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10. CORBAMed Patient Identification Service (PIDS)

I. Description of the Option

CORBAMed is the healthcare division of the Object Management Group (OMG). OMG is an industry consortium for promoting the applications of Object Oriented Technologies. CORBA stands for Common Object Request Broker Architecture. It is the industry standard for object oriented interoperability among disparate computer systems. It provides notation for defining interfaces called OMG Interface Definition Language (IDL). CORBAMed is intended to be the object oriented interoperability standard for healthcare. The CORBAMed approach includes multiple levels of MPIs including departmental/service level, organizational level, enterprise level, etc. It uses an ID Domain Manager that manages the identification and correlation of patient demographic profile for searching and matching patient information. The CORBAMed specification currently does not include complex searches, such as searching for the location of a patient's previous sites of care or records. It requires the location of the site to communicate with its MPI. CORBAMed has issued a Request For Proposal for its Patient Identification Service and has received response from a consortium of vendors. The CORBAMed solution is not a proposal for a Unique Patient Identifier. It will, rather facilitate MPI level communication. It will search and match patient profiles for identifying patient and patient information. It will perform correlation of identifiers among ID domains in order to match the patient and patient information. According to CORBAMed representatives, both a Unique Patient Identifier and a central governing body with the knowledge of the various sites of a patient's record will help CORBAMed Patient Identification Service.

II. Author/Proponent and Documentation

1. CORBA has been in use for several years to implement interoperability among systems and handle integration needs. It is the industry standard for object-oriented technology.
2. OMG has published its Object Management Architecture for interoperability. CORBAMed's RFP specifications and responses to the RFP are available on the internet.

III. Compliance with ASTM Conceptual Characteristics

The CORBAMed PIDS is an object oriented software solution that searches and matches patient profiles for identifying patients and patient information. It is not a Unique Patient Identifier Proposal. Therefore, most of the ASTM Conceptual Characteristics relating to a UHID are not applicable to CORBAMed PIDS.

a) Functional Characteristics

Accessible: Does not apply; not a Unique Patient Identifier proposal.

Assignable: Does not apply; not a Unique Patient Identifier proposal.

Identifiable: Does not apply; not a Unique Patient Identifier proposal.

Verifiable: Does not apply; not a Unique Patient Identifier proposal.

Mergeable: Does not apply; not a Unique Patient Identifier proposal.

Splittable: Does not apply; not a Unique Patient Identifier proposal.

b) Linkage of Lifelong Health Record

Linkable: CORBAMed PIDS uses patient profiles and available identifiers to facilitate linkage of health records from multiple providers.

Mappable: Does not apply; not a Unique Patient Identifier proposal.

c) Patient Confidentiality and Security

Content Free: CORBAMed PIDS utilizes patient's demographic information and any available identifier for its searching and matching.

Controllable: Does not apply; not a Unique Patient Identifier proposal.

Healthcare Focused: CORBAMed PIDS is not a Unique Patient Identifier proposal, but it is healthcare focused.

Secure: Does not apply; not a Unique Patient Identifier proposal. The secure nature of the CORBAMed PIDS will depend on the design and development, yet to be performed.

Disidentifiable: CORBAMed PIDS is not a Unique Patient Identifier proposal. Encryption scheme to disidentify an individual is not part of the model.

Public: The patient identification information used by the CORBAMed PIDS for matching cannot be disclosed in public.

d) Compatibility with Standards and Technology

Based on Industry Standards: CORBAMed PIDS is not a Unique Patient Identifier proposal.

Deployable: CORBAMed PIDS is not a Unique Patient Identifier proposal. The implementation requires the use of object-oriented technology.

Usable: Does not apply; not a Unique Patient Identifier proposal.

e) Design Characteristics

The CORBAMed approach uses OMA and OMG IDL as the technology architecture. It does not require an administrative infrastructure and its specifications do not address this. However, CORBAMed representatives point out a Central Trusted Authority with the knowledge of the patient record locations will help their process. These requirements and capabilities will be subject to the design and development that are yet to be performed.

Unique: Does not apply; not a Unique Patient Identifier proposal.

Repository-based: CORBAMed PIDS is not a repository-based Unique Patient Identifier..

Atomic: Does not apply; not a Unique Patient Identifier proposal.

Concise: Does not apply; not a Unique Patient Identifier proposal.

Unambiguous: Does not apply; not a Unique Patient Identifier proposal.

Permanent: Does not apply; not a Unique Patient Identifier proposal.

Centrally governed: CORBAMed PIDS proposal does not include a central governing body. However, a Central Trusted Authority would help the search process more efficient.

Networked: Deployable across networks

Longevity: Does not apply; not a Unique Patient Identifier proposal.

Retroactive: Does not apply; not a Unique Patient Identifier proposal.

Universal: Does not apply; not a Unique Patient Identifier proposal.

Incremental Implementation: Does not apply; not a Unique Patient Identifier proposal.

f) Reduction of Cost and Enhanced Health Status

Cost-effectiveness: The CORBAMed PIDS has the potential to link patient information distributed among multiple providers and enhance the health status of the nation. However, it is not a Unique Patient Identifier proposal and its cost- effectiveness will depend on its capability to fulfill all of the basic functions of a Unique Patient Identifier.

IV. Compliance with Unique Patient Identifier's Operational Characteristics

The CORBAMed Patient Identification Service's scope is limited to facilitating MPI level communication. It is not a Unique Patient Identifier proposal.

Currently operational: CORBAMed Patient Identification Service is not currently operational. It is in the RFP process.

Existing infrastructure: Does not have existing administrative or technology infrastructure.

Readiness of the required technology: The basic technology necessary to develop the infrastructure is ready and available.

Timeliness: CORBAMed has issued a Request For Proposal for its Patient Identification Service and has received response from a consortium of vendors. The method also requires the development of the software and communication solution and an implementation plan before nation-wide adoption. The project may require substantial amount of time.

Adequacy of information to support identification functions: CORBAMed PIDS will not maintain patient identification information.

V. Compliance with Unique Patient Identifier Components Requirements

Identifier

Not an Unique Patient Identifier proposal

Identification Information

Does not maintain patient identification information

Index

Does not maintain patient index

Mechanism to protect, mask or encrypt the identifier

Does not use encryption

Technology Infrastructure

CORBAMed Patient Identification Service is in RFP process to develop the technology.

Administrative Infrastructure

The Administrative Infrastructure is not included in the proposal, but indicates that both a Unique Patient Identifier and a central authority with the knowledge of record locations will help the CORBAMed Patient Identification Service.

VI. Compliance with Unique Patient Identifier's Basic Functions Criteria

The main focus of the CORBAMed Patient Identification Service is to facilitate MPI to MPI communication. It is not a Unique Patient Identifier proposal. It does not meet all of the operational characteristics and component requirements of a Unique Patient Identifier. Therefore, its ability to perform the basic functions of the Unique Patient Identifier is significantly limited.

Identification of individuals

Delivery of care functions: The objective of the CORBAMed Patient Identification Service is MPI level communication. It is not a Unique Patient Identifier that can support the positive identification of an individual required during the course of delivery of care.

Administrative functions: CORBAMed Patient Identification Service is not a Unique Patient Identifier that can be used for patient identification during the course of delivery of care for administrative functions required by practitioners, insurers, HMOs, federal health plan agencies, etc.

Identification of information

Coordination of multi-disciplinary care processes: CORBAMed Patient Identification Service is not a Unique Patient Identifier that can facilitate the multi- disciplinary functions and coordination of care processes among multi-disciplinary team members.

Organization of patient information and medical record keeping: CORBAMed Patient Identification Service is not an identifier that can be used for medical record keeping or the organization of patient information.

Manual and automated linkage of lifelong health records: The CORBAMed Patient Identification Service is aimed at facilitating MPI level communication. Upon successful implementation, it will have the potential to search and match patients from multiple provider organizations. Together with the use of a Unique Patient Identifier and record locations, it can facilitate the linkage of information from different providers toward creating a lifelong health record.

Aggregation of health information for analysis and research: CORBAMed Patient Identification Service is not a Unique Patient Identifier for the aggregation of health information on the basis of diseases, treatments, outcomes, regions, etc. for research, planning and preventive measures.

Protection of privacy, confidentiality & security

Access Security: The CORBAMed Patient Identification Service's access security will depend on its final design and implementation.

Content-free Identifier: The CORBAMed Patient Identification Service is not a Unique Identifier proposal. It utilizes patient identification information for its searching and matching.

Mask/Hide/Encrypt/Protect/Disidentify: The CORBAMed Patient Identification Service is not a Unique Identifier proposal.

Improve health status and help reduce cost

Upon successful implementation and subject to cooperation and participation by provider organizations, the CORBAMed Patient Identification Service will have the potential to search and match patients from multiple provider organizations. It will have a positive impact on the nation's health status. However, it is not a Unique Identifier proposal and its scope is limited to MPI level communication.

VII. Strengths and Weaknesses

Strengths:

1. Uses patient's demographic information and available identifier information to search and match patients, it does not mandate the implementation of a Unique Patient Identifier.
2. Eliminates the effort, time and investment that are required for developing and implementing a new identifier.

Weaknesses:

1. Not a Unique Patient Identifier and does not meet the ASTM conceptual characteristics of UHID (meets only 3 of the 30 requirements).
2. Does not meet three of the five Unique Patient Identifier's operational characteristics and only partially meets the remaining two characteristics.
3. Does not meet any of the Unique Patient Identifier Components' requirements.
4. Does not meet most of the Unique Patient Identifier Basic Functions requirements. The focus is mainly on MPI to MPI communication.
5. The search is limited to participating locations.
6. Does not perform search for sites of care/record location.
7. Requires:

a) prior knowledge of record location and sufficient identification information. More the availability of patient identification information the greater the success.

b) provider organization's participation in the CORBAMed project and their authorization for searching the patient, patient identifier and patient information by another computer system.

c) adequate security arrangements for searching and exchanging patient information.

d) development and implementation of powerful and reliable searching and matching algorithms.

8. The probabilistic matching does not assure 100% result. Discrepancies may require human intervention for resolution.

9. Currently, the CORBAMed PIDS is in the RFP process and for most part remains as a concept. Its fruition will depend upon significant planning, preparation, specification, design and development.

10. Untested - implementing a brand new system nationwide that has not been proven in healthcare industry has inherent risk for its success.

11. The method requires the development of an implementation plan and creation of necessary operating procedures.

VIII. Potential Barriers & Challenges to Overcoming the Barriers

1. CORBAMed PIDS is in the RFP process. Its development, testing, nation-wide deployment and user acceptance are yet to be accomplished.
2. CORBAMed PIDS is a software solution for MPI level searching and matching of patients with available information including Unique Patient Identifiers. It is not a Unique Patient Identifier proposal. Therefore, it lacks the ability to assume the role of a Unique Patient Identifier and perform its functions.
3. Timely development of necessary communication technology and computer software.

IX. Solutions to the Barriers:

The CORBAMed Patient Identification Service is not a Unique Patient Identifier Proposal. It must include a Unique Patient Identifier solution in addition to its MPI to MPI communication capability. The solutions to barriers will include:

1. Inclusion of the missing Unique Patient Identifier's operational characteristics
2. Inclusion of the missing Unique Patient Identifier's components
3. Inclusion of the missing Unique Patient Identifier's basic functions requirements

4) Development of the CORBAMed PIDS software, implementation of standards, technology, communication protocols, etc.

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