PIX Update Notification

The ITI-46 transaction is used by the PIX Manager and PIX Consumer actors. The PIX Manager manages the cross-referencing of patient identifiers across Patient Identification Domains by providing a list of patient ID "aliases" via notification to a configured list of interested PIX Consumers. The PIX Consumer receives notifications from the PIX Manager of changes to patient ID aliases. Typically the PIX Consumer uses this information to maintain information links about patients in a different patient ID domain.

The PIX Manager shall notify a PIX Consumer when there is a change in a set of cross-referenced patient identifiers for any of the patient identifiers belonging to Patient Identifier Domains of interest to the consumer. The configuration of the domains of interest to a Patient Consumer is maintained by the PIX Manager.

Several notifications may have to be issued to communicate a single update to a set of cross reference patient identifiers as required to reflect all the changes on the resulting sets of cross reference patient identifiers belonging to Patient Identifier Domains of interest to the PIX Consumer.

Message Semantics

The PIX Update Notification transaction id is conducted by the Patient Revise (PRPA_MT201302UV02) message. The PIX Manager initiates the transaction whenever identifier list information is updated for a patient. Each message shall be acknowledged by the HL7 v3 Accept Acknowledgement (MCCI_MT0000200UV01)

It is wholly the responsibility of the PIX Manager to perform the matching of patient identifiers based on the patient traits it receives. The information provided by the PIX Manager to the PIX Consumer shall only contain a list of cross-referenced identifiers for the domains of interest as configured with the PIX Manager in two or more of the domains managed by the PIX Manager. Multiple notifications may need to be sent. For example:

Consumer CON_A is configured to receive update notifications for domains DOM_A and DOM_AD. Notifications are sent as follows:

A PIXv3 Patient Registry Record Add message is sent for a patient for DOM_A. The update notification shall contain the patient identifier for DOM_A.
A PIXv3 Patient Registry Record Add message is processed for DOM_AD. The PIX Manager cross references this patient with DOM_A. The update notification shall contain the patient identifiers for both DOM_A and DOM_AD.
A PIXv3 Patient Registry Record Revise message is processed for DOM_AD changing the patient address. The PIX Manager cross references and determines that this patient is no longer the same as DOM_A. Two update notifications shall be sent. One containing the patient identifier for DOM_A. The other one containing the patient identifier for DOM_AD.

The PIX Manager shall have configuration indicating which consumers are interested in receiving the PIXv3 Update Notification Transactions. This configuration information shall include identification of the identity consumer systems interested in receiving notifications and, for each of those systems, a list of the patient identifier domains of interest. The PIX Manager should account for consumers interested in all domains. Each message shall be acknowledged by the Accept Acknowledgement message sent by the receiver of the Patient Registry Revise message to its sender.

<?xml version="1.0" encoding="UTF-8"?> 
<PRPA_IN201302UV02 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" 
 xsi:schemaLocation="urn:hl7-org:v3 ../../schema/HL7V3/NE2008/multicacheschemas/PRPA_IN201302UV02.xsd" 
 xmlns="urn:hl7-org:v3" ITSVersion="XML_1.0"> 
    <id root="2.16.840.1.113883.1.18"/> 
    <creationTime value="20070806091603"/> 
    <interactionId root="2.16.840.1.113883.1.6" extension="PRPA_IN201302UV02"/> 
    <processingCode code="P"/> 
    <processingModeCode code="T"/> 
    <acceptAckCode code="AL"/> 
    <receiver typeCode="RCV"> 
        <device classCode="DEV" determinerCode="INSTANCE"> 
            <id root="1.2.840.114350.1.13.99999.4567"/> 
            <telecom value="https://example.org/PatientFeed"/> 
        </device> 
    </receiver> 
    <sender typeCode="SND"> 
        <device classCode="DEV" determinerCode="INSTANCE"> 
            <id root="1.2.840.114350.1.13.99998.8734"/> 
        </device> 
    </sender> 
    <controlActProcess classCode="CACT" moodCode="EVN"> 
        <subject typeCode="SUBJ"> 
            <registrationEvent classCode="REG" moodCode="EVN"> 
                <statusCode code="active"/> 
                <subject1 typeCode="SBJ"> 
                    <patient classCode="PAT"> 
                        <id root="1.2.840.114350.1.13.99998.8734" extension="34827G409"/> 
                        <statusCode code="active"/> 
                        <patientPerson> 
                            <name> 
                                <given>James</given> 
                                <family>Dean</family> 
                            </name> 
                            <telecom value="tel:+1-299-555-4444;ext=2342" use="WP"/> 
                            <telecom value="tel:+1-399-555-2345" use="HP"/> 
                            <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"/> 
                            <birthTime value="19570323"/> 
                            <addr> 
                                <streetAddressLine>3443 South Beach Avenue</streetAddressLine> 
                                <city>Some City</city> 
                                <state>IL</state> 
                            </addr> 
                            <asOtherIDs classCode="PAT"> 
                                <id root="1.2.840.114350.1.13.99997.2.3412" extension="38273N237"/> 
                                <scopingOrganization classCode="ORG" determinerCode="INSTANCE"> 
                                    <id root="1.2.840.114350.1.13.99997.2.3412"/> 
                                </scopingOrganization> 
                            </asOtherIDs> 
                            <asOtherIDs classCode="CIT"> 
                                <id root="2.16.840.1.113883.4.1" extension="999-99-4452"/> 
                                <scopingOrganization classCode="ORG" determinerCode="INSTANCE"> 
                                    <id root="2.16.840.1.113883.4.1"/> 
                                </scopingOrganization> 
                            </asOtherIDs> 
                        </patientPerson> 
                        <providerOrganization classCode="ORG" determinerCode="INSTANCE"> 
                            <id root="1.2.840.114350.1.13.99998.8734"/> 
                            <name>Good Health Clinic</name> 
                            <contactParty classCode="CON"> 
                                <telecom value="tel:+1-342-555-8394"></telecom> 
                            </contactParty> 
                        </providerOrganization> 
                    </patient> 
                </subject1> 
                <custodian typeCode="CST"> 
                    <assignedEntity classCode="ASSIGNED"> 
                        <id  root="1.2.840.114350.1.13.99998.8734"/> 
                        <assignedOrganization classCode="ORG" determinerCode="INSTANCE"> 
                            <name>Good Health Clinic</name> 
                        </assignedOrganization>    
                    </assignedEntity> 
                </custodian> 
            </registrationEvent> 
        </subject> 
    </controlActProcess> 
</PRPA_IN201302UV02>