PA Interdependent Registries

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Introduction

The primary implementer of the HL7 V3 role-based registries appears to be Canada. Canada has production implementations of Client (AKA Patient) and Provider registries. At the May 2010 Working Group Meeting Ron Parker of Canada Infoway gave a presentation to the Patient Administration work group addressing lessons learned and future architectural plans for Canada. See Ron's presentation to PA at the Rio WGM here Ron Parker presentation on Interdependent Registries.

The most significant finding is that real world applications require that different types of registries work together. The challenge for Patient Administration is to define interactions that span a number of topics:

• Person topic (DSTU in Patient Administration domain)
• Patient topic (DSTU in Patient Administration domain)
• Service Delivery Location (DSTU in Patient Administration domain)
• Provider topic (Normative R1 in Personnel Management domain)
• Organization topic (Normative R1 in Personnel Management domain)

Also, the Canadian Notional Architecture includes two additional registries for which a standard has not been defined. We need to do more research to determine whether these registries should be defined within Patient Administation. Defining interactions that would also include these registries could present a technical challenge.

• Health Service
• Health Program

Basic definitions
From Goldfarb and Prescod, XML Handbook, 5th Ed

1. Directory: a catalog in which things may be listed with or without theirowners’ overt participation (or even knowledge!)
2. Registry: a catalog whose participants must request participation, either explicitly or as a by-product of organization membership, legal action, etc.
3. Repository: a place where things are stored, often in conjunction with a registry or directory

Project Scope Statement

Interdependent Registries Project Scope Statement

Business Requirements

1. HITSP/IS03 Consumer Empowerment and Access to Clinical Information via Networks V3.1 identified three standards gaps:
   • IER 13 – Request/receive provider information
   • IER 14 – Access/select provider information
   • See section 4.2 GAPS WHERE THERE ARE NO STANDARDS, page 90:
     • Major gap in the specification of a provider registry (if using the HIE variant); its content, privacy issues, organization-provider relationship(s), and organization-organization relationship(s). Also, if this is related to addressing the permissions issue then are there other. organizations/individuals that we need to cover as well. This provider list is required for inclusion in /association to the permissions/access control entries
     • 1. Need to do query/retrieve access with a provider registry (assumes that one exists and is maintained) or do pt-to-pt request (in-person, phone) to a healthcare entity. The entity pushes this info to the consumer (using HITSP/C32).
     • 2. Consumer creates and is capable of communicating this list to others (method for building the relationship to permissions?)
     • Consider payor-provided portals to provider lists for its members as a source of provider list content
   • DR 13 – Provider identification (consumer oriented terminology for provider type role)
     • Provider identification, details, location
     • Superset of HITSP/C32 - Summary Documents Using HL7 Continuity of Care Document (CCD) & C37 - Lab Report Document provider identification, and additional elements as needed for entity resolution
     • Consistent representation of practice sites, nature of practice, all alternatively presented in lay person friendly terms
2. HITSP/CAP121 Communicate Referral Request Capability identified a gap:
   • Currently no standard available for a provider registry from which to select a provider based on patient preferences or on Health Plan Eligibility. Candidate standards in HL7 and ASC X12 are awaiting harmonization.
3. The Health Information Technology Policy Committee's Information Exchange Workgoup has identified Provider Directories as a key enabler for nationwide health information exchange.
4. HIT Policy Committee - Provider Directory Task Force presentation 2011-01-12
5. HL7 EHR System Functional Model see IN.3 Registry and Directory Services

Business Use Cases

The following are business use cases that rely on interactions between person, patient, provider and organization registries.

1. Consumer Empowerment: Consumer Access to Clinical Information ONC Use Case
2. Consultations and Transfers of Care ONC Use Case
3. Scheduling ONC Use Case
4. Healthcare Service Directory Use Cases from OMG RFP - new 2010-12-27
5. NHIN Direct User Stories - these business use case assume the existence of a Healthcare Provider Registry for organizations and individual providers.

Related Standards

1. ASC X12 274 Health Care Provider Directory
2. ANSI/HL7 V3 Personnel Management, Provider topic - message specification
3. CMS National Provider Identifier page 3457
4. HITSP/C83 CDA Content Modules Component – HL7 V3 CDA Healthcare Provider module
5. HL7 Healthcare, Community Services and Provider Directory - service functional model
6. HL7 V3 Patient Administration, SDLOC DSTU
7. IHE Healthcare Provider Directory (based on LDAP and ISO 21091) - draft
8. ISO/DIS 21091 Health Informatics – Directory services for security, communications and identification of professionals and patients
9. Medbiquitous Healthcare Professional Profile Schema
10. OASIS ebXML Registry Information Model v2.0 -new 2010-12-23
11. OASIS ebXML Registry Services Specification v2.0 -new 2010-12-23

Analysis Documents

1. HITSP Information Interchange Subcommittee Interface to Provider Directory/Registry Harmonization Project
2. Healthcare, Community Services and Provider Director Service Functional Profile, Release 1 mapped to HL7 Personnel Management
3. Analysis of Registry Behavior - new 2010-12-20

May 2010 Ballot: Domain Analysis

The use cases that specify the main use cases regarding the use of registries in complex, inter-dependent ways:

• Registry Use Cases
• Infoway Use Cases new 20110111
• Registry Actors
• Glossary of Registry Terms

Related Proposals

1. Patient Registry Additional Query Parameters - approved
2. AORTA Application Registry Use Case
3. Person Registry Additional Query Parameter - approved

Meeting Minutes

• Interdependent Registries Project Meeting Minutes