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Patient Identity Feed FHIR [ITI-104]

This section describes the national extension for the Swiss EPR to the Patient Identity Feed FHIR [ITI-104] transaction defined in the IUA profile published in the IHE IT Infrastructure Technical Framework Trial Implementation “Patient Identifier Cross-referencing for mobile”.

Scope

This transaction communicates patient information, including corroborating demographic data, after a patient’s identity is established, modified or merged or after the key corroborating demographic data has been modified.

Actor Roles

Actor: Patient Identity Source
Role: Provides notification to the Patient Identifier Cross-reference Manager for any patient identification related events including: creation, updates, merges, etc.
Actor: Patient Identifier Cross-reference Manager
Role: Serves a well-defined set of Patient Identification Domains. Based on information provided in each Patient Identification Domain by a Patient Identity Source Actor, it manages the cross-referencing of patient identifiers across Patient Identification Domains.

Referenced Standards

1. Patient Identifier Cross-referencing for mobile (PIXm), Rev. 3.0.3
2. This PIXm Profile is based on Release 4 of the emerging HL7® FHIR® standard.

Messages

Request

Trigger Events

The Add Patient message is triggered when a new patient is added to a Patient Identity Source. The Revise Patient message is triggered when the patient information is revised within a Patient Identity Source (e.g., change in patient name, patient address, etc.). A Resolve Duplicate Patient message is triggered when the Patient Identity Source does a merge within its Patient Identification Domain.

Message Semantics

The same message semantic apply as in 2:3.104.4.1.2 and 2:3.104.4.2.2 Message Semantics.

The patient data (see Patient example) SHALL conform to the PIXm Patient Feed profile. The Patient Identifier Cross-reference Manager SHALL reference the PIXm Patient Feed profile or a derived constrained profile as a supportedProfile in the CapabilityStatement.

The EPR-SPID as an identifier SHALL be added. The birthname can be added with the ISO 21090 qualifier extension, the religion SHALL not be added.

Message Example

Add Patient Franz Muster:

PUT http://example.org/fhir/Patient?identifier=urn:oid:2.16.756.888888.3.1|8734 HTTP/1.1
Accept: application/fhir+json
Content-Type: application/fhir+json
traceparent: 00-0af7651916cd43dd8448eb211c80319c-b7ad6b7169203331-00

{
  "resourceType" : "Patient",
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MR"
          }
        ]
      },
      "system" : "urn:oid:2.16.756.888888.3.1",
      "value" : "8734"
    },
    {
      "system" : "urn:oid:2.16.756.5.30.1.127.3.10.3",
      "value" : "the EPR-SPID value"
    }
  ],
  "name" : [
    {
      "family" : "Muster",
      "given" : [
        "Franz"
      ]
    },
    {
      "family" : "Muster",
      "_family" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/iso21090-EN-qualifier",
            "valueCode" : "BR"
          }
        ]
      }
    }
  ],
  "gender" : "male",
  "birthDate" : "1995-01-27",
  "managingOrganization" : {
    "identifier" : {
      "system" : "urn:oid:2.51.1.3",
      "value" : "7601000201041"
    }
  }
}

Response

See https://hl7.org/fhir/R4/http.html#cond-update for response.

CapabilityStatement Resource

The CapabilityStatement resource for the Patient Identity Source is PIXm Patient Identity Source.

The CapabilityStatement resource for the Patient Identifier Cross-reference Manager is PIXm Patient Identifier Cross-reference Manager.

Security Consideration

TLS SHALL be used. This national extension enforces authentication and authorization of access to the Patient Identifier Cross-reference Manager using the IUA profile with basic access token. Consequently the Patient Identity Feed FHIR [ITI-104] request must authorize using the [ITI-72] transaction of the IUA profile.

For the traceparent header handling refer to Trace Context header.

Security Audit Considerations

Patient Identity Source Audit

The Patient Identity Source shall record a PIXm Feed Source Audit Event Log. Audit Example for a PIXm Feed transaction from source perspective.

Patient Identifier Cross-reference Manager Audit

The Patient Identifier Cross-reference Manager shall record audit events:

• on an Add Patient message: Audit Event for Patient Identity Feed FHIR by the Manager that Creates a Patient. Audit Example of ITI-104 Create at Manager.
• on a Revise Patient message: Audit Event for Patient Identity Feed FHIR by the Manager that Updates a Patient. Audit Example of ITI-104 Update at Manager.