Patient Master Identity Registry (PMIR)

Overview

The Patient Master Identity Registry (PMIR) Profile supports creating, updating, and deprecating patient identity information about a subject of care, as well as subscribing to changes, using HL7 FHIR resources and RESTful transactions. This profile includes the Patient Identifier Cross-reference for Mobile (PIXm) and Patient Demographics Query for Mobile (PDQm) profiles. The “patient master identity” is the dominant patient identity managed centrally among many participating organizations (a.k.a., “Golden Patient Identity”).

Beyond the basic create, retrieve, update, and delete transaction set, this profile addresses important patient safety issues related to cases where there are two or more patient master identities that have been established for the same person, thus it is not clear which identity is the “true” one. There is also a risk that health data (possibly conflicting) may be associated with each identity – and these disparate data, together, may need to be reconciled before a fully and accurate “health picture” can be developed for this person. These situations represent patient safety risks. This profile addresses how these multiple patient master identities can be merged into a single patient master identity, and how this merge flows down to data custodians so that they take appropriate actions. It is outside the scope of this profile to define how references to the deprecated patient master identity from other data should be handled.

Actors and Transactions

The following diagram provides an overview of the PMIR profile Actors, Transactions and their interactions.

The table below lists the transactions for each actor directly involved in the PMIR profile. To claim compliance with PMIR, an actor shall support all required transactions (labeled “R”).

Actor	Transaction	Optionality
Patient Identity Source	Mobile Patient Identity Feed [ITI-93]	R
Patient Identity Consumer	Mobile Patient Identity Feed [ITI-93]	R
Patient Identity Manager	Mobile Patient Identity Feed [ITI-93] Mobile Patient Identifier Cross-Reference Query [ITI-83] Mobile Patient Demographic Query [ITI-78] Subscribe to Patient Updates [ITI-94]	R R R R
Patient Demographics Consumer	Mobile Patient Demographic Query [ITI-78]	R
Patient Identity Cross-Reference Consumer	Mobile Patient Identifier Cross-Reference Query [ITI-83]	R
Patient Identity Subscriber	Subscribe to Patient Updates [ITI-94]	R

Transactions

Mobile Patient Demographic Query [ITI-78] - Requests a list of patients matching the supplied set of demographics criteria (example: ID or Name) from the Patient Demographics Supplier. The Patient Demographics Consumer populates its attributes with demographic information received from the Patient Demographics Supplier. Uses a FHIR Patient Query: GET [base]/Patient?<query>
Mobile Patient Identifier Cross-Reference Query [ITI-83] - Used by the Patient Identity Cross-Reference Consumer actor to solicit information about patients whose Patient Identifiers cross-match with Patient Identifiers provided in the query parameters of the request message. The request is received by the Patient Identifier Cross-Reference Manager. The Patient Identifier Cross-Reference Manager processes the request and returns a response in the form of zero or more Patient Identifiers for the matching patient. Uses a FHIR Patient $ihe-pix operation: GET [base]/Patient/$ihe-pix?<query>
Mobile Patient Identity Feed [ITI-93] – Used to send a FHIR Bundle of new and updated Patient Resources. POSTs a FHIR Bundle containing at least one Patient resource.
Subscribe to Patient Updates [ITI-94] - allows a Patient Identity Subscriber to subscribe to a Mobile Patient Resource Feed [ITI-93] depending on the requested criteria. POSTs a FHIR Subscription resource.