HITSP Patient ID Cross-Referencing Transaction Package

The HITSP Patient ID Cross-Referencing Transaction Package is used for identifying and cross-referencing different attributes for the same patient. It includes the following transactions from the Patient Identifier Cross-Referencing (PIX) Integration Profile in the Integrating the Healthcare Enterprise (IHE) IT Infrastructure (ITI) Technical Framework (TF), Volume I and II:

Patient Identity Management transaction as described in IHE-ITI TF-2 3.8.4.1. Optionality for including Pediatrics Demographics are shown in IHE IT Infrastructure (ITI) Technical Framework Supplement 2008-2009, Pediatric Demographics, Draft for Trial Implementation (August 22, 2008)

If using the Pediatric Demographics option, the Patient Identity Management [ITI-30] transaction is added to PIX and is used in addition to the Patient Identity Feed [ITI-8]. Note that the Pediatric Demographics option uses Health Level Seven (HL7) Version 2.5 rather than earlier versions.

The PIX Query and Patient Identity Feed transactions are intended for use wherever HL7 messages are suitable for identifying patients from a list of potentials, and/or where patient demographic data needs to be communicated. The PIX Query transaction provides an identified patient query and patient(s) identified response message pair, The PIX Query transaction uses the HL7 Version 2.5 Query and Response data mapping. The Patient Identity Feed transaction allows sending of patient identification information from one system to another. The Patient Identity Feed transaction uses the HL7 Version 2.3.1 ADT data mapping.

The PIX Query and Patient Identity Feed transactions, as described in this document, do not include messages for other purposes, e.g., patient enrollment/identification, patient visit/encounter, and obtaining detailed patient demographics. Messages for such other purposes are provided by other specifications in the suite.

2.1.1 Transaction Package Constraints

Constraint
The PIX and Patient Identity Feed transactions may be used by any system capable of performing real-time HL7 query and response and/or unsolicited patient demographic feed transactions
The Patient Identifier Cross-Reference Consumer interface must store and be able to communicate the data elements necessary for the Patient Identifier Cross-Reference Manager to be able to process the received query and return a list of matching patient identifiers
The Patient Identifier Cross-Reference Manager interface must be able to create a possibly empty list of matching patient identifiers solely based on the data elements received in the query message from the Patient Identifier Cross-Reference Consumer. Additionally, the Patient Identifier Cross-Reference Manager must be able to receive patient demographic data from the patient identity source interface to maintain its database of patient information
The patient identity source interface must be able to send patient demographic data to the Patient Identifier Cross-Reference Manager when new or changed information is captured
The Document Registry described in IHE-ITI TF-2 3.8.2 is not applicable
PID Segment constraints as shown in Table 2-8, Table 2-9, and Table 2-10

2.1.2 Interfaces

Interface	Description	Used in Component/ Standard	Transaction/ Content	T/C Optionality [1]
Patient Identifier Cross-Reference Consumer	Queries the Patient Identifier Cross-Reference Manager for a list of corresponding patient identifiers, if any Receives a list of corresponding patient identifiers from the Patient Identifier Cross-Reference Manager	IHE-ITI TF-2	PIX Query [ITI-9]	R
Patient Identifier Cross-Reference Consumer			PIX Update Notification [ITI-10]	O
Patient Identifier Cross-Reference Manager	Receives the query for a list of corresponding patient identifiers from the Patient Identifier Cross-Reference Consumer Sends a list of corresponding patient identifiers to the Patient Identifier Cross-Reference Consumer. Receives patient demographic information from the Patient Identity Source	IHE-ITI TF-2	Patient Identity Feed [ITI-8]	C[ ^101][102]
			PIX Query [ITI-9]	R
			PIX Update Notification [ITI-10]	R
		IHE-ITI TF Pediatric Demographics supplement	Patient Identity Management [ITI-30]	C[ ¹⁰⁰ ^][102]
Patient Identity Source	Sends patient demographic information when requested, assigns a unique identifier to each instance of a patient, and maintains a collection of identity traits	IHE-ITI TF-2	Patient Identity Feed [ITI-8]	C[ ^101][102]
Patient Identity Source		IHE-ITI TF Pediatric Demographics supplement	Patient Identity Management [ITI-30]	C[ ¹⁰⁰ ^][102]

Constraint Code	Constraint Description
100	Required if Pediatric Demographic option is selected
101	Required if HL7 2.3.1 is used for patient identity feed
102	Must select at least one of ITI-8 or ITI-30

2.1.3 Interface Interactions

2.1.3.1 PIX Query Transaction

Interface interactions in the PIX Query Transaction are shown in IHE-ITI TF-2 3.9.2. Interface interactions in the Patient Identity Feed Transaction are as shown in IHE-ITI TF-2 3.8.2. Note that as stated in Table 2-1 Transaction Package Constraints a HITSP Constraints for the transaction is that the Document Registry described in IHE-ITI TF-2 3.8.2 is not applicable.

The PIX Query transaction involves a request by a Patient Identifier Cross-Reference Consumer for a list of patient identifiers that correspond to a patient identifier known by the Consumer. The request is sent as a Get Corresponding Identifiers query and received by a Patient Identifier Cross-Reference Manager. The Patient Identifier Cross-Reference Manager immediately processes the query and sends a Return Corresponding Identifiers response to the Patient Identifier Cross-Reference Consumer that originated the query. ^{^[2]} This response contains a list of corresponding patient identifiers if any were found. The process flows in the PIX Query transactions are shown in IHE-ITI TF-2 3.9.4.

2.1.3.2 Patient Identity Feed Transaction

The Patient Identity Feed Transaction sends patient identity and other demographic information from Patient Identity Source to a Patient Identifier Cross-Reference Manager whenever relevant patient data are created or updated. ^{^[3]} The process flows in the Patient Identity Feed Transaction are shown in IHE-ITI TF-2 3.8.4. Patient Identity Source interfaces which support the Pediatric Demographics option are required to support the Patient Identity Management [ITI-30] Transaction and shall provide values, when available, for the fields identified as Pediatric Demographics fields transaction are shown in IHE-ITI TF-2 3.30.

2.1.4 Pre-conditions

Pre-condition
It is expected that the security framework under which this Transaction Package operates is in accordance with the HITSP Interoperability Specification that references this construct. Therefore, all applicable HITSP Security and Privacy constructs are implemented as required
Patient Identifier Cross-Reference Consumer: Contains patient identification numbers based on at least one patient identification domain/assigning authority known to the Patient Identifier Cross-Reference Manager
Patient Identifier Cross-Reference Manager: Maintains a list of patient identification numbers from and correlated with that sent by Patient Identifier Cross-Reference Consumers and additional domains/assigning authorities
Patient Identity Source: Maintains patient demographic information for at least one patient identification domain/assigning authority known to the Patient Identifier Cross-Reference Manager

2.1.4.1 Process Triggers

Process Trigger
Patient Identifier Cross-Reference Consumer: as described in IHE-ITI TF-2 3.9.4.1.1
Patient Identifier Cross-Reference Manager: as described in IHE-ITI TF-2 3.9.4.2.1
Patient Identity Source: as described in IHE-ITI TF-2 3.8.4.1.1

2.1.5 Post-conditions

Post-condition
Patient Identifier Cross-Reference Consumer: A list, where found by the Patient Identifier Cross-Reference Manager, of one or more patient identification numbers from domains/assigning authorities beyond those for which patient identification numbers were previously available
Patient Identifier Cross-Reference Manager: Creating or updating of patient identification information received
Patient Identity Source: None beyond providing outputs related to this Transaction

2.1.5.1 Required Output

Required Output	Format/Usage
Patient Identifier Cross-Reference Consumer: None specifically related to the PIX transaction
Patient Identifier Cross-Reference Manager: A Return Corresponding Identifiers message containing, where applicable, a list of one or more patient identification numbers from domains/assigning authorities beyond those for which patient identification numbers were requested; where no list of applicable patient identification numbers is possible, indicators in the message as to the reason no list was provided	See IHE PIX
Patient Identity Source: None beyond sending a Patient Identity Feed message

2.1.6 Data Flows

Consistent with the process flows discussed above, there are two data flows for the PIX transaction:

Query from Consumer to Cross-Reference Manager: Query to Get Corresponding Identifiers from Patient Identifier Cross-Reference Consumer to Patient Identifier Cross-Reference Manager

Response from Cross-Reference Manager to Consumer: Response to a query to Return Corresponding Identifiers from Patient Identifier Cross-Reference Manager to Patient Identifier Cross-Reference Consumer

Details of these two data flows are contained in Sections 2.1.6.1 and 2.1.6.2 below.

Only one data flow exists for the Patient Identity Feed Transaction for sending demographic data from the Patient Identity Source to the Patient Identifier Cross-Reference Manager, although there are two variants depending on whether patient merging is performed or not. Details of this data flow and its variants are contained in Subsection 2.1.6.3.

2.1.6.1 Query Consumer to Cross-Reference Manager

The Get Corresponding Identifiers query portion of the Patient ID Cross-Reference Transaction is described in IHE-ITI TF-2 3.9.4.1.2. It consists of three segments: MSH, QPD, and RCP.

Use of the QPD segment is described in IHE-ITI TF-2 3.9.4.1.2.2. A HITSP constraint on this usage is that the data element QPD-3.4.2 must be an ISO object identifier (OID) and QPD-3.4.3 must contain ISO [4] .

2.1.6.2 Response Cross-Reference Manager to Consumer

The Return Corresponding Identifiers response portion of the Patient ID Cross-Reference Transaction is described in IHE-ITI TF-2 3.9.4.2.2. It consists of up to six segments: MSH, MSA, ERR, QAK, QPD, and PID.

Use of the QPD segment is described in IHE-ITI TF-2 3.9.4.2.2.4. Given the fact that QPD-3 must echo QPD-4, QPD-3.4.2 must be an ISO object identifier (OID) and QPD-3.4.3 must contain ISO.

Use of the PID segment is described in IHE-ITI TF-2 3.9.4.2.2.5. Additional PID segment usage for Pediatrics Demographics Option is contained in the IHE-ITI Supplement 2008-2009 Pediatrics Demographics. Table 2-8 shows additional HITSP constraints on this usage.

Table 2-8 HITSP Additional PID Segment Constraints HL7 Segment Patient Identification

SEQ	LEN	DT	OPT [5]	RPT	TBL	Data Element Name	Description/Comments
3.4.2		ST	R			Assigning Authoritys Universal ID	Shall only contain an ISO Object Identifier (OID)
3.4.3		ID	R			Assigning Authoritys Universal ID Type	Shall only contain ISO Note: ISO is the code that means OID

2.1.6.3 Feed Source to Cross-Reference Manager

The Patient Identity Source is responsible to map their internal patient identification information as specified by this section, such as Patient ID, Patient Name, etc.

The Patient Identity Feed is described in IHE-ITI TF-2 3.8.4.1.2 and 3.8.4.2.2. It consists of up to four segments: MSH, EVN, PID, and sometimes MRG.

Use of the PID segment is described in IHE-ITI TF-2 3.8.4.1.2.3 and 3.8.4.2.2.3. Table 2-9 shows additional HITSP constraints on this usage.

Table 2-9 HITSP Additional PID Segment Constraints: HL7 Segment PID- Patient Identification [6]

SEQ	LEN	DT	OPT⁴	RPT	TBL	Data Element Name	Description/Comments
3.4.2		ST	R			Assigning Authoritys Universal ID	Shall only contain an ISO Object Identifier (OID)
3.4.3		ID	R			Assigning Authoritys Universal ID Type	Shall only contain ISO Note: ISO is the code that means OID
5.3		ST	R2			Middle Names	If more than one middle name is available, all available middle names shall be concatenated with separating spaces in this component
11.1.1		ST	O			Street or Mailing Address	Though not required by the HL7 standard, use of national postal service standardized values is strongly recommended
11.1.2		ST	O			Street Name
11.1.3		ST	O			Dwelling Number
11.2		ST	O			Other Designation	May be used for second line of street address
11.3		ST	O			City	Though not required by the HL7 standard, use of national postal service standardized values is strongly recommended [7]
11.4		ST	O			State/Province
11.5		ST	O			ZIP/Postal Code
13	250	XTN	O	Y		Phone Number - Home	If repetition occurs, then first occurrence shall be the primary telephone number used for patient contact ^{^[8]}
13.5		NM	O			Country Code	Though not required by the HL7 standard, use of international and national standardized values is strongly recommended For Country Code, if no value is present, 1 assumed for United States and Canada
13.6		NM	O			Area/City Code
13.7		NM	O			Local Number

Use of the PID segment is described in IHE-ITI TF-2 3.8.4.2.2.4 and IHE-ITI TF-2 Table 3.8-4. The Table 2-10 shows additional HITSP constraints on this usage.

Table 2-10 HITSP Additional MRG Segment Constraints: HL7 Segment-MRG-Merge Patient Information [9]

SEQ	LEN	DT	OPT⁴	RPT	TBL	Data Element Name	Description/Comments
1.4.2		ST	R			Assigning Authoritys Universal ID	Shall only contain an ISO Object Identifier (OID)
1.4.3		ID	R			Assigning Authoritys Universal ID Type	Shall only contain ISO NOTE: ISO is the code that means OID
7.3		ST	R2			Middle Names	If more than one middle name is available, all available middle names shall be concatenated with separating spaces

There are no additional HITSP constraints on the additional elements as specified in the Pediatrics Demographics option supplement.

2.2 List of HITSP Constructs

Construct Name	Description	Transaction/Content
No applicable constructs

2.2.1 Construct Dependencies

Construct	Depends On (Name of Component that it depends on)	Dependency Type (Pre-condition, post-condition, general)	Purpose (Reason for this dependency)
No applicable construct dependencies

2.2.2 Additional Constraints on Required Constructs

Data Element	Construct	Constraint	Constraint Type (Pre-condition, post-condition, general)	Purpose (Reason for this constraint)
No applicable constraints

2.3 Standards

2.3.1 Regulatory Guidance

Regulation	Description
No applicable regulatory standards

2.3.2 Selected Standards

Standard	Description
Health Level Seven (HL7) Version 2.3.1 Chapter 2 Control, Chapter 3 Patient Administration	The HL7 Version 2.3.1 Messaging Standard is an application protocol for electronic data exchange in healthcare. It and prior versions have widespread use in the U.S. and internationally. Both message formats and value sets/code tables are contained in the standard. For more information visit www.hl7.org
Health Level Seven (HL7) Version 2.5, Chapter 2 Control, Chapter 3 Patient Administration, Chapter 5 - Query	The HL7 Version 2.5 Messaging Standard is an application protocol for electronic data exchange in healthcare. It and prior versions have widespread use in the U.S. and internationally. Both message formats and value sets/code tables (e.g., diagnosis type, gender, patient class, result status, specimen collection method, abnormal flags, observation result status codes interpretation, timestamp format) are contained in the standard. For more information visit www.hl7.org
Integrating the Healthcare Enterprise (IHE) IT Infrastructure Technical Framework (ITI-TF) Revision 4.0 or later, Patient Identifier Cross-Referencing Integration Profile (PIX)	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. By specifying the above transactions among specific interfaces, this integration profile does not define any specific enterprise policies or cross-referencing algorithms. By encapsulating these behaviors in a single interface, this integration profile provides the necessary interoperability while maintaining the flexibility to be used with any cross-referencing policy and algorithm as deemed adequate by the enterprise. For more information visit www.ihe.net
Integrating the Healthcare Enterprise (IHE) IT Infrastructure Technical Framework (ITI-TF) Supplement 2008 - 2009, Pediatric Demographics, Draft for Trial Implementation (August 22, 2008)	The experience of immunization registries and other public health population databases has shown that matching and linking patient records from different sources for the same individual person in environments with large proportions of pediatric records requires additional demographic data. Pediatric Demographics makes use of the following six additional demographic fields to aid record matching in databases with many pediatric records. The latest version of the IHE Technical Framework is available at www.ihe.net

2.3.3 Informative Reference Standards

The following table lists standards that provide additional background information or guidance; however, they are not required for the implementation of the Transaction Package specification.

2.0Transaction Package Definition

2.1 Context Overview