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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.

The traceparent header is required, as described in Trace Context header.

Security Audit Considerations

Patient Identity Source Audit

The Patient Identity Source shall be able to 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 be able to 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.