Patient Encounter TrackingPatient Encounter Tracking QueryQuery (PEQ)(PEQ)

Yutaka AndoYutaka Ando MDMD 　　ando_y@nirs.go.jpando_y@nirs.go.jp

Location of PatientLocation of Patient

• Patient Encounter Tracking Query (PEQ) Patient Encounter Tracking Query (PEQ) Integration Profile :To track the whereabouts of Integration Profile :To track the whereabouts of patients in a hospitalpatients in a hospital

• At the hospital reception patients are to proceed to At the hospital reception patients are to proceed to indicated area such as outpatient clinic, laboratory, indicated area such as outpatient clinic, laboratory, radiological diagnosis and radiotherapy treatment radiological diagnosis and radiotherapy treatment room. room.

• Patient does not show up at the appointment time. Patient does not show up at the appointment time. By knowing patient’s whereabouts, medical staffs By knowing patient’s whereabouts, medical staffs are able to utilize the resource more efficiently. are able to utilize the resource more efficiently.

Use CaseUse Case

• Patient Tanaka has scheduled CT scan at today’s 10:00 Patient Tanaka has scheduled CT scan at today’s 10:00 am. But Tanaka not arrived at the reception of radiology am. But Tanaka not arrived at the reception of radiology department, so medical staff cannot start CT scan. department, so medical staff cannot start CT scan.

• To check patient location information, staff of the radiology To check patient location information, staff of the radiology department uses the PEQ Consumer. After a query he department uses the PEQ Consumer. After a query he gets the information that Tanaka is in the ECG examination gets the information that Tanaka is in the ECG examination room at the lab department. room at the lab department.

• Staff of the radiology department has started CT scan of Staff of the radiology department has started CT scan of patient Suzuki who has accepted the radiology reception.patient Suzuki who has accepted the radiology reception.

Proposed Standards & SystemsProposed Standards & Systems

• SystemsSystems– Patient Admission/Management systemPatient Admission/Management system– RIS(Radiology Information System)RIS(Radiology Information System)– LIS(Laboratory Information System)LIS(Laboratory Information System)– EMR(Electronic Medical Record)EMR(Electronic Medical Record)– OIS(Radiation Oncology Information system)OIS(Radiation Oncology Information system)– Modality (Radiology)Modality (Radiology)

• StandardsStandards– HL7HL7--ADTADT//PID, PV1, PV2, QBP message PID, PV1, PV2, QBP message

DiscussionDiscussion

• If the patients’ whereabouts is accessible and referable, If the patients’ whereabouts is accessible and referable, current medical information system could provide more current medical information system could provide more efficient patient management to the users of the system. efficient patient management to the users of the system. Recently improved technologies, such as RFID, enables to Recently improved technologies, such as RFID, enables to build the system which can easily shows patient location in build the system which can easily shows patient location in a medical facility.a medical facility.

• PAM (Patient Administration Management), which has PAM (Patient Administration Management), which has already been published in the ITI-Domain, is the one-way already been published in the ITI-Domain, is the one-way function that shares information by receiving one and then function that shares information by receiving one and then passing the same to the pre-designated receiver. There are passing the same to the pre-designated receiver. There are no managers in the PAM integration profile.no managers in the PAM integration profile.

PAMPAM

• Patient Administration Management (PAM) Patient Administration Management (PAM) Integration profile is able to provide current Integration profile is able to provide current information regarding a patient’s encounter status information regarding a patient’s encounter status and location. The Temporary Patient Transfer and location. The Temporary Patient Transfer Tracking Option defines the information exchange Tracking Option defines the information exchange needed for tracking a temporary leave/return of a needed for tracking a temporary leave/return of a patient from/to a care facility.patient from/to a care facility.

Patient Encounter Patient Encounter SupplierSupplier

Patient Encounter Patient Encounter ConsumerConsumer

ITI-31 Patient Encounter Management

Discussion cont.Discussion cont.• PEQ has three actors (Patient Encounter Source, Patient PEQ has three actors (Patient Encounter Source, Patient

Encounter Manager and Patient Encounter Consumer). Encounter Manager and Patient Encounter Consumer). Patient Encounter Manager always knows where the patient Patient Encounter Manager always knows where the patient is and can answer the patient location to respond a query.is and can answer the patient location to respond a query.

Figure Patient Encounter Tracking Query Actor DiagramFigure Patient Encounter Tracking Query Actor Diagram

Patient Encounter Manager

Patient Encounter Manager

Patient Encounter Source

Patient Encounter Source

Patient Encounter Consumer

Patient Encounter Consumer

Patient Encounter Management [ITI-031](It will be necessary for this transaction to be expanded)

Patient Encounter Query [ITI-XXX]

Q&A-1Q&A-1Q1) Q1)

What is the scope of your proposal in terms of application to a What is the scope of your proposal in terms of application to a single enterprise or across enterprises. We believe the single enterprise or across enterprises. We believe the proposal is designed to address across departments within proposal is designed to address across departments within a hospital or similar facility but not for outside the hospital a hospital or similar facility but not for outside the hospital or across enterprises. Can you clarify the scope in this or across enterprises. Can you clarify the scope in this respect?respect?

A1)A1)

PEQ is used in a single hospital not across enterprises. PEQ is used in a single hospital not across enterprises.

Q&A-2Q&A-2Q2) Q2)

How is the patient management system tracking the location How is the patient management system tracking the location of patients? We believe other systems are expected to of patients? We believe other systems are expected to feed information into the patient management system.feed information into the patient management system.

A2)A2)

PEQ’s actors consist of (1) Patient Encounter Source, (2) PEQ’s actors consist of (1) Patient Encounter Source, (2) Patient Encounter Manager and (3) Patient Encounter Patient Encounter Manager and (3) Patient Encounter Consumer. Patient Encounter Manager updates the patient Consumer. Patient Encounter Manager updates the patient location by receiving the location transaction. location by receiving the location transaction.

Other systems (such as ADT, OP, OF, Modality) feed patient Other systems (such as ADT, OP, OF, Modality) feed patient location to PEQ manager.location to PEQ manager.

Q&A-5Q&A-5Q3) Q3)

What level of detail are you expecting for the location of a What level of detail are you expecting for the location of a patient? For example, we could manage location by patient? For example, we could manage location by department or at a finerdepartment or at a finer level detail like specific room or level detail like specific room or specific spot within a room or hall. Use of RFID wouldspecific spot within a room or hall. Use of RFID would provide more detailed information like specific location in provide more detailed information like specific location in hall or room, are you expecting to support this level ofhall or room, are you expecting to support this level of detail?detail?

A3)A3)

The detail of location depends on the purpose of a user. By The detail of location depends on the purpose of a user. By our preliminary discussion the location needs 2our preliminary discussion the location needs 2 levels,levels, for for example department and room. We expect future analysis example department and room. We expect future analysis of location.of location.

Q&A-4Q&A-4Q4) Q4)

Are you expecting the system to understand the differences Are you expecting the system to understand the differences between a patient entering a room or department, vs. a between a patient entering a room or department, vs. a patient having left the room or department. Is this level of patient having left the room or department. Is this level of detail required or expected.detail required or expected.

A4)A4)

Ideal Patient Encounter Source detects the three events of Ideal Patient Encounter Source detects the three events of (1) entering, (2) existing and (3) leaving of a location. (1) entering, (2) existing and (3) leaving of a location. Patient Encounter Source optionally transmits the Patient Encounter Source optionally transmits the information of entering, existing and leaving. information of entering, existing and leaving.

Q&A-5Q&A-5Q5) Q5)

Is this expected to interact with the systems that manage Is this expected to interact with the systems that manage patient patient transport within the hospital and if yes, how.transport within the hospital and if yes, how.

A5)A5)

No. No.

Q&A-6Q&A-6Q6) Q6)

Are you interested in interfacing with a physical location Are you interested in interfacing with a physical location patient management system.patient management system.

A6)A6)

Yes. In Japan patients often have multiple reservations of Yes. In Japan patients often have multiple reservations of outpatient consultation ( ex. Internal medicine,outpatient consultation ( ex. Internal medicine, Ophthalmology and Orthopedics) in a day. Perhaps Ophthalmology and Orthopedics) in a day. Perhaps physicians want to know the location of patient.physicians want to know the location of patient.

Q&A-7Q&A-7Q7) Q7)

What are the encounter management assumptions? For example, What are the encounter management assumptions? For example, when an encounter is started you know where patient is but when an when an encounter is started you know where patient is but when an encounter is completed the patient location of the patient becomes encounter is completed the patient location of the patient becomes unknown. What are the assumptions on the location of a patient in unknown. What are the assumptions on the location of a patient in between encounters.between encounters.

A7)A7)

We believe that some assumptions are necessary for manager actor. At We believe that some assumptions are necessary for manager actor. At least one of the events (entering, existing and leaving) must be least one of the events (entering, existing and leaving) must be reported. reported.

For example, physician of the outpatient clinic wants to know the For example, physician of the outpatient clinic wants to know the patient’s entering to waiting area. If there is no Patient Encounter patient’s entering to waiting area. If there is no Patient Encounter Source in the waiting area, the hospital reception will transmit Source in the waiting area, the hospital reception will transmit information and PEQ consumer will suppose that the patient will be information and PEQ consumer will suppose that the patient will be in the waiting room. This assumption will depend upon the clinical in the waiting room. This assumption will depend upon the clinical usage.usage.

ENDENDThank you !Thank you !