Re: IHE DEC DOR - PCD-01
Paul Sherman
Hi Paul,
I am a Software Developer at Getinge and we are currently investigating a DOR system based on IHE DEC. In the course of this, we have been in contact with several EMR/EHR vendors. Many of those use either a device centric approach for mapping device messages (PCD-01) to a patient, or require identifying information in at least one of the following HL7 segments: PID or PV1. In the PCD TF, both segments PV1 and PID of PCD-01 messages are set to required (R), in contrast to e.g. PCD-04 message of ACM where one or both of those segments are needed I have some question about this, I hope you can answer:
1. What is the reasoning behind setting both PCD-01 segments, PV1 and PID, to required?
2. Has there been any interest regarding the optionality of PV1 and PID (e.g. to require at least one instead of both)?
Thanks a lot for your help and time!
Best Regards,
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Monroe Pattillo
Lena,
I can speak to ACM [PCD-04]. The ACM profile defines multiple use cases and is not always patient focused, sometimes equipment focused, and sometimes location focused. Early on HL7 wanted alarm (alert, ACM profile) transactions [PCD-04] to be readily identifiable from DEC [PCD-01] transactions and so HL7 was modified to assign ORU^R40 to alarms (alerts). This allowed ACM to define the R40 template uniquely and different from the R01 template used by DEC [PCD-01]. Thus with ACM the presence of the PID and PV1 segments are optional in support of the various use cases defined by ACM. The presence and absence these segments and their content is the use case dispatching indicator for ACM Alert Manager (AM) and Alert Consumer (ACON) actors.
As far as I know DEC [PCD-01] is always about patient associated observations and so always requiring a PID segment seems to make sense. The PV1 segment is about assigned patient location (manually entered or ADT provided) and not about active location (current or RTLS provided). While DEC [PCD-01] requires the presence of the PV1 segment the PV1-3 Assigned Patient Location field content is optional. In Emergency Room (ER) scenarios when equipment is rapidly configured and used that might affect PID and PV1 content, but the segments are there. Or in outpatient scenarios where the patient might not go through a formal ADT process which might affect PID and PV1 content, but the segments are there. I’ve assumed that DEC knows how to deal with these scenarios, but I’ll allow a DEC subject matter expert to respond to those scenarios.
Regards,
Monroe Pattillo
IHE PCD Co-Chair Emeritus
IHE 2020 NA Connectathon Testing Monitor
HIMSS 2018 IO Showcase TPM
Integrations Consultant
Member IEEE, IHE, ACCE, HIMSS
IHE ACM Working Group Co-Lead
IHE MEM DMC & LS Working Group Lead
Practical Health Interoperability, LLC
Managing Member
Mobile 954-850-7405
E-mail monroe....@gmail.com
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Eldon Metz
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Ken Fuchs
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Monroe Pattillo
Eldon,
I recognize the use case where PID is void at the device and reconciled downstream, preferably before it gets to enterprise storage. Presumptive reconciliation has its risks. I believe the HL7 standard PID segment might even have a way of signaling that the values need to be reconciled.
Yes, PCIM should be resurrected and implemented by vendors and verified at Connectathons. Given that I’m retired, although still a lead on two WGs, I don’t have the cycles to drive it, but would be interested in being a part of the peanut gallery to add my 2 cents worth.
Regards,
Monroe Pattillo
IHE PCD Co-Chair Emeritus
IHE 2020 NA Connectathon Testing Monitor
HIMSS 2018 IO Showcase TPM
Integrations Consultant
Member IEEE, IHE, ACCE, HIMSS
IHE ACM Working Group Co-Lead
IHE MEM DMC & LS Working Group Lead
Practical Health Interoperability, LLC
Managing Member
Mobile 954-850-7405
E-mail monroe....@gmail.com
From: ihepcdcon...@googlegroups.com [mailto:ihepcdcon...@googlegroups.com] On Behalf Of Eldon Metz
Sent: Friday, December 04, 2020 8:18 AM
To: monroe_...@bellsouth.net
Cc: Paul Sherman; Lena (Eva) Mondrejevski; PCD Technical Committee GG; PCD Connectathon and Showcase WG; Peter Verständig
Subject: Re: [pcdconnectathon:3464] [ihepcdtech:3021] Re: IHE DEC DOR - PCD-01
Monroe: My understanding too is that PCD-01 is all about patient observations and thus the PID requirement. It makes a lot of sense to me and is a good requirement that data leaving the DOR should be stamped with who it belongs too and further checks / confirmation can be applied by the receiving systems to ensure they agree.
However, for devices other than patient monitors or aggregators like that which output PCD-01 directly it is just too much pain/hassle in workflow at point of care to try and enter this on every device with their small screen and lack of keyboard in multiple acuity settings. Thus, currently adopted approaches “hack” this and send PCD-01 with empty PID or missing PID and do the patient association further downstream in a non interoperable way, often based on known or fixed location.
Lena: We really need something like PCIM where a patient device association manager provides a interoperability layer for the many devices at the point of care to be managed with varying implementations that meet cost and functionality desires of healthcare organizations and allow device manufacturers to support it natively.
I do think PCIM needs to move forward, and really should have years ago to make life easier at the point of care in terms of digitization, and would love to hear from enough people to start this back up. I know there is a lot of interest in FHIR, but the same interoperability concept can be applied there if this is advanced and moved to implementation and connectathon stage in hl7 v2.
Eldon
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Rhoads, John
Strongly agree with what Eldon says, there is a real role for PCIM! An every-other-week Monday 2 PM ET phone call on PCIM with the goal of preparing for Connectathon testing, making any refinements needing to be made in the current spec and possibly considering a FHIR version (the profile is probably a better fit for FHIR than other IHE PCD profiles).
I you are interested, please contact Brian Witkowski, Tom Kowalczyk, or me so we can add you to the existing Google Group and send you a meeting invite (I’m not enclosing it with this email, just because I’m suspicious that the .ics meeting notice file that I have may have a defect _ (Brian or Tom, would you be able to circulate a notice).
Thanks for your interest,
John
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