North West Genomic Medicine Service Alliance, published by NHS North West GMSA. This guide is not an authorized publication; it is the continuous build for version 0.0.7 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/nw-gmsa/R4/ and changes regularly. See the Directory of published versions

Patient Administration (PAM)

References

1. NHS England IHE PAM and HL7 v2 Messaging Specification from NHS England HL7 v2 ADT Message Specification
2. IHE Patient Administration Module (PAM) HL7 v2
3. IHE Patient Administration Module HL7 FHIR
   • Patient Identifier Cross-referencing for mobile (PIXm)
   • Patient Demographics Query for Mobile (PDQm)
   • Patient Master Identity Registry (PMIR)

Overview

While the order is being fulfilled, patient demographics may change and systems involved in fulfilling the order require notification of these changes.

Actors and Transactions

Actor	Definition
Patient Identity Source	Commonly implemented by Patient Administration (PAS) or Electronic Patient Record (EPR) Systems
Patient Identifier Cross-reference Manager	For the purposes of this IG, this is either Order Filler or Automation Manager
Patient Demographics Consumer	Requests a list of patients matching the supplied set of demographics criteria (example: ID or Name) from the Patient Demographics Supplier.
Patient Demographics Supplier	Returns demographic information for all patients matching the demographics criteria provided by the Patient Demographics Consumer

Patient Identifier Cross-referencing (PIX)

Patient Identity Feed

• Patient Identity Source (left box)
  • The system that creates or maintains patient identity information (e.g., a hospital registration system, EHR, or patient administration system).
  • It sends identity data such as patient identifiers, name, date of birth, and updates like merges or changes.
• Patient Identifier Cross-reference Manager (right box)
  • A system that manages multiple patient identifiers across different domains.
  • It links and reconciles identifiers for the same patient coming from different hospitals, clinics, or systems.
  • Example: If Hospital A identifies a patient as 12345 and Hospital B as XYZ678, this manager can cross-reference them to the same person.
• Patient Identity Feed (top label)
  • The interaction between the Identity Source and the Cross-reference Manager.
  • There are several technical transactions defined:
    • Patient Identity Feed (ITI-8): HL7 v2-based standard (classic hospital integration).
    • Patient Identity Feed FHIR (ITI-104): Modern RESTful FHIR-based implementation.
    • Mobile Patient Identity Feed (ITI-93): Lightweight RESTful API (FHIR/REST) optimized for mobile/web apps.

✅ In summary: This diagram shows how a Patient Identity Source (like an EHR or registration system) sends patient identity information to a Patient Identifier Cross-reference Manager using different technical standards (HL7 v2, FHIR, or mobile REST). The cross-reference manager then ensures consistent patient identity mapping across multiple systems.

IHE PIX/PIX(m) Actor Diagram

• The Patient Identity Source sends a IHE ITI-8/HL7 v2 A31 (or ITI-104/FHIR PUT (upsert)) event to the RIE
• The RIE forwards this event to the local Order Filler
• For external orders (how do we know this?), the RIE to NHS England’s Automation Manager Genomic Order Management System. At present this is:
  • Lookup up existing Patient via supplied identifiers (MRN or NHS Number) via a FHIR RESTful Search.
  • If a Patient record is found, then update the Patient record via a FHIR RESTful Update

Patient Demographic Query (PDQ)

Patient Demographic Query

• Patient Demographics Consumer (left box)
  • This is the system or application that needs patient demographic information (for example, an EHR system, a registration system, or another clinical application).
  • It sends a query to request demographic details (like name, DOB, address, identifiers, etc.) about a patient.
• Patient Demographics Supplier (right box) -This is the system that maintains and provides patient demographic information (e.g., a Master Patient Index (MPI) or a hospital registration system).
  • It receives the query and responds with the matching patient demographic data.
• Patient Demographic Query (top label)
  • Represents the type of interaction between the consumer and supplier.
  • There are two technical transaction standards for this query:
    • Mobile Patient Demographics Query (ITI-78) → uses modern RESTful APIs (FHIR-based), suitable for mobile or web apps.
    • Patient Demographics Query (ITI-21) → the older HL7 v2 message-based standard.

✅ In short: The diagram shows that a Patient Demographics Consumer system can request patient demographic data from a Patient Demographics Supplier system using either the older ITI-21 transaction or the newer ITI-78 transaction.