PIXv3 Add/Update/Merge
- Odysseas Pentakalos
Patient Identity Management - Add or Revise Patient Record
The Patient Identity Feed transaction is carried out by the HL7 v3 Patient Activate (PRPA_MT201301UV02) and Patient Revise (PRPA_MT201302UV02) messages. The Patient Identity Source shall generate the message whenever a patient is registered or when some patient demographic data changes. Each message shall be acknowledged by the HL7 v3 Accept Acknowledgement (MCCI_MT000200UV01) message.
Major Components of the Added/Revised Messages
The Patient class is the entry point to the R-MIMs for the Patient Activate and Patient Revise models. The patient identifiers are captured using an Instance Identifier (II) data type. The Patient class is scoped by the provider organization where this person is a patient. The definition of the CMET requires that the provider organization needs to be identified by an id attribute, and at least one of address, telecommunications address, or contact person to be present. The id attribute SHALL have only a root, expressed as an ISO OID.
The Person class contains identifying and demographic data elements for the focal person such as name, gender, date of birth, marital status and deceased indicator and time.
The Language Communication components sends information about what language can be used to communicate with the person.
The PersonalRelationship class is used to send information about the mother's maiden name.
The Citizen class sends citizenship information.
The OtherIDs class is used to capture other identifiers associated with the person such as a driver's license number or social security number. In this transaction the IDs assigned by the scoping provider organization are represented in the id attribute of the Patient class. All other IDs are represented in the OtherIDs class. For the purposes of interoperability where both HL7 v3 and HL7 v2 based transactions are used, the following requirements is imposed on the OtherIDs.id attribute and on the scopingOrganization.id attribute.
OtherIDs.id.root SHALL be identical to scopingOrganization.id.root
scopingOrganization.id extension SHALL NOT have any value.
For details on the meaning and correct interpretation of the fields of each component, see page 175-178 of IHE IT Infrastructure Technical Framework Volume 2b.
PIX Manager - Expected Actions
The Patient Identifier Cross-reference Manager shall be capable of accepting attributes specified in the messages above. This is to ensure that the Patient Identifier Cross-reference Manager can handle a sufficient set of corroborating information in order to perform its cross-referencing function. The PIX Manager should only recognize a single Patient Identity Source per domain. Once the PIX Manager has completed its cross-referencing function, it shall make the newly cross-referenced identifiers available to PIX queries and send out notification to any Patient Identifier Crross-reference Consumers that have been configured as being interested in receiing such notifications using the PIX Update Notification HL7 v3 transaction.
The following is a sample PIX Feed message to register a patient.
<?xml version="1.0" encoding="UTF-8"?>
<urn:PRPA_IN201301UV02 ITSVersion="XML_1.0" xmlns:urn="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<urn:id root="21acf7be-007c-41e6-b176-d0969794983b"/>
<urn:creationTime value="20091112115139"/>
<urn:interactionId extension="PRPA_IN201301UV02" root="2.16.840.1.113883.1.6"/>
<urn:processingCode code="P"/>
<urn:processingModeCode code="T"/>
<urn:acceptAckCode code="AL"/>
<urn:receiver typeCode="RCV">
<urn:device classCode="DEV" determinerCode="INSTANCE">
<urn:id root="1.2.840.114350.1.13.99999.4567"/>
<urn:asAgent classCode="AGNT">
<urn:representedOrganization determinerCode="INSTANCE" classCode="ORG">
<urn:id root="1.2.840.114350.1.13.99999.1234"/>
</urn:representedOrganization>
</urn:asAgent>
</urn:device>
</urn:receiver>
<urn:sender typeCode="SND">
<urn:device classCode="DEV" determinerCode="INSTANCE">
<urn:id root="1.2.840.114350.1.13.99998.8734"/>
<urn:asAgent classCode="AGNT">
<urn:representedOrganization determinerCode="INSTANCE" classCode="ORG">
<urn:id root="1.2.840.114350.1.13.99998"/>
</urn:representedOrganization>
</urn:asAgent>
</urn:device>
</urn:sender>
<urn:controlActProcess classCode="CACT" moodCode="EVN">
<urn:code code="PRPA_TE201301UV02" codeSystem="2.16.840.1.113883.1.6"/>
<urn:subject typeCode="SUBJ">
<urn:registrationEvent classCode="REG" moodCode="EVN">
<urn:id nullFlavor="NA"/>
<urn:statusCode code="active"/>
<urn:subject1 typeCode="SBJ">
<urn:patient classCode="PAT">
<urn:id extension="JW-824-v3" assigningAuthorityName="NIST2010" root="2.16.840.1.113883.3.72.5.9.1"/>
<urn:statusCode code="active"/>
<urn:patientPerson>
<urn:name>
<urn:given>WILMA</urn:given>
<urn:family>JOYNER</urn:family>
</urn:name>
<urn:telecom use="H" value="tel:610-220-4354"/>
<urn:administrativeGenderCode code="F"/>
<urn:birthTime value="19350102"/>
<urn:addr>
<urn:streetAddressLine>1710 Tree Top Lane</urn:streetAddressLine>
<urn:city>PLYMOUTH MEETING</urn:city>
<urn:state>PA</urn:state>
<urn:postalCode>19462</urn:postalCode>
</urn:addr>
<urn:asOtherIDs classCode="CIT">
<urn:id root="2.16.840.1.113883.4.1" extension="197-18-9761"/>
<urn:scopingOrganization classCode="ORG" determinerCode="INSTANCE">
<urn:id root="2.16.840.1.113883.4.1"/>
</urn:scopingOrganization>
</urn:asOtherIDs>
<urn:personalRelationship classCode="PRS">
<urn:code codeSystem="2.16.840.1.113883.5.111" codeSystemName="PersonalRelationshipRoleType" code="MTH" displayName="Mother"/>
<urn:relationshipHolder1 classCode="PSN" determinerCode="INSTANCE">
<urn:name xsi:type="urn:PN">
<urn:family qualifier="BR">PALMER</urn:family>
</urn:name>
</urn:relationshipHolder1>
</urn:personalRelationship>
</urn:patientPerson>
<urn:providerOrganization classCode="ORG" determinerCode="INSTANCE">
<urn:id root="1.2.840.114350.1.13.99998.8734"/>
<urn:contactParty classCode="CON"/>
</urn:providerOrganization>
</urn:patient>
</urn:subject1>
<urn:custodian typeCode="CST">
<urn:assignedEntity classCode="ASSIGNED">
<urn:id root="1.2.840.114350.1.13.99998.8734"/>
</urn:assignedEntity>
</urn:custodian>
</urn:registrationEvent>
</urn:subject>
</urn:controlActProcess>
</urn:PRPA_IN201301UV02>
The following is a sample PIX Feed revised patient message (update).
<?xml version="1.0" encoding="UTF-8"?>
<PRPA_IN201302UV02 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3" ITSVersion="XML_1.0">
<id root="cdc0d3fa-4467-11dc-a6be-3603d6866807"/>
<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"/>
</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">
<code code="PRPA_TE201302UV02" codeSystem="2.16.840.1.113883.1.6"/>
<subject typeCode="SUBJ">
<registrationEvent classCode="REG" moodCode="EVN">
<id nullFlavor="NA"/>
<statusCode code="active"/>
<subject1 typeCode="SBJ">
<patient classCode="PAT">
<id extension="LD-165-002" assigningAuthorityName="NIST2010-2" root="2.16.840.1.113883.3.72.5.9.2"/>
<statusCode code="active"/>
<patientPerson>
<name>
<given>CAROL</given>
<family>LEDESMA</family>
</name>
<telecom use="H" value="tel:321-414-9668"/>
<administrativeGenderCode code="F"/>
<birthTime value="19590111"/>
<addr>
<streetAddressLine>3727 Terry Lane</streetAddressLine>
<city>ORLANDO</city>
<state>FL</state>
<postalCode>32801</postalCode>
</addr>
<asOtherIDs classCode="PAT">
<id root="2.16.840.1.113883.4.1" extension="590-52-6470"/>
<scopingOrganization classCode="ORG" determinerCode="INSTANCE">
<id root="2.16.840.1.113883.4.1"/>
</scopingOrganization>
</asOtherIDs>
<personalRelationship classCode="PRS">
<code codeSystem="2.16.840.1.113883.5.111" codeSystemName="PersonalRelationshipRoleType" code="MTH" displayName="Mother"/>
<relationshipHolder1 classCode="PSN" determinerCode="INSTANCE">
<name xsi:type="PN">
<family qualifier="BR">BEVERIDGE</family>
</name>
</relationshipHolder1>
</personalRelationship>
</patientPerson>
<providerOrganization classCode="ORG" determinerCode="INSTANCE">
<id root="1.2.840.114350.1.13.99998.8734"/>
<contactParty classCode="CON"/>
</providerOrganization>
</patient>
</subject1>
<custodian typeCode="CST">
<assignedEntity classCode="ASSIGNED">
<id root="1.2.840.114350.1.13.99998.8734"/>
</assignedEntity>
</custodian>
</registrationEvent>
</subject>
</controlActProcess>
</PRPA_IN201302UV02>
Patient Identity Management - Patient Identity Merge
When two patients' records are found to identify the same patient by a Patient Identity Source in a Patient Identifier Domain, the Patient Identity Source shall indicate this information using the Patient Registry Duplicates Resolved event message. This message indicates that the Patient Identity Source has done a merge within a specific Patient Identification Domain. That is, the surviving identifier (patient ID has subsumed a duplicate patient identifier.
The Patient Registry Duplicates Resolved interaction is carried out by the HL7 v3 Patient Demographics message (PRPA_MT201303UV02). The message shall be generated by the Patient Identity Source that performs the update whenever two patient records are found to reference the same person. Each message shall be acknowledged by the HL7 v3 Accept Acknowledgement (MCCI_MT000200UV01) message.
When two Patient Identifiers are to be merged, the subsumed identifier is reference in the control act wrapper and the payload is sent for the surviving identifier. For example, if patients A, B, and C are all to be merged into patient B, then two messages are sent. In the first message Patient A's, identifier is reference in the control act wrapper via the replacementOf act relationship and patient B's identifier is reference in the Patient class of the payload. In the second message patient C's identifier is referenced in the wrapper and patient B's identifier is again in the payload.
PIX Manager - Expected Actions
The Patient Identifier Cross-reference Manager shall be capable of accepting attributes in the Resolve Duplicates message. When the PIX Manager receives the Resolve Duplicates message type of the Patient Identify Feed transaction, it shall cross-reference the patient identifiers provided in the wrapper and the payload of the message by replacing any references it is maintaining internally to the patient ID provided in the wrapper by the patient ID included in the payload. After the identifier references are replaced, the Patient Identifier Cross-reference Manager shall reapply its internal cross-referencing logic/policies before providing the updated information via either the PIX Query or PIX Notification transactions.
The following is a sample PIX Merge message.
<?xml version="1.0" encoding="UTF-8"?>
<urn:PRPA_IN201304UV02 ITSVersion="XML_1.0" xmlns:urn="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<urn:id root="52918b99-dc72-4d17-8714-f39b9b6f16e8"/>
<urn:creationTime value="20091112115139"/>
<urn:interactionId root="2.16.840.1.113883.1.6" extension="PRPA_IN201304UV02"/>
<urn:processingCode code="P"/>
<urn:processingModeCode code="T"/>
<urn:acceptAckCode code="AL"/>
<urn:receiver typeCode="RCV">
<urn:device classCode="DEV" determinerCode="INSTANCE">
<urn:id root="1.2.840.114350.1.13.99999.4567"/>
<urn:asAgent classCode="AGNT">
<urn:representedOrganization determinerCode="INSTANCE" classCode="ORG">
<urn:id root="1.2.840.114350.1.13.99999.1234"/>
</urn:representedOrganization>
</urn:asAgent>
</urn:device>
</urn:receiver>
<urn:sender typeCode="SND">
<urn:device classCode="DEV" determinerCode="INSTANCE">
<urn:id root="1.2.840.114350.1.13.99998.8734"/>
<urn:asAgent classCode="AGNT">
<urn:representedOrganization determinerCode="INSTANCE" classCode="ORG">
<urn:id root="1.2.840.114350.1.13.99998"/>
</urn:representedOrganization>
</urn:asAgent>
</urn:device>
</urn:sender>
<urn:controlActProcess classCode="CACT" moodCode="EVN">
<urn:code code="PRPA_TE201304UV02" codeSystem="2.16.840.1.113883.1.6"/>
<urn:subject typeCode="SUBJ">
<urn:registrationEvent classCode="REG" moodCode="EVN">
<urn:id nullFlavor="NA"/>
<urn:statusCode code="active"/>
<urn:subject1 typeCode="SBJ">
<urn:patient classCode="PAT">
<urn:id extension="FC-303" assigningAuthorityName="NIST2010" root="2.16.840.1.113883.3.72.5.9.1"/>
<urn:statusCode code="active"/>
<urn:patientPerson determinerCode="INSTANCE">
<urn:name>
<urn:given>CRYSTAL</urn:given>
<urn:family>FORD</urn:family>
</urn:name>
</urn:patientPerson>
</urn:patient>
</urn:subject1>
<urn:custodian typeCode="CST">
<urn:assignedEntity classCode="ASSIGNED">
<urn:id root="1.2.840.114350.1.13.99998.8734"/>
</urn:assignedEntity>
</urn:custodian>
<urn:replacementOf typeCode="RPLC">
<urn:priorRegistration classCode="REG" moodCode="EVN">
<urn:statusCode code="obsolete"/>
<urn:subject1 typeCode="SBJ">
<urn:priorRegisteredRole classCode="PAT">
<urn:id extension="BC-659" assigningAuthorityName="NIST2010" root="2.16.840.1.113883.3.72.5.9.1"/>
</urn:priorRegisteredRole>
</urn:subject1>
</urn:priorRegistration>
</urn:replacementOf>
</urn:registrationEvent>
</urn:subject>
</urn:controlActProcess>
</urn:PRPA_IN201304UV02>
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