Healthcare: Patient Identifier Cross-reference Manager pattern

Solution

You can use the Healthcare: Patient Identifier Cross-reference Manager pattern to create an integration solution that receives ADT or QBP HL7 messages over MLLP from a clinical application (the Patient Identity Source in the PIX profile). The integration solution then returns an appropriate acknowledgment to the clinical application, as specified by the PIX profile (transaction ITI-8 for ADT messages, or transaction ITI-9 for QBP messages). If the message is valid then the integration solution uses SOAP request/response messages to update or retrieve information from the enterprise master patient index (EMPI) as specified by the content of the message. The EMPI runs in IBM InfoSphere MDM.

The behavior of the integration solution depends on the type of the incoming message. For ADT messages, the integration solution completes the following tasks:

• If the incoming message is an ADT message of type A01, A04, or A05, the patient details contained in the message are added to the EMPI as a new record. You cannot add a patient if an existing patient with those details already exists.
• If the incoming message is an ADT message of type A08, the patient details contained in the message are used to update an existing record in the EMPI. You can update a patient only if an existing patient with those details already exists.
• All other ADT message types result in an AR (application reject) ACK.
• For successful updates, an AA (application accept) ACK is sent after a success response is received from the EMPI.
• For unsuccessful updates, an AE (application error) or AR (application reject) ACK is sent. You can see additional information about the error in the ERR.3.HL7ErrorCode field of the ACK, which contains the HL7 error code. The error codes are defined by HL7 Table 0357. If there is a SOAP fault associated with the error, you can see more information about the error in the ERR.7.DiagnosticInformation field.

For QBP messages, the integration solution completes the following tasks:

• If the incoming message is a QBP message of type Q23, the integration solution retrieves a list of IDs and domains from the EMPI for the patient that is specified in the incoming message. The list of of IDs and domains is returned in an RSP (response) message.
• For successful queries, an AA RSP (response) message of type K23 is returned. This message contains the list of IDs and domains for the patient that is specified in the incoming message.
• For unsuccessful queries, an AE RSP, AE ACK, or AR ACK message is returned, depending on the reason for the failure. Additional information about the failure is contained in the ERR segment of the response.

When you generate an instance of the Healthcare: Patient Identifier Cross-reference Manager pattern, a library named IHEHL7DFDLLibrary is created automatically. The library contains a DFDL version 2.5.1 model, which is used to define the HL7 messages that are used by the pattern.

Acknowledgments

The following tables describe the values in the acknowledgment (ACK) messages that are returned by the pattern. ACK messages are returned by the pattern in response to ADT messages and in response to QBP messages if there is an error because the EMPI server was not contacted.

Responses

The following tables describe the values in the response (RSP) messages that are returned by the pattern. RSP messages are returned by the pattern in response to QBP messages.

Providing a fully qualified assigning authority in response messages

A fully qualified assigning authority is the combination of namespace ID, universal ID, and universal ID type. By default, in response (RSP) messages, the PID 3 field contains only the namespace ID, in field PID.3.4.1. If you require your integration solution to provide a fully qualified assigning authority, you can create a configurable service that will add the universal ID to field PID.3.4.2 and the universal ID type to field PID.3.4.3.

The configurable service contains a list of namespace IDs, together with the associated universal IDs and universal ID types for each namespace ID. When the integration solution is running, the PID.3.4.1 field in RSP messages is checked against the list of namespace IDs in the configurable service. If field PID.3.4.1 matches a namespace ID in the configurable service, the associated universal ID is added to field PID.3.4.2 and the associated universal ID type is added to field 3.4.3 of the RSP message. You can update and redeploy the configurable service to update the list while the integration solution is running.

To use a configurable service to provide a fully qualified assigning authority, complete the following steps:

1. Create a new configurable service; see "Creating configurable services" in the IBM Integration Bus documentation. The configurable service must meet the following requirements:
   • The name of the configurable service must be AssigningAuthority.
   • The configurable service must be of type UserDefined.
   • For each namespace ID that you want to define, add a property to the configurable service, where the name of the property is the same as the namespace ID. For example, if you want to use a namespace ID MH, add a property called MH.
   • For each namespace ID that you define, add a value ID&ID_type to the corresponding configurable service property, where ID is the universal ID for the namespace ID and ID_type is the universal ID type for the namespace ID. For example, if for namespace ID MH the universal ID is 1.23 and the universal ID type is ISO, add the value 1.23&ISO to the configurable service property MH.
2. Deploy the configurable service to the same integration node that you deploy your Healthcare: Patient Identifier Cross-reference Manager integration solution to.