Extended PDQ Detailed Profile Proposal

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1. Proposed Profile: <initial working name for profile>

• Proposed Editors: Alean Kirnak (akirnak@swpartners.com), Sandy Thames (sthames@cdc.gov), David Shields (dshields@swpartners.com)
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: ITI Infrastructure (Public Health)

Summary

The IHE IT Infrastructure Technical Framework Volume 2, Section 3.21, Patient Demographics Query, starting on line 4137 and ending on line 4145, states that “the Patient Demographic Consumer shall specify, and the Patient Demographic Supplier shall support” a list of six demographic traits for searching. Public Health registries, including immunization and cancer registries, contain population databases with many demographic records collected from a variety of sources. As a result of this, the quality of demographic data may be uneven, as registries often prefer partial or mixed quality data to no data at all. Effective searches on such demographic databases are thus more difficult and require a larger number of demographic fields both to locate matches and to avoid falsely matching records for separate patients. The cited section is found to be too restrictive for practical use by public health registries. This proposal also includes a recommended change to a PIX transaction, the Patient Identity Feed transaction, which is often used in conjunction with PDQ, and hence should be renamed from the brief proposal as “Extended PIX and PDQ”.

2. The Problem

<Describe the integration problem. What doesn’t work, or what needs to work.>

3. Key Use Case

Use Case #1 – Problematic Case:

Two Patient Identity Feeds are sent to SDIR for twins Casey and Carey Smith. No multiple birth indicator or birth order is supplied. Upon receiving the feeds, the San Diego Immunization Registry (SDIR) matching software first adds Casey, then Carey. Upon adding Carey, the records are improperly determined to belong to the same patient and linked. Mrs. Smith brings twins Casey and Carey into North County Health Services clinic for childhood immunizations. SDIR is searched for Casey’s record using Name, Date of Birth, Sex and Address. The combined record is returned and there is no indication that this record represents an incorrect combination of both twins’ records.

Use Case #1 – Solution Case:

SDIR is instead searched for Casey’s record using Name, Date of Birth, Sex, Address, Multiple Birth Indicator and Birth Order. The combined record is returned with an alert that this could represent an incorrect combination of both twins’ records, and a recommendation to unlink.

Use Case #2 – Problematic Case:

Naomi Gonzalez brings son Jose into North County Health Service clinic for childhood immunizations. Jose does not have an account number at North County Health Services, and Mrs. Gonzalez does not have an immunization record with her for Jose. SDIR is searched for Jose’s record using Name, Date of Birth, Sex and Address. However, Date of Birth was incorrectly recorded in SDIR as 11/24/04 and not 1/24/04, and his last name is misspelled. A large number of low-probability matches are returned.

Use Case #2 – Solution Case:

In addition to Name, Date of Birth, Sex and Address, Naomi’s first name and her husband’s first name are also passed as search criteria. The set of records returned is substantially smaller (possibly a single candidate match) in spite of the Date of Birth and Last Name errors in the SDIR data.

4. Standards & Systems

Systems

• EHR-S
• Immunization Information Systems (IISs)
• Central Cancer Registries (CCRs)
• Other Public Health Registries
• Master Person Indices (MPI)
• Other systems implementing PDQ

Standards

1. IHE PIX and PDQ profile and transactions Version 4.0.
   1. http://www.ihe.net/Technical_Framework/upload/IHE_ITI_TF_4_0_Vol1_FT_2007_08_22.pdf
   2. http://www.ihe.net/Technical_Framework/upload/IHE_ITI_TF_4.0_Vol2_FT_2007-08-22.pdf
2. HL7 Version 2.5 Chapter 3 Sections 3.3.8 and 3.3.57.
3. Implementation Guide for Immunization Data Transactions Using V 2.3.1 of the Health Level Seven (HL7) Standard Protocol.
   1. http://www.immregistries.org/pubs/index.phtml
   2. http://www.cdc.gov/vaccines/programs/iis/stds/downloads/hl7guide.pdf
4. HSSP Entity Identification Service
   1. Service Functional Model (SFM), balloted HL7 Draft Standard for Trial Use (DSTU), references PIX and PDQ. See: http://hssp-eis.wikispaces.com/
   2. Initial submission to OMG includes a profile that demonstrates PIX/PDQ compatibility, with the above stated extensions. See:

http://www.omg.org/cgi-bin/doc?health/2007-09-02

5. Technical Approach

<This section can be very short but include as much detail as you like. The Technical Committee will flesh it out when doing the effort estimation.>

<Outline how the standards could be used/refined to solve the problems in the Use Cases. The Technical Committee will be responsible for the full design and may choose to take a different approach, but a sample design is a good indication of feasibility.>

<If a phased approach would make sense indicate some logical phases. This may be because standards are evolving, because the problem is too big to solve at once, or because there are unknowns that won’t be resolved soon.>

Existing actors

<Indicate what existing actors could be used or might be affected by the profile.>

New actors

<List possible new actors>

Existing transactions

<Indicate how existing transactions might be used or might need to be extended.>

New transactions (standards used)

<Describe possible new transactions (indicating what standards would likely be used for each. Transaction diagrams are very helpful here. Feel free to go into as much detail as seems useful.>

Impact on existing integration profiles

<Indicate how existing profiles might need to be modified.>

New integration profiles needed

<Indicate what new profile(s) might need to be created.>

Breakdown of tasks that need to be accomplished

<A list of tasks would be helpful for the technical committee who will have to estimate the effort required to design, review and implement the profile.>

6. Support & Resources

<List groups that have expressed support for the proposal and resources that would be available to accomplish the tasks listed above.>

7. Risks

<List technical or political risks that could impede successfully fielding the profile.>

8. Open Issues

<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>

9. Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA

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