate Affinity Domain, and a separate domain of patient identifiers
In practice, at the Connectathon, we bundle all XDS Registry actors into a single Affinity Domain with one domain of patient identifiers
This is a huge simplification that makes switching from one Registry to another possible
Otherwise, there would be unmanageable confusion

10. Connectathon Affinity Domain ID Source
We use the HIMSS Registration Tool as the source of Patient Identifiers in the ‘Affinity Domain’ at the Connectathon
If a vendor participant wants to step up and take that responsibility, we would be glad to share or turn that over
That source of Affinity Domain Patient Identifiers (HIMSS tool or vendor participant) is responsible for sending ADT messages to the Registry actors, PIX Managers and PDQ Servers

11. Connectathon: Doc Source, Doc Consumer
To obtain an Affinity Domain Patient ID, what are my Connectathon choices as a Doc Source or Doc Consumer?
Get an ADT feed from the Patient ID source
There is no IHE transaction defined to the Doc Source or Doc Consumer, but we can use ITI-8 (or ITI-44)
Use PDQ query
Use PIX query
Configure the ID by hand
The operative term is “Connectathon test”. IHE/XDS does not require a specific solution. These are your choices.

12. Two Models For PIX If you choose PIX… Model 1: My Local Identifier
Affinity Domain Patient ID Source sends master Patient ID to PIX Manager
I send my local ID to the PIX Manager
I ask the PIX Manager: “For my local ID, what is the Affinity Domain ID?”
Model 2: Delegated Identifier
See next slide

13. PIX Delegated Identifier
Affinity Domain Patient ID Source sends master Patient ID to PIX Manager
Some other patient ID source (my delegate) sends a local identifier to the PIX Manager and to me
I send a query to the PIX Manager: “Given the local identifier sent by my delegate, what is the Affinity Domain identifier?”

14. PIX Models You can choose either model for Connectathon testing
Demonstration rules are not the same as Connectathon testing rules
Demonstration committee makes decisions/documents requirements
Your use of PIX, PDQ, ADT feeds is governed by the demonstration committee. You need to have a clear understanding of their requirements.

15. Identifier Challenges
XDS-I presents a challenge because departmental Image Managers are accustomed to receiving local identifiers
Now, they have to manage the local identifier and get an identifier for the Affinity Domain
This is no different than requirements on other Document Source actors

16. What About XCA?
Until the method for Cross-Community Patient Identification is defined by the ITI TC in the ‘09-10 season, we will use the same Affinity Domain patient identifier in the Initiating and Responding Gateways’ domains.
HIMSS demonstration requirements may be different.