The Technology Behind the Solution: PIX/PDQ to the Rescue!
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Bill Klaver explains the tools necessary for HIE success.
Once you’ve answered the questions we asked last week, you can get a bit more technical in building your HIE solution, starting with core services for interoperability.
Let's take a simple look. On one side we have Content Creators; like PACS systems, lab systems, etc, where we want to share the data they create with Content Consumers (portals, EHRs, PHRs etc).
Sure, you could create a 1-to-1 mapping from system to system, but as we have learned in the past, this doesn't scale. What we really need is something in the middle that will provide a set of common/core services for both the creators to make their content available and the consumers to have an easy way to discover what content is shared.
Health information exchange seeks to enable these different core services (sometimes referred to as the enterprise service bus) to exchange patient data with each other. Core services are so named because they’re at the crux of every healthcare delivery system, though obviously the amount and scale differs greatly.
Logically, we can see that our general problem, sharing information from a content creator to a content consumer, can be broken down into smaller problems.
Our first problem is that each content creator may know the patient differently within their respective systems. As an example, the registration may know me as William Klaver and give me an ID of 1234 while the PACS system who took my images knows me as Bill Klaver and uses the ID 789 to store those images locally.
As you add other systems (i.e.Lab, Dietary, etc) to the healthcare environment, Bill may also be known as B Klaver or W Klaver and have 2 more identities. These identities are great for each of these individual systems but not so good for sharing their content; how does the PHR or EHR know how Bill Klaver is represented in each of these systems?
A PIX/PDQ Manager helps solve this problem by sitting between the content creators and consumers and using HL7 standards to exchange, match and link data as it flows between systems.
Each of the contributing systems sends identity data (in industry-standard formats, whether HL7V2 or HL7V3) to the PIX/PDQ Manager, including the patients demographic data and all identifiers. The PIX/PDQ Manager accepts these messages, then links each of the local identifiers and demographics to a higher-level or global identifier. This means that we can search for Bill or William Klaver and always know how he is represented in each and every system across the Health care environment.
If somebody needs to retrieve any content, such as lab results, they can first query the PIX/PDQ manager to discover who Bill is and the global ID used to glue all of Bill's records together. As additional records are added, this patient record grows more robust and contains more information about each patient. For example, when a patient with chronic health issues seeks treatment for the latest symptoms, he may first go to his family physician for assessment before being referred for further tests. As each additional test is ordered, a new specialist is involved, potentially culminating with surgery and post-surgical care. Linking these records is essential to ensuring that each care provider has the complete and most up to date information he or she needs to make the right treatment
In my next post, we’ll dig a bit deeper into the mechanics of the other core components like document/image registries and why they’re essential to a successful HIE. So far we have only addressed the identity issue next we address how the PIX/PDQ Manager works with the Document Location Service called a XDS Registry.
This is part of Bill Klaver's series, Building a Health Information Exchange Through International Standards. For other posts in the series, visit the Table of Contents.
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