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11. HL7 Master Patient Index Mediator

I. Description of the Option

The HL7 mediation is a software transaction process transmitted to search and locate patients in other MPIs. The software device will send demographic characteristics using HL7 transaction standards to locate and match demographic information in the receiving MPI. The greater the number of demographic characteristics the greater is the matching success. HL7 has organized a MPI Special Interests Group (SIG) to develop this concept further and implement the solution. The SIG's goal is to recommend improvements or extensions to existing HL7 specifications which support mediation among local MPI's (Master Patient Indices). The specifications will describe processes by which an individual can be uniquely identified and coordinated across multiple internal and external systems as well as existing and future systems. Although HL7 does not require a Unique Patient Identifier for mediation, it will be greatly benefitted by it.

Mr. James M. Gabler, Co-chair of the HL7 MPI Special Interest Group points out that multiple identifiers exist and should continue to be used. He believes that a system (provider organization) must be able to assign a system specific unique ID and the role of internal and external ID should be kept separate. HL7's MPI Mediation initiative is to support the on-going facilitation for the multiplicity of identifiers associated with each person through cross-referencing (mediation). It will create a seamless patient population across the participating patient registration systems within a multi-system enterprise.

II. Author/Proponent and Documentation

1. HL7 transaction standards are already used by the industry to update and maintain local MPIs. The proposed improvement adds the use of object-oriented technology to facilitate mediation among both internal and external MPIs.
2. HL7 is an ANSI accredited Standards Developing Organization. HL7 Transaction Standards have been published. The document relating to the MPI Mediator's scope and objectives is used for this analysis.

III. Compliance with ASTM Conceptual Characteristics

The HL7 Mediation is an object-oriented software solution to identify patients and patient information across multiple internal and external systems. It is not a Unique Patient Identifier Proposal. Therefore, most of the ASTM Conceptual Characteristics relating to a UHID are not applicable to HL7 Mediation.

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. Provider specific internal identifier and MPI will be referenced for identification.

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: HL7 Mediation 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: HL7 MPI Mediator utilizes patient's demographic information and available identifier for its searching and matching.

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

Healthcare Focused: The HL7 MPI Mediator is intended for the use of healthcare.

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

Disidentifiable: Encryption scheme to disidentify an individual is not part of the model.

Public: The patient information used by the HL7 MPI Mediator for matching is not public information.

d) Compatibility with Standards and Technology

Based on Industry Standards: HL7 MPI Mediator is not a Unique Patient Identifier proposal.

Deployable: HL7 MPI Mediator is not a Unique Patient Identifier proposal. Object- oriented technology will be used for its implementation.

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

e) Design Characteristics

The HL7 is planning to use object-oriented technology for designing and developing its MPI Mediator. It does not require an administrative infrastructure and its specifications do not address this. However, HL7 representatives point out a Unique Patient Identifier with appropriate Central Trusted Authority and knowledge of the patient record locations will help their process.

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

Repository-based: It is not repository-based. This is, however, not a Unique Patient Identifier proposal.

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: HL7 MPI Mediator does not include a central governing body. A Central Trusted Authority with the knowledge of the patient record locations will help the process.

Networked: HL7 MPI Mediator is 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 HL7 Mediation 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 depends on its capability to fulfill all of the basic functions of a Unique Patient Identifier.

IV. Compliance with Operational Characteristics and Readiness

Currently operational: The HL7 MPI Mediation is not a Unique Identifier. It is not currently operational.

Existing infrastructure: The HL7 MPI Mediation is not a Unique Patient Identifier proposal. Its objective is to improve existing transaction standards to facilitate communication among MPIs from different organizations.

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

Timeliness: The HL7 MPI Mediation Special Interest Group is a new initiative in a planning stage. The development of specifications and the final solution may require substantial amount of time.

Adequacy of information to support identification functions: HL7 MPI Mediator is not a Unique Patient Identifier and it will not maintain patient identification information.

V. Compliance with Unique Patient Identifier Components Requirements

Identifier

The HL7 MPI Mediator is not a Unique Patient Identifier

Identification Information

The HL7 Mediation is not a Unique Patient Identifier and it does not maintain a patient identification data base.

Index

The HL7 Mediation is not an Unique Patient Identifier and it does not maintain a patient index.

Mechanism to protect, mask or encrypt the identifier

Does not use encryption

Technology Infrastructure

The HL7 Mediation is not an Unique Patient Identifier. Its specifications and technology development are at a planning stage.

Administrative Infrastructure

The HL7 Mediation is not a Unique Patient Identifier. Administrative Infrastructure is not addressed. HL7 representatives indicate that both the availability of a Unique Patient Identifier and the use of a Central Trusted Authority with the knowledge of record locations will help the HL7 Mediation process.

VI. Compliance with Basic Functions Criteria

The main focus of the HL7 MPI Mediation is to search and locate patients in other MPIs through the use of software transactions. It is not a Unique Patient Identifier proposal. It does not meet all of the operational characteristics and component requirements of the 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 HL7 Mediation 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: HL7 Mediation 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: HL7 Mediation 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: HL7 Mediation is not a Unique Patient Identifier that can be used for medical record keeping or organization of patient information.

Manual and automated linkage of lifelong health records: The HL7 Mediation 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 to create a lifelong health record.

Aggregation of health information for analysis and research: HL7 Mediation is not a Unique Patient Identifier that can be used 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 HL7 Mediation's access security will depend on its final design and implementation.

Content-free Identifier: The HL7 Mediation is not a Unique Patient Identifier proposal. It utilizes patient identification information for searching and matching.

Mask/Hide/Encrypt/Protect/Disidentify: The HL7 Mediation is not a Unique Identifier proposal. It does not include encryption.

Improve health status and help reduce cost

Upon successful implementation and subject to cooperation and participation by provider organizations, the HL7 Mediation 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 identifiers to search and match patients and does not mandate the use of a Unique Patient Identifier, although it will be helped by it.
2. Eliminates the effort, time and investment that will be required for developing andimplementing 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 the five Unique Patient Identifier's operational characteristics
3. Does not meet any of the Unique Patient Identifier Components' requirements
4. Does not meet most of the Unique Patient Identifier's basic functional requirements. The focus is mainly on cross-referencing existing internal and external identifiers
5. The search will be limited to participating locations.
6. Does not perform search for sites of care/record locations.
7. Requires:

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

b) provider organization's participation in the HL7 Mediation and authorization for searching for 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 utilized by software approaches does not assure 100% result. Discrepancies may require human intervention for resolution

9. Currently, the HL7 Mediation is in the preliminary stage and its fruition depends on significant planning, specification, design and development.

10. The method requires development of an implementation plan and creation of necessary operating procedures, etc.

VIII. Potential Barriers & Challenges to Overcoming the Barriers

1. Failure to meet all of the Unique Patient Identifier's operational characteristics
2. Failure to meet all of the Unique Patient Identifier's component requirements
3. Inability to fulfill all of the basic functions of a Unique Patient Identifier
4. Development of the necessary communication technology and computer software to facilitate the exchange of information from multiple institutions with multiple identifiers for the same patient
5. Timeliness.

IX. Solutions to the Barriers:

The HL7 Mediation is not a Unique Patient Identifier Proposal. It must include a Unique Patient Identifier solution in addition to its software matching process. 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 HL7 Mediation software, implementation of standards, technology, communication protocols, etc.

TABLE OF CONTENTS