Health Record Locator - Brief Proposal

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1. Proposed Profile: Health Record Locator

  • Proposal Editor: Keith W. Boone
  • Profile Editor: unknown
  • Date: N/A (Wiki keeps history)
  • Version: N/A (Wiki keeps history)
  • Domain: IT Infrastructure

2. The Problem

Patient Health Records are presently being stored in a variety of information systems. Presently, there exists IHE profiles which support exchange of patient health records, but there is no easy way for patients to convey the location of their health record to a provider. The purpose of this profile is to provide a mechanism for patients to easiy specify the location of their health record, and to develop a protocol for one provider to access the health record of a patient from another provider.


3. Key Use Case

A. Patient becomes a new patient at a specialist or inpatient setting. The consumer already has health records stored in either within a PHR or within his provider's EHR that he/she wants to make available to the new healthcare provider. Presently, to accomplish this, A. Patient would need to obtain copies of existing medical records and hand carry them, or have the current provider transmit them to the new provider in paper or electronic form. Even using existing IHE profiles, A. Patient would need to provide information about the organization that currently has the information, and might need to convey his electronic medical record number to the new provider to enable access, or rely on MPI capabilities between the two organizations to ensure access.

Under this profile, A. Patient provides the new provider with a very short string, easily remembered or written down, which is sufficient for the new provider to supply to his/her EMR system. The provider's EMR would then be able to identify the appropriate system to connect to, and access the patient information.

Preconditions
PCP and Specialist provider have previously established an agreement for sharing of information.
Success Scenario
  1. PCP indexes patient documents in XDS Registry.
  2. Patient provides specialist with his/her "Health Record Locator"
  3. Specialist enters "Health Record Locator" (HRL) into EMR.
  4. EMR parses HRL into medical record / account identifier and hostname.
  5. EMR queries DNS for XDS Service end-point addresses supported by the specified host.
  6. EMR obtains end-point addresses and determines that there is previously established agreement for sharing of information.
Post Condition
Patient records can be accessed from the EMR.

4. Standards & Systems

  • DNS
  • URL
  • SMTP
  • UDDI
  • RFC-2782
  • IHE NAV
  • IHE XDS, XDR, XDS.b, QED, PIX/PDQ V3

5. Discussion

IHE has developed many profiles that are supportive of sharing patient records. This is a logical next step. The IT Infrastructure domain is the right committee given the potential solution space.

Technical Approach
Use techniques suggested by the configuration management white paper to support location of web service end points for IHE profiles (e.g., XDS, XDS.b, QED, PIX/PDQ V3). Use an e-mail like address (username@hostname) to repesent the health record locator, and to serve as the NAV e-mail address for notifications of updates to this patient record. Parsing this into a medical record identifier, and a hostname is easy. The mechanism used to resolve web service end-point addresses could be very similar to what is presently used for e-mail locations, using SRV records as described in RFC-2782.
Risks
  • State of current standards
  • Security issues
  • Internet configuration issues regarding DNS SRV records
  • The lack of mechanism to negotiate new trusted relationships may limit utility of this proposal
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