September, 2005What IHE Delivers 1 François Macary – AGFA HES PAM.

1September, 2005 What IHE Delivers

François Macary – AGFA HESFrançois Macary – AGFA HES

PAMPAM

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Patient Administration ManagementPatient Administration Management

Where does PAM come fromWhere does PAM come from

PAM scopePAM scope

PAM actors, transactions and optionsPAM actors, transactions and options

Actors groupingActors grouping

Choice of HL7 2.5Choice of HL7 2.5

Message profilesMessage profiles

Reminders and conclusionReminders and conclusion

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3 hitch-hikers jump into a magic bus3 hitch-hikers jump into a magic busRadio LandRadio Land

ProfilesProfiles

ActorsActors

TransactionsTransactions

Basic SecurityBasic Security

ADTADT

1, 121, 12

Cardio LandCardio Land Lab LandLab Land

ADTADT

Rad-1, Rad-1,

Rad-12Rad-12

Rad-1, Rad-1,

Rad-12Rad-12

ADTADT

The ITI The ITI Magic Magic BusBus

CTCT

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The MahabharataThe Mahabharata

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3 hitch-hikers jump into a magic bus3 hitch-hikers jump into a magic busRadio LandRadio Land

ProfilesProfiles

ActorsActors


Basic SecurityBasic Security

ADTADT

1, 121, 12

Cardio LandCardio Land Lab LandLab Land

ADTADT

Rad-1, Rad-1,

Rad-12Rad-12

Rad-1, Rad-1,

Rad-12Rad-12

ADTADT


CTCTATNAATNAEUA EUA XUAXUA

PDQ PDQ

PIXPIX

XDS XDS NAV NAV DSGDSG

PAMPAM

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3 hitch-hikers jump into a magic bus3 hitch-hikers jump into a magic busRadioRadio

ProfilesProfiles

ActorsActors


CardioCardio LabLab


CTCTATNAATNAEUA EUA XUAXUA

PDQ PDQ

PIXPIX

XDS XDS NAV NAV DSGDSG

PAMPAM

PathologyPathology PCCPCC PCDPCD

RID RID PSAPSAPWPPWP

SWF SWF PIR …PIR …

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PIXPIX

Future rearrangement in ITI Future rearrangement in ITI

Patient Identity Patient Identity SourceSource

Patient Identifier Patient Identifier Cross-reference Cross-reference

ManagerManager


ConsumerConsumer

ITI-9ITI-9

ITI-10ITI-10

ITI-9ITI-9

Patient Identity Feed (HL7 2.3.1)Patient Identity Feed (HL7 2.3.1)

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PIXPIX

Future rearrangement in ITI Future rearrangement in ITI

Patient Identity Patient Identity SourceSource


ConsumerConsumer

ITI-9ITI-9

ITI-10ITI-10

ITI-9ITI-9

Patient Identity Feed (HL7 2.3.1)Patient Identity Feed (HL7 2.3.1)


ManagerManager

Option 1Option 1

PAMPAM

Patient Patient Demographics Demographics

ConsumerConsumer


SourceSource

ITI-030ITI-030

Patient Identity Feed Patient Identity Feed

(HL7 2.5)(HL7 2.5)OOppt t iioonn

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PDQPDQ

PAM & PDQ: The push-pull brothersPAM & PDQ: The push-pull brothers

PAMPAM


ConsumerConsumer


SourceSource

ITI-030 ITI-030 Patient Patient Identity Identity

Feed Feed

Patient Patient EncounterEncounter ConsumerConsumer

Patient Patient Encounter Encounter

SourceSource

ITI-031 ITI-031 Patient Patient

Encounter Encounter Management Management

Patient Demographics Patient Demographics ConsumerConsumer

Patient Demographics Patient Demographics SourceSource

ITI-021 ITI-021 Demographics Demographics

Query Query

ITI-022 ITI-022 Demographics Demographics & Visit Query & Visit Query

HL7 v2.5HL7 v2.5

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PAM scopePAM scope

Acute care Acute care settingsetting

Care providersCare providerscommunitycommunity

Admitted & ambulatoryAdmitted & ambulatory

Patient identification Patient identification & demographics& demographics

Patient Account Patient Account & Encounter& Encounter

Patient Patient MovementMovement

Admitted & ambulatoryAdmitted & ambulatory

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Patient IdentificationPatient 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

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““EncounterEncounter” extends “Visit”” 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’)

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Patient Patient AccountAccount

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’)

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““MovementMovement” extends “Transfer”” 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

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Movements are eventsMovements 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

In emergency wardIn emergency ward In ICUIn ICU In MedicineIn Medicine

A04 Movement Id = M0




Movements are events that trigger sub-encounters

= periods during which the patient situation is stable

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PAM fulfills these purposesPAM 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

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PAM Actors / Transactions / OptionsPAM Actors / Transactions / OptionsPatient Patient

Demographics Demographics ConsumerConsumer


SourceSource

ITI-030 Patient Identity Feed ITI-030 Patient Identity Feed

Patient Patient EncounterEncounter ConsumerConsumer


SourceSource

ITI-031 Patient Encounter Management ITI-031 Patient Encounter Management

Patient Demographics Source & Consumer

Options

Merge

Actors pairs

Link / Unlink

ITI 030

Patient Encounter Source & Consumer

Inpatient / Outpatient Encounter Management

Pending Event Management

Advanced Encounter Management

Temporary Patient Transfer Tracking

ITI 031

Historic Movement

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The mandatory options for FranceThe mandatory options for France


Options

Merge

Actors pairs

ITI 030

Patient Encounter Source & Consumer

Inpatient / Outpatient Encounter Management

Advanced Encounter ManagementITI 031

Historic Movement

In the acute care setting environmentIn the acute care setting environment

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The mandatory options for FranceThe mandatory options for France


OptionsActors pairs

ITI 030

In the pure ambulatory environmentIn the pure ambulatory environment

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ITI-30 message setsITI-30 message sets

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ITI-31 basic subsetITI-31 basic subset

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ITI-31 is self-containedITI-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:The Patient Encounter Source sends in ITI-31 messages:

In addition, ITI-31 also allows the Patient Encounter Source to send In addition, ITI-31 also allows the Patient Encounter Source to send messages to the Patient Encounter Consumer for patient identity messages to the Patient Encounter Consumer for patient identity maintenance in the encounter context, including patient update and maintenance in the encounter context, including patient update and identity merge.identity merge.

Thus there is no required grouping for the Patient Encounter Thus there is no required grouping for the Patient Encounter Consumer Actor: It may receive all information needed through the Consumer Actor: It may receive all information needed through the only transaction ITI-31.only transaction ITI-31.

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ITI-31 Inpatient/OutpatientITI-31 Inpatient/Outpatient

This is what the old ménage à trois (ADT, 1, 12) This is what the old ménage à trois (ADT, 1, 12) was up to.was up to.

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PAM actors groupingPAM actors groupingTo be able to put patient identity and demographics in its encounter To be able to put patient identity and demographics in its encounter messages of transaction ITI-31, a Patient Encounter Source is messages of transaction ITI-31, a Patient Encounter Source is required to be grouped with either a Patient Demographics Source or required to be grouped with either a Patient Demographics Source or a Patient Demographics Consumer:a Patient Demographics Consumer:

Patient Encounter Patient Encounter ConsumerConsumer

Patient Encounter Patient Encounter SourceSource


ITI-31ITI-31

Patient Encounter Patient Encounter ConsumerConsumer

Patient Encounter Patient Encounter SourceSource


ITI-31ITI-31


ITI-30ITI-30

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PAM leveraged by other ITI profilesPAM leveraged by other ITI profiles

PDQPDQ



ITI-022 ITI-022 Demographics Demographics & Visit Query & Visit Query

ITI-021 ITI-021 Demographics Demographics

Query Query

PAMPAMPatient Patient

Demographics Demographics ConsumerConsumer

Patient Patient Encounter Encounter ConsumerConsumer


SourceSource


SourceSource

ITI-030 ITI-030 Patient Patient Identity Identity

FeedFeed

ITI-031 ITI-031 Patient Patient Encounter Encounter ManagementManagement

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PAM leveraged by domain profilesPAM leveraged by domain profiles

Domain ProfileDomain Profile

Order PlacerOrder Placer

ADTADT

Rad-12Rad-12

Rad-1Rad-1

Option 1Option 1

PAMPAM


ConsumerConsumer

Patient Patient Encounter Encounter ConsumerConsumer

Op Op t t I I o o n n 22


SourceSource


SourceSource

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Choice of the standard HL7 v2.5 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

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Message static definitionMessage static definition

The applicative acknowledgement messageThe applicative acknowledgement message

(Original mode acknowledgement of HL7)(Original mode acknowledgement of HL7)

The ERR segment is present if the receiving application encountered an The ERR segment is present if the receiving application encountered an error while integrating the original message.error while integrating the original message.

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Segment static definitionSegment static definition

The Error segment in the acknowledgement messageThe Error segment in the acknowledgement message

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Data Type static definitionData Type static definition

ERL: Data Type of ERR-2ERL: Data Type of ERR-2

Example:Example:

ERR||MSH^1^9^1^1|200^unsupported message type^HL70357

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RemindersReminders

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

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ConclusionConclusion

PAM mandates more fields and subfields, and brings PAM mandates more fields and subfields, and brings more constraints than ADT, Rad-1 & Rad-12 did.more constraints than ADT, Rad-1 & Rad-12 did.

On the other hand, PAM extends widely the capacities On the other hand, PAM extends widely the capacities of these. It offers a rich set of options to meet the of these. It offers a rich set of options to meet the needs of all kinds of healthcare organizations.needs of all kinds of healthcare organizations.

Not all options are needed for a particular Not all options are needed for a particular implementation. PAM is a constrainable profile. Each implementation. PAM is a constrainable profile. Each organization must select the appropriate subset.organization must select the appropriate subset.

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September, 2005What IHE Delivers 1 François Macary – AGFA HES PAM.

Documents

patient movements

patient encounters

events patient

patient situation

patient accounts

patient class

patient identities

patient identifier list