1. Cross Domain Patient Identity Management Eric Heflin Dir of Standards and Interoperability/Medicity

2. Audience/Scope Agenda –Introduction –Terms Used –The Patient ID Problem –The IHE Solution –For More Information

3. 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

4. IHE PATIENT IDENTITY MANAGEMENT INTRODUCTION

5. 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)

6. 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: Others?

7. 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?

8. 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

9. PATIENT IDENTITY CROSS- REFERENCING (PIX)

10. 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

11. 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.

12. 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.

13. PIX Use Cases 1.Use Case: Multiple Identifier Domains within a Single Facility / Enterprise 2. Use Case: Multiple ID Domains Across Cooperating Enterprise

14. PIX Transaction Diagram

15. PIX Actors

16. 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

17. 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

18. 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”

19. 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

20. IHE Profile Grouping Each actor implementing PIX shall be grouped with the Time Client Actor Required to manage and resolve conflicts in multiple updates

21. PIX Workflow(s) List one or more typical workflows Should be a less technical diagram, like the appendix, not a UML sequence diagram

22. PIX Security and Privacy Describe how security and privacy are implemented for this profile

23. 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…

24. PDQ Use Case Use case

25. PDQ Transaction Diagram Insert transaction diagram from ITI TF

26. PDQ List and define each PDQ actor List each PDQ transaction

27. PDQ Options List and define each PDQ option

28. PDQ Workflow(s) List one or more typical workflows

29. PDQ Security and Privacy Describe how security and privacy are implemented for this profile

30. PDQ Typical Architecture Simplistic architectural diagram

31. XCPD 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

32. 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?

33. XCPD Use Case Use case

34. XCPD Transaction Diagram Insert transaction diagram from ITI TF

35. XCPD Actors List and define each XCPD actor List each XCPD transaction

36. XCPD Options List and define each XCPD option

37. XCPD Workflow(s) List one or more typical workflows

38. XCPD Security and Privacy Describe how security and privacy are implemented for this profile

39. Typical XCPD Architecture Simplistic diagram

40. Patient Administration Repeat the above for PAM

41. References For more information on this topic, please see: –IHE content

43. Other topics??

44. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Query Documen t Retrieve Document Provide & Register Register Provide & Register Register Retrieve Document Query Documen t Document Registry 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

45. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application A87631 M8354673993 14355 L-716 M8354673993 Patient Identity Feed PIX Query

46. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query Patient Identity Feed M8354673993 A87631 14355 L-716

47. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application PDQ Query to Acquire XAD Patient ID Patient Demographics Supplier

48. 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

49. August 18, 2005 IHE Technical Webinar 49 IHE PIX / PDQ Profiles Implementation Considerations Master Patient ID Domain Administration and Service Functions PIX Notification Service PIX Query Service PDQ Service Enhanced PDQ Service MPI Service Patient Identity Source HL7 Service defined in IHE Technical Framework Service out of IHE scope Patient Identity Feed Service

50. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Query Documen t Retrieve Document Provide & Register Register Provide & Register Register Retrieve Document Query Documen t Document Registry 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

51. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application A87631 M8354673993 14355 L-716 M8354673993 Patient Identity Feed PIX Query

52. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application 14355 M8354673993 L-716 A87631 Patient Identity Feed PIX Query Patient Identity Feed M8354673993 A87631 14355 L-716

53. 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 Source M8354673993 Retrieve Document Provide & Register Register Query Document Patient Identity Feed Document Registry Document Repository ED Application PDQ Query to Acquire XAD Patient ID Patient Demographics Supplier

54. 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

55. August 18, 2005 IHE Technical Webinar 55 IHE PIX / PDQ Profiles Implementation Considerations Master Patient ID Domain Administration and Service Functions PIX Notification Service PIX Query Service PDQ Service Enhanced PDQ Service MPI Service Patient Identity Source HL7 Service defined in IHE Technical Framework Service out of IHE scope Patient Identity Feed Service