January, 2009 1 Steve Moore Lynn Felhofer Connectathon Patient Identifiers.

January, 2009 1

Steve MooreSteve Moore

Lynn FelhoferLynn Felhofer

Connectathon Patient Connectathon Patient IdentifiersIdentifiers

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Connectathon Patient IDs – Connectathon Patient IDs – 2 areas of concern2 areas of concern

This presentation explains the use of Patient IDs at the Connectathon:

1. In departmental workflow tests: SWF, CATH, ECHO, STRESS – Slides 3-5

2. In XDS tests – Slides 6-16

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Patient IDs inPatient IDs inDepartmentalDepartmental

Workflow testsWorkflow tests

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Patient Identifiers: IHE, DepartmentPatient Identifiers: IHE, Department

IHE manages identifiers in the IHE manages identifiers in the departmental workflows through SWF, departmental workflows through SWF, Cath and other workflow profilesCath and other workflow profiles

An ADT system is the source of patient identifiersAn ADT system is the source of patient identifiers

Emergency, unidentified patients have special Emergency, unidentified patients have special casescases

This is not the ID that is used in XDS (XDS.a, This is not the ID that is used in XDS (XDS.a, XDS.b)XDS.b)

Identifiers: Connectathon, DepartmentIdentifiers: 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

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Patient IDs inPatient IDs inXDS.a & XDS.b testsXDS.a & XDS.b tests

Identifiers: XDS Affinity DomainIdentifiers: 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”

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Meta Data vs DocumentMeta Data vs DocumentXDS 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

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Identifiers: Connectathon, Affinity DomainIdentifiers: 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

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Connectathon Affinity Domain ID SourceConnectathon 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

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Connectathon: Doc Source, Doc Connectathon: Doc Source, Doc ConsumerConsumer

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.

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Two Models For PIXTwo 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

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PIX Delegated IdentifierPIX 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?”

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PIX ModelsPIX 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.

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Identifier ChallengesIdentifier 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

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What About XCA?What About XCA?

Until the method for Cross-Community Patient Identification is defined by the ITI TC in the ‘09-10 season, we will usethe same Affinity Domain patient identifier in the Initiating and Responding Gateways’ domains.

HIMSS demonstration requirements may be different.

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