+
7.4.2.5.5 Post-conditions
+
+
Upon completion of this use case, the association record identifying the patient and associated device is marked as wrong in the Device-Patient Association Manager.
+
+
+
+
+
+
+
+7.6 PCIM TI - PCIM Cross Profile Considerations, add text after the ADT section that references the use of MEMLS for device and patient location tracking |
+
+
+
A Device-Patient Association Reporter or Device-Patient Association Consumer should utilize the MEMLS profile if the most up-to-date location information is needed.
+
-Section A.1.2.4 in PCIM TI - OBR - Observation Request, update the text to clarify population of OBR-7/8 on deleted, corrected and wrong scenarios: |
+3.51.4.1.2 in PCIM TI - Message Semantics, update the first bullet to include considerations for patient identity corrections: |
+
+
The significant content of the message is the following:
+
+
+
+-
+
Confirmed unique identity of patient, preferably derived from an AIDC (Automatic Identification and Data Capture) such as scanning the patient wristband or reading an RFID tag.
+Code used to identify the patient must be chosen so as to be unique at least over the scope of the set of patients seen over all information systems in the institution, such as a Medical Record Number issued by the institution for the patient, or, if available, a national id number.
+The type and issuing entity shall be recorded with the code.
+Additional identity codes may be provided at the discretion of the institution.
+Note that any code identifiable with an individual patient must by secured from misuse in accordance with applicable legal and policy procedures.
+
+
+
-
The OBR shall also include the timestamp of the earliest participant involvement (OBR-7) and latest participant involvement (OBR-8) for an association or disassociation event report. Each report consists of two Participation Information Segments (PRT) and each may have timestamps for their involvement in PRT-11 and/or PRT-12. OBR-7 and OBR-8 conveys the range of time of both participants. See Table A.1.2.6-3 and Table A.1.2.6-4 for definitions of the timestamp semantics in PRT-11 and PRT-12. The logic for filling in the timestamp values for OBR-7 and OBR-8 is to examine both the PRT segments that will be sent out in the report and set OBR-7 to the earliest timestamp value and OBR-8 to the latest timestamp value. OBR-7 and 8 may contain the same timestamp.
+
Proposed Text:
+
+
+
The significant content of the message is the following:
+
+
+
+-
+
Confirmed unique identity of patient, preferably derived from an AIDC (Automatic Identification and Data Capture) such as scanning the patient wristband or reading an RFID tag.
+Code used to identify the patient must be chosen so as to be unique at least over the scope of the set of patients seen over all information systems in the institution, such as a Medical Record Number issued by the institution for the patient, or, if available, a national id number.
+The type and issuing entity shall be recorded with the code.
+Additional identity codes may be provided at the discretion of the institution.
+Note that any code identifiable with an individual patient must by secured from misuse in accordance with applicable legal and policy procedures. Implementations should account for cases where the patient identity may change as a result of chart corrections. This should trigger the sending of a correction message of the patient identity to the Manager for active associations known to the reporter. This may also trigger the sending of a correction message to the Manager for completed associations.
+
+
+
+
+
+
+
+3.51.4.1.3 in PCIM TI - Message Semantics, add another subsection, 3.51.4.1.3 Correction Semantics to specify the semantics of corrections: |
+
+
+
+
Corrections should be sent from the Device-Patient Association Reporter to the Device-Patient Association Manager when a key parameter for an existing device association has changed. The considerations around which parameters should initiate corrections may differ for active vs completed associations.
+
+
+
Table 3.51.4.1.3-1: Correctable Parameters for Active Associations
+
+
+
+
+
+
+
+
+| Parameter |
+Semantics |
+
+
+
+
+Begin Time |
+Changes to the begin time of an active association shall trigger a correction. |
+
+
+Patient ID |
+Changes to the Patient ID should trigger a correction if the human is semantically the same. Otherwise, it is a “Wrong” association and needs to be marked as such. This solves the use-case of patient merges (ADT A40), ID change (e.g. EMPI deduplication ADT A47), unmerge (ADT A43), or contact move (ADT A45). |
+
+
+Participant (RO, AUT) |
+Changes to a participant may trigger a correction. |
+
+
+Location |
+Changes to the beginning location of the association may trigger a correction. |
+
+
+
+
+
Table 3.51.4.1.3-2: Correctable Parameters for Completed Associations
+
+
+
+
+
+
+
+
+| Parameter |
+Semantics |
+
+
+
+
+Begin Time |
+Changes to the begin time of a completed association shall trigger a correction. |
+
+
+End Time |
+Changes to the end time of a completed association shall trigger a correction. |
+
+
+Patient ID |
+Changes to the Patient ID should trigger a correction if the human is semantically the same. Otherwise, it is a “Wrong” association and needs to be marked as such. This solves the use-case of patient merges (ADT A40), ID change (e.g. EMPI deduplication ADT A47), unmerge (ADT A43), or contact move (ADT A45). |
+
+
+Participant (RO, AUT) |
+Changes to a participant may trigger a correction. |
+
+
+Location |
+Changes to the beginning or ending location of the association may trigger a correction. |
+
+
+
+
+
The device identifier and the association unique instance identifier SHALL NOT be changed in a correction message. All correction messages shall reference the association unique instance identifier from the original message in OBR-29.2.
+
+
+
+
+
+
+
+3.51.4.1.4 in PCIM TI - Message Semantics, add another subsection, 3.51.4.1.4 Wrong Semantics to specify the semantics of wrong associations: |
+
+
+
-
The OBR shall also include the timestamp of the earliest participant involvement (OBR-7) and latest participant involvement (OBR-8) for an association or disassociation event report. Each report consists of two Participation Information Segments (PRT) and each may have timestamps for their involvement in PRT-11 and/or PRT-12. OBR-7 and OBR-8 conveys the range of time of both participants. See Table A.1.2.6-3 and Table A.1.2.6-4 for definitions of the timestamp semantics in PRT-11 and PRT-12. The logic for filling in the timestamp values for OBR-7 and OBR-8 is to examine both the PRT segments that will be sent out in the report and set OBR-7 to the earliest timestamp value and OBR-8 to the latest timestamp value. OBR-7 and 8 may contain the same timestamp.
+
Proposed Text:
+
+
+
An existing device-patient association should be asserted as "Wrong" from the Device-Patient Association Reporter to the Device-Patient Association Manager whenever either the device or the patient that was reported with the association was wrong. All messages asserting an existing device-patient association as wrong shall reference the association unique instance identifier in OBR-29.2 that was sent in OBR-3 of the original message that asserted the association.
+A new association with the valid patient may be asserted after the Wrong has been reported.
+
+
Note that there are chart correction use cases where the Device-Patient Association Reporter’s understanding of the identity of the patient changes but the human who is associated to the device is semantically the same (such as with a patient merge). In these cases, the patient identity change may be handled either by correcting the patient identity for the existing association as described in section 3.51.4.1.3 above or by marking the existing association as wrong and re-asserting the association. The new assertion shall have a new association unique instance identifier in OBR-3 and includes the corrected patient identity.
+
+
+
+
+
+
+
+3.52.4.1.2 in PCIM TI - Message Semantics, add subsection header 3.52.4.1.2 Message Semantics right before the sentence "The significant content of the message is the following" in section 3.52.4.1.1: |
+
+
+
-Section A.1.2.6 in PCIM TI - OBR - Observation Request, Table A.1.2.6-3 update to clarify interpretation of PRT-11 on deleted, corrected and wrong scenarios: |
+3.52.4.1.3 in PCIM TI - Message Semantics, add subsection 3.52.4.1.3 Correction Semantics to specify the semantics of correctable associations: |
-
Existing Table:
+
Proposed Text:
-
Table A.1.2.6-3: PRT-11 Interpretation
+
Correction reports must be sent from the Device-Patient Association Manager to Device-Patient Association Consumers when they are validated. See table 3.51.4.1.3-1 and table 3.51.4.1.3-2 for correctable parameters that may be reported for active and completed associations.
+
+
+
+
+
+
+
+3.52.4.1.4 in PCIM TI - Message Semantics, add subsection 3.51.4.1.4 Wrong Semantics to specify the semantics of wrong associations: |
+
+
+
+
+
+
An existing device-patient association should be reported as "Wrong" from the Device-Patient Association Manager to the Device-Patient Association Consumer whenever either the device or the patient that was reported with the association was wrong. All messages reporting an existing device-patient association as wrong shall reference the association unique instance identifier in OBR-29.2 that was sent in OBR-3 of the original message that reported the association.
+
+
+
When a device-patient association is reported to be "Wrong", any device data that was reported for that device-patient association should also be deleted or flagged for review in any consumers that are using the device-patient association to file received device data to the patient. Device-Patient Association Consumers that are also device data reporter actors shall stop including the wrong patient identifier in outgoing messages as soon as it receives the Wrong association report.
+
+
+
+
+
+
+
+A.3 PCIM TI - Example Messages, add example #5 to illustrate how correcting a patient identify for a merge can be handled: |
+
+
+
+
+
+
+
Patient record Trauma, Unknown represents a patient of unknown identity who is admitted to the ICU after a vehicle accident. At 06:30, Nurse Diesel connected the patient to a continuous physiological monitor with ID MON6789. At 06:45, she records the association on the Critical Care application. As she is an RN and has witnessed and entered the association in the Critical Care system, this is considered a validated association.
+
+
+
+
MSH|^~&|CritCare||AssocMgr||20160726064502||ORU^R01^ORU_R01|94e03d4|P|2.6|||AL|AL|USA||||IHE_DEV_051^IHE PCD^1.3.6.1.4.1.19376.1.6.1.51.1^ISO
+PID|||AB60005^^^A^PI||TRAUMA^UNKNOWN^^^^^L
+PV1||E|3 WEST ICU^3004^1
+OBR|||15404649|69136^MDC_OBS_ASSOCIATION_PATIENT_DEVICE^MDC|||20160726063000|20160726064500
+OBX|1|CWE|68487^MDC_ATTR_EVT_COND^MDC||198332^MDC_EVT_ASSOCIATION_PATIENT_DEVICE^MDC||||||F
+PRT|1|UC||EQUIP^EQUIP^HL70912|||||3 West ICU^3004^1|MON6789^^231A8456B1CB2484^EUI-64|20160726063000
+PRT|2|UC||AUT^AUT^HL70912|58793^Diesel^N||||3 WEST ICU^3004^1||20160726064500
+
+
+
+
(Acknowledgement messages not shown)
+
+
+
At 08:00, the patient’s identity has been ascertained to be patient Benjamin Davis, who has an existing record in the Critical Care system. Working with Health Information Management, it is determined to be safe to merge the temporary trauma record with the patient’s existing permanent patient record. The merge is performed in the Critical Care system, and a correction for the verified association is sent to the device manager containing the updated patient information in PID. A unique identifier for the correction event is sent in OBR-3, and the association identifier that was sent in OBR-3 for the original association message is sent in OBR-29.2. Additionally, the observation status in OBX-11 is sent as "C" to indicate the event is a correction to a verified association.
+
+
+
+
MSH|^~&|CritCare||AssocMgr||20160726082502||ORU^R01^ORU_R01|94e05d9|P|2.6|||AL|AL|USA||||IHE_DEV_051^IHE PCD^1.3.6.1.4.1.19376.1.6.1.51.1^ISO
+PID|||AB40001^^^A^PI||DAVIS^BENJAMIN^C^^^^L
+PV1||E|3 WEST ICU^3004^1
+OBR|||15404649-0001|69136^MDC_OBS_ASSOCIATION_PATIENT_DEVICE^MDC|||20160726063000|20160726064500|||||||||||||||||||||^15404649
+OBX|1|CWE|68487^MDC_ATTR_EVT_COND^MDC||198332^MDC_EVT_ASSOCIATION_PATIENT_DEVICE^MDC||||||C
+PRT|1|UC||EQUIP^EQUIP^HL70912|||||3 West ICU^3004^1|MON6789^^231A8456B1CB2484^EUI-64|20160726063000
+PRT|2|UC||AUT^AUT^HL70912|58793^Diesel^N||||3 WEST ICU^3004^1||20160726064500
+
+
+
+
(Acknowledgement messages not shown)
+
+
+
+
+
+
+
+A.3 PCIM TI - Example Messages, add example #6 to illustrate declaring an association is wrong: |
+
+
+
+
+
+
+
At 22:00, Nurse Diesel connected patient Harrison to a continuous physiological monitor with ID MON5568. At 22:15, she records the association in the Critical Care application, but she selects MON5569 from the pick list by mistake. As she is an RN and has witnessed and entered the association on the Critical Care system, this is considered a validated association.
+
+
+
+
MSH|^~&|CritCare||AssocMgr||20160726221502||ORU^R01^ORU_R01|95e03fa|P|2.6|||AL|AL|USA||||IHE_DEV_051^IHE PCD^1.3.6.1.4.1.19376.1.6.1.51.1^ISO
+PID|||AB60009^^^A^PI||HARRISON^D^F^^^^L
+PV1||E|3 WEST ICU^3002^1
+OBR|||15404852|69136^MDC_OBS_ASSOCIATION_PATIENT_DEVICE^MDC|||20160726220000|20160726221500
+OBX|1|CWE|68487^MDC_ATTR_EVT_COND^MDC||198332^MDC_EVT_ASSOCIATION_PATIENT_DEVICE^MDC||||||F
+PRT|1|UC||EQUIP^EQUIP^HL70912|||||3 West ICU^3002^1|MON5569^^231A8456B1CB2491^EUI-64|20160726220000
+PRT|2|UC||AUT^AUT^HL70912|58793^Diesel^N||||3 WEST ICU^3002^1||20160726221500
+
+
+
+
(Acknowledgement messages not shown)
+
+
+
At 22:20, Nurse Diesel notices that the physiological monitor data isn’t flowing into the Critical Care system as expected and discovers that the device originally associated with the patient is wrong. She deletes the association for MON5569 from patient Harrison in the Critical Care system, which originates a message to the Device-Patient Association Manager indicating that the previously reported association is wrong. A unique identifier for the deletion event is sent in OBR-3, and the association unique instance identifier that was sent in OBR-3 for the original association is in OBR-29.2. Additionally, the observation status in OBX-11 is sent as "W" to indicate the association is wrong.
+
+
+
+
MSH|^~&|CritCare||AssocMgr||20160726222135||ORU^R01^ORU_R01|95e0405|P|2.6|||AL|AL|USA||||IHE_DEV_051^IHE PCD^1.3.6.1.4.1.19376.1.6.1.51.1^ISO
+PID|||AB60009^^^A^PI||HARRISON^D^F^^^^L
+PV1||E|3 WEST ICU^3002^1
+OBR|||15404852-0001|69136^MDC_OBS_ASSOCIATION_PATIENT_DEVICE^MDC|||20160726222000|20160726222000|||||||||||||||||||||^15404852
+OBX|1|CWE|68487^MDC_ATTR_EVT_COND^MDC||198332^MDC_EVT_ASSOCIATION_PATIENT_DEVICE^MDC||||||W
+PRT|1|UC||EQUIP^EQUIP^HL70912|||||3 West ICU^3002^1|MON5569^^231A8456B1CB2491^EUI-64|
+PRT|2|UC||AUT^AUT^HL70912|58793^Diesel^N||||3 WEST ICU^3002^1||20160726222000
+
+
+
+
(Acknowledgement messages not shown)
+
+
+
+
+
+
+
+Table A.1.2.6-3 in PCIM TI - PRT-11 Interpretation, update the table to to remove the participation status of deleted and to allow corrections and wrong declarations for the AUT role: |
+
+
+
+
@@ -614,9 +994,6 @@
@@ -642,26 +1019,20 @@
-Section A.1.2.6 in PCIM TI - OBR - Observation Request, Table A.1.2.6-4 update to clarify interpretation of PRT-12 on deleted, corrected and wrong scenarios: |
+Section A.1.2.5 in PCIM TI - OBX - Observation, Table A.1.2.5-3 update to remove "Deleted" status option: |
+
+
+
+
+
+
+
+
+
+
+
+
+| Status |
+HL7 Description |
+Adaptation |
+
+
+
+
+C |
+Record coming over is a correction and thus replaces a final result. |
+Record coming over is a correction and thus replaces a validated association. |
+
+
+D |
+Deletes the OBX record |
+Deletes the association record. |
+
+
+F |
+Final results;
+can only be changed with a corrected result. |
+Validated association.
+Can only be changed with a corrected association record. |
+
+
+R |
+Results entered — not verified |
+An association has been asserted, but not validated. |
+
+
+W |
+Post original as wrong, e.g., transmitted for wrong patient. |
+Post original as wrong, e.g., transmitted for wrong patient. |
+
+
+
+
+
+
+
+
+
+
+
+
+
+| Status |
+HL7 Description |
+Adaptation |
+
+
+
+
+C |
+Record coming over is a correction and thus replaces a final result. |
+Record coming over is a correction and thus replaces a validated association. |
+
+
+F |
+Final results;
+can only be changed with a corrected result. |
+Validated association.
+Can only be changed with a corrected association record. |
+
+
+R |
+Results entered — not verified |
+An association has been asserted, but not validated. |
+
+
+W |
+Post original as wrong, e.g., transmitted for wrong patient. |
+Post original as wrong, e.g., transmitted for wrong patient. |
+
+
+
+
+
+
+
+
+
+Section A.1.2.6 in PCIM TI - PRT — Participation (Observation Participation), Table A.1.2.6-4 update to remove "Deleted" status option: |
@@ -743,10 +1213,6 @@