Patient Identifier Cross-Reference for Mobile (PIXm)

The Patient Identifier Cross-reference for Mobile (PIXm) Profile defines a lightweight RESTful interface to a Patient Identifier Cross-reference Manager, leveraging technologies readily available to mobile applications and lightweight browser based applications.

Summary

The Patient Identifier Cross-reference for Mobile Integration Profile provides a transaction for mobile and lightweight browser based applications to query a Patient Identifier Cross- reference Manager for a list of patient identifiers based on the patient identifier in a different domain and retrieve a patient’s cross-domain identifiers information into the application.

This profile provides a lightweight alternative to PIX Query [ITI-9] or PIXv3 Query [ITI-45], using a HTTP RESTful Query. This profile depends upon the implementation of the PIX or PIXV3 Profile or equivalent for the patient identity feed and update notifications. Two example groupings are shown in TF-1: 41.5.

This profile does not assume Patient Identifier Cross-reference Manager has the ability to act as a full-fledged FHIR server, other than for the profiled transaction. The profile can be used to provide a RESTful interface to a PIX or PIXv3 Patient Identifier Cross-reference Manager without providing other FHIR services.

Benefits

The Patient Identifier Cross-reference for Mobile Profile is intended to be used by lightweight applications and mobile devices present in healthcare enterprises of a broad range of sizes (hospital, a clinic, a physician office, etc.). It supports the cross-reference query of patient identifiers from multiple Patient Identifier Domains via the following interaction:

• The ability to access the list(s) of cross-referenced patient identifiers via a query/response.

The following use case and descriptions assume familiarity with the profiles in ITI TF-1:5 and ITI TF-1:23, and only describe the RESTful actors and transaction alternatives.

This diagram shows how PIXm actors (in solid outlined, white boxes) can integrate into a PIX environment (gray boxes; described in ITI TF-1: 5.2). For a discussion of the relationship between this Integration Profile and an enterprise master patient index (eMPI) see ITI TF-1: 5.4

Details

The Patient Identifier Cross-reference Consumer fits into the combination of actors and transactions defined for PIX, see ITI TF-1:5. It adds the alternative of using the Mobile Patient Identifier Cross-reference Query [ITI-83] instead of the PIX Query [ITI-9], or PIXV3 Query [ITI-45] transactions. The PIXm Patient Identifier Cross-reference Consumer uses a query for sets of cross-referenced patient identifiers.

Multiple Identifier Domains with a Single Facility/Enterprise Use Case Description

A patient is in an ambulance on his way to the hospital after an accident. The mobile Care system in the ambulance wants to get allergy information (e.g., using the MHD Profile) for the patient. The mobile Care system uses the patient’s driver’s license number ‘E-123’ as their patient ID. Before requesting the allergy information from the hospital, it must translate the known patient identity (driver’s license) to the patient’s identity known by the hospital (MRN). To achieve this correlation, the mobile Care system issues a Mobile Patient Identifier Crossreference Query to the Patient Identifier Cross-reference Manager and retrieves the corresponding patient identity. It requests a list of patient ID aliases corresponding to patient ID = ‘E-123’ (within the “mobile Care domain”) from the Patient Identifier Cross-reference Manager. Having linked this patient with a patient known by medical record number = ‘007’ in the ‘ADT Domain’, the Patient Identifier Cross-reference Manager returns this list to the mobile Care system so that it may retrieve the allergies information for the desired patient. The mobile Care system can now request the allergy information from the hospital allergy system using the allergy system’s own patient ID (MRN-007) including the domain identifier/assigning authority. In this scenario, the hospital’s main ADT system (acting as a Patient Identity Source) would provide a Patient Identity Feed (using the patient’s MRN as the identifier) to the Patient Identifier Cross-reference Manager. Similarly, the mobile Care system or the external assigning authority would also provide a Patient Identity Feed to the Patient Identifier Cross-reference Manager using the patient driver’s license as the patient identifier and providing its own unique identifier domain identifier.

Multiple Identifier Domains with a Single Facility/Enterprise Process Flow

The PIXm Profile is intended to provide a different transport mechanism for the cross-identifier Query functionality described in the PIX Profile. Hence, the Mobile Patient Identifier Crossreference Query [ITI-83] transaction can be used where the PIX Query [ITI-9] (or equivalent) transaction is used. The following diagram describes only Patient Cross-Identity for Mobile Process Flow.

Systems Affected

<List (in user terms) the types of systems they might expect to have implemented actors from this profile, e.g. RIS, PACS, HIS, CAD Workstation, etc. and for each, how it would participate.>

• Local and enterprise-wide information systems that utilize and patient identity (i.e., admit-discharge-transfer (ADT)/registration systems and hospital information system (HIS ))

Actors & Transactions:

Specification

Profile Status: "Trial Implementation"

Documents:

• PIXm Supplement - PIXm TI Supplement

Additional Supplements: Appendix Z on HL7 FHIR

Underlying Standards:

• HL7 FHIR STU3 http://hl7.org/fhir/STU3
  • Patient
  • Operation
  • Parameter
  • OperationOutcome
  • Bundle

FHIR Implementation Guide

Informatively this profile is also as a set of FHIR conformance resources, that are also registered at https://registry.fhir.org

The conformance resources are available on the Implementation Material folder.

See Also

Related Profiles

• Patient Identifier Cross Referencing [PIX] PIXm defines a RESTful interface for the same functionalities.
• MHD
• PDQm
• PRIM