september, 2005what ihe delivers 1 françois macary – agfa hes pam
TRANSCRIPT
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1September, 2005 What IHE Delivers
François Macary – AGFA HESFrançois Macary – AGFA HES
PAMPAM
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Patient Administration ManagementPatient Administration Management
Where does PAM come fromWhere does PAM come from
PAM scopePAM scope
PAM actors, transactions and optionsPAM actors, transactions and options
Actors groupingActors grouping
Choice of HL7 2.5Choice of HL7 2.5
Message profilesMessage profiles
Reminders and conclusionReminders and conclusion
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3 hitch-hikers jump into a magic bus3 hitch-hikers jump into a magic busRadio LandRadio Land
ProfilesProfiles
ActorsActors
TransactionsTransactions
Basic SecurityBasic Security
ADTADT
1, 121, 12
Cardio LandCardio Land Lab LandLab Land
ADTADT
Rad-1, Rad-1,
Rad-12Rad-12
Rad-1, Rad-1,
Rad-12Rad-12
ADTADT
The ITI The ITI Magic Magic BusBus
CTCT
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The MahabharataThe Mahabharata
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3 hitch-hikers jump into a magic bus3 hitch-hikers jump into a magic busRadio LandRadio Land
ProfilesProfiles
ActorsActors
TransactionsTransactions
Basic SecurityBasic Security
ADTADT
1, 121, 12
Cardio LandCardio Land Lab LandLab Land
ADTADT
Rad-1, Rad-1,
Rad-12Rad-12
Rad-1, Rad-1,
Rad-12Rad-12
ADTADT
The ITI The ITI Magic Magic BusBus
CTCTATNAATNAEUA EUA XUAXUA
PDQ PDQ
PIXPIX
XDS XDS NAV NAV DSGDSG
PAMPAM
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3 hitch-hikers jump into a magic bus3 hitch-hikers jump into a magic busRadioRadio
ProfilesProfiles
ActorsActors
TransactionsTransactions
CardioCardio LabLab
The ITI The ITI Magic Magic BusBus
CTCTATNAATNAEUA EUA XUAXUA
PDQ PDQ
PIXPIX
XDS XDS NAV NAV DSGDSG
PAMPAM
PathologyPathology PCCPCC PCDPCD
RID RID PSAPSAPWPPWP
SWF SWF PIR …PIR …
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PIXPIX
Future rearrangement in ITI Future rearrangement in ITI
Patient Identity Patient Identity SourceSource
Patient Identifier Patient Identifier Cross-reference Cross-reference
ManagerManager
Patient Identifier Patient Identifier Cross-reference Cross-reference
ConsumerConsumer
ITI-9ITI-9
ITI-10ITI-10
ITI-9ITI-9
Patient Identity Feed (HL7 2.3.1)Patient Identity Feed (HL7 2.3.1)
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PIXPIX
Future rearrangement in ITI Future rearrangement in ITI
Patient Identity Patient Identity SourceSource
Patient Identifier Patient Identifier Cross-reference Cross-reference
ConsumerConsumer
ITI-9ITI-9
ITI-10ITI-10
ITI-9ITI-9
Patient Identity Feed (HL7 2.3.1)Patient Identity Feed (HL7 2.3.1)
Patient Identifier Patient Identifier Cross-reference Cross-reference
ManagerManager
Option 1Option 1
PAMPAM
Patient Patient Demographics Demographics
ConsumerConsumer
Patient Patient Demographics Demographics
SourceSource
ITI-030ITI-030
Patient Identity Feed Patient Identity Feed
(HL7 2.5)(HL7 2.5)OOppt t iioonn
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PDQPDQ
PAM & PDQ: The push-pull brothersPAM & PDQ: The push-pull brothers
PAMPAM
Patient Patient Demographics Demographics
ConsumerConsumer
Patient Patient Demographics Demographics
SourceSource
ITI-030 ITI-030 Patient Patient Identity Identity
Feed Feed
Patient Patient EncounterEncounter ConsumerConsumer
Patient Patient Encounter Encounter
SourceSource
ITI-031 ITI-031 Patient Patient
Encounter Encounter Management Management
Patient Demographics Patient Demographics ConsumerConsumer
Patient Demographics Patient Demographics SourceSource
ITI-021 ITI-021 Demographics Demographics
Query Query
ITI-022 ITI-022 Demographics Demographics & Visit Query & Visit Query
HL7 v2.5HL7 v2.5
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PAM scopePAM scope
Acute care Acute care settingsetting
Care providersCare providerscommunitycommunity
Admitted & ambulatoryAdmitted & ambulatory
Patient identification Patient identification & demographics& demographics
Patient Account Patient Account & Encounter& Encounter
Patient Patient MovementMovement
Admitted & ambulatoryAdmitted & ambulatory
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Patient IdentificationPatient Identification
All patients in PAM must be identified.
PID-3 (CX, mandatory, repeatable) = Patient Identifier List
Each patient identifier has an assigning authority (CX-4)
Each identifier is typed (CX-5 = Identifier Type Code)
‘PE’ = Living Subject Enterprise Number
‘PI’ = Patient internal identifier assigned by the HC organization
‘NH’ = National Health Plan Identifier
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““EncounterEncounter” extends “Visit”” extends “Visit”
An interaction between a patient and care provider(s)
for the purpose of providing healthcare-related
service(s). Healthcare services include health
assessment.
Examples: inpatient hospital stay, emergency room
visit, field visit (e.g., traffic accident), physician’s
office visit…
Encounters may uniquely be identified in PAM:
PV1-19 (CX) = Visit Number (CX-5 = ‘VN’)
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Patient Patient AccountAccount
Assigned by accounting. Records all charges,
invoices, payments
A Patient Account may be associated with one
Encounter, or span several Encounters.
Accounts may uniquely be identified in PAM:
PID-18 (CX) = Account Number (CX-5 = ‘AN’)
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““MovementMovement” extends “Transfer”” extends “Transfer”
An event describing a change of the situation of the
patient in the context of the encounter.
Examples: transfers of patient location, change of
patient class, new attending doctor, new consulting
doctor, new encounter starting, encounter closing
Movements may uniquely be identified in PAM:
ZBE-1 (EI, repeatable) = Movement Id List
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Movements are eventsMovements are events
Patient received at the emergency room
Two hours later, the patient is admitted to a ICU
After two days, the patient is transferred to a regular bed in Medicine
The patient is discharged
In emergency wardIn emergency ward In ICUIn ICU In MedicineIn Medicine
A04 Movement Id = M0
A06 Movement Id = M1
A02 Movement Id = M2
A03 Movement Id = M3
Movements are events that trigger sub-encounters
= periods during which the patient situation is stable
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PAM fulfills these purposesPAM fulfills these purposes
Create, update, merge, link, unlink, delete patient identities
Opens, moves, closes patient accounts
Opens, updates, closes patient encounters
Creates, updates, cancels patient movements
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PAM Actors / Transactions / OptionsPAM Actors / Transactions / OptionsPatient Patient
Demographics Demographics ConsumerConsumer
Patient Patient Demographics Demographics
SourceSource
ITI-030 Patient Identity Feed ITI-030 Patient Identity Feed
Patient Patient EncounterEncounter ConsumerConsumer
Patient Patient Encounter Encounter
SourceSource
ITI-031 Patient Encounter Management ITI-031 Patient Encounter Management
Patient Demographics Source & Consumer
Options
Merge
Actors pairs
Link / Unlink
ITI 030
Patient Encounter Source & Consumer
Inpatient / Outpatient Encounter Management
Pending Event Management
Advanced Encounter Management
Temporary Patient Transfer Tracking
ITI 031
Historic Movement
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The mandatory options for FranceThe mandatory options for France
Patient Demographics Source & Consumer
Options
Merge
Actors pairs
ITI 030
Patient Encounter Source & Consumer
Inpatient / Outpatient Encounter Management
Advanced Encounter ManagementITI 031
Historic Movement
In the acute care setting environmentIn the acute care setting environment
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The mandatory options for FranceThe mandatory options for France
Patient Demographics Source & Consumer
OptionsActors pairs
ITI 030
In the pure ambulatory environmentIn the pure ambulatory environment
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ITI-30 message setsITI-30 message sets
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ITI-31 basic subsetITI-31 basic subset
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ITI-31 is self-containedITI-31 is self-contained
Encounter, account & movement information
Patient identity and demographics (in the context of the encounter)
The Patient Encounter Source sends in ITI-31 messages:The Patient Encounter Source sends in ITI-31 messages:
In addition, ITI-31 also allows the Patient Encounter Source to send In addition, ITI-31 also allows the Patient Encounter Source to send messages to the Patient Encounter Consumer for patient identity messages to the Patient Encounter Consumer for patient identity maintenance in the encounter context, including patient update and maintenance in the encounter context, including patient update and identity merge.identity merge.
Thus there is no required grouping for the Patient Encounter Thus there is no required grouping for the Patient Encounter Consumer Actor: It may receive all information needed through the Consumer Actor: It may receive all information needed through the only transaction ITI-31.only transaction ITI-31.
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ITI-31 Inpatient/OutpatientITI-31 Inpatient/Outpatient
This is what the old ménage à trois (ADT, 1, 12) This is what the old ménage à trois (ADT, 1, 12) was up to.was up to.
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PAM actors groupingPAM actors groupingTo be able to put patient identity and demographics in its encounter To be able to put patient identity and demographics in its encounter messages of transaction ITI-31, a Patient Encounter Source is messages of transaction ITI-31, a Patient Encounter Source is required to be grouped with either a Patient Demographics Source or required to be grouped with either a Patient Demographics Source or a Patient Demographics Consumer:a Patient Demographics Consumer:
Patient Encounter Patient Encounter ConsumerConsumer
Patient Encounter Patient Encounter SourceSource
Patient Demographics Patient Demographics SourceSource
ITI-31ITI-31
Patient Encounter Patient Encounter ConsumerConsumer
Patient Encounter Patient Encounter SourceSource
Patient Demographics Patient Demographics ConsumerConsumer
ITI-31ITI-31
Patient Demographics Patient Demographics SourceSource
ITI-30ITI-30
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PAM leveraged by other ITI profilesPAM leveraged by other ITI profiles
PDQPDQ
Patient Demographics Patient Demographics ConsumerConsumer
Patient Demographics Patient Demographics SourceSource
ITI-022 ITI-022 Demographics Demographics & Visit Query & Visit Query
ITI-021 ITI-021 Demographics Demographics
Query Query
PAMPAMPatient Patient
Demographics Demographics ConsumerConsumer
Patient Patient Encounter Encounter ConsumerConsumer
Patient Patient Demographics Demographics
SourceSource
Patient Patient Encounter Encounter
SourceSource
ITI-030 ITI-030 Patient Patient Identity Identity
FeedFeed
ITI-031 ITI-031 Patient Patient Encounter Encounter ManagementManagement
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PAM leveraged by domain profilesPAM leveraged by domain profiles
Domain ProfileDomain Profile
Order PlacerOrder Placer
ADTADT
Rad-12Rad-12
Rad-1Rad-1
Option 1Option 1
PAMPAM
Patient Patient Demographics Demographics
ConsumerConsumer
Patient Patient Encounter Encounter ConsumerConsumer
Op Op t t I I o o n n 22
Patient Patient Encounter Encounter
SourceSource
Patient Patient Demographics Demographics
SourceSource
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Choice of the standard HL7 v2.5 Choice of the standard HL7 v2.5
The latest available balloted standard as of June 2005
For consistency with PDQ
Extends the length of key data types (e.g. CX for patient identifiers), which is necessary for large affinity domains (assigning authority systematically mentioned)
Enables a more expressive error reporting (in ACK messages) than previous versions.
Brings built in message profiles, which facilitate the message validation. The PAM supplement uses the message static definitions at:
Message level Segment level Data type level
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Message static definitionMessage static definition
The applicative acknowledgement messageThe applicative acknowledgement message
(Original mode acknowledgement of HL7)(Original mode acknowledgement of HL7)
The ERR segment is present if the receiving application encountered an The ERR segment is present if the receiving application encountered an error while integrating the original message.error while integrating the original message.
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Segment static definitionSegment static definition
The Error segment in the acknowledgement messageThe Error segment in the acknowledgement message
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Data Type static definitionData Type static definition
ERL: Data Type of ERR-2ERL: Data Type of ERR-2
Example:Example:
ERR||MSH^1^9^1^1|200^unsupported message type^HL70357
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RemindersReminders
Pay attention to the data types (Appendix N)
Review the examples (Appendix P)
Choose the options appropriate to your
environment
Choose the same options set for a pair of actors
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ConclusionConclusion
PAM mandates more fields and subfields, and brings PAM mandates more fields and subfields, and brings more constraints than ADT, Rad-1 & Rad-12 did.more constraints than ADT, Rad-1 & Rad-12 did.
On the other hand, PAM extends widely the capacities On the other hand, PAM extends widely the capacities of these. It offers a rich set of options to meet the of these. It offers a rich set of options to meet the needs of all kinds of healthcare organizations.needs of all kinds of healthcare organizations.
Not all options are needed for a particular Not all options are needed for a particular implementation. PAM is a constrainable profile. Each implementation. PAM is a constrainable profile. Each organization must select the appropriate subset.organization must select the appropriate subset.
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