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Re: [Health-dev] Should PUID be a compulsory field when creating new pat

From: Emilien Klein
Subject: Re: [Health-dev] Should PUID be a compulsory field when creating new patients?
Date: Sat, 27 Sep 2014 14:21:37 +0200

2014-09-27 1:51 GMT+02:00 Luis Falcon <address@hidden>:
> Hi Andrew !
> Thanks for your mail ! Let me try to explain the current status and
> upcoming developments on this matter.
> On Sun, 21 Sep 2014 12:33:35 +0100 (BST)
> "address@hidden" <address@hidden> wrote:
>> Hi Luis
>> I have just noticed that when creating a new "patient" in GNU Health
>> that the PUID field is optional. I think that it should be made a
>> compulsory field otherwise it will be possible to create duplicated
>> records for the same patient. And we all know what havoc that
>> creates...
> In version 2.6, the PUID is not required, so we can have unidentified
> ("NN"[1]) patients, that are unable or unwilling to show any valid /
> credible identification means. Some scenarios are :
> - The patient wishes to remain anonymous
> - Unconscious patients
> - Major disasters
> Once the institution is able to find a positive ID, or the patient does
> not want to be anonymous anymore, then, we can set an ID (new or
> existing).
> So, currently GNU Health allows empty IDs. At the moment you
> put any ID on the PUID, this must be unique.
> For 2.8, and especially thinking about distributed / health
> institution networks, and the unique/universal person identifier across
> the public health system, we have to consider the following situations.
> Scenario A : The NN person has no previous record .
> Scenario B : The NN person already exists in the system. This implies
> demographics, medical history, etc.. is already in the system.
> Steps to take in 2.8 series, to come up with a generic and scalable
> approach to NN .
> 1) The field PUID will be required. The PUID will be used in
> synchronization processes in distributed environments / national health
> networks as the person ID. So, whether is a "NN-" or a positive ID, the
> creation of the person will have this value. Also, this patient
> might be derived to another institution, and the initial
> evaluation and procedures will be available upon arrival, with the
> unique ID (again, regardless is NN or not).
> 2) If we set the "unidentified" attribute, then the "NN-"
> prefix will be set.
> 3) We have to be extremely careful with "reconciliation" of NN to
> positive / valid IDs. For example, the patient might have been
> transferred to another institution and will be recognized by the unique
> NN number. Another situation is that some tests might have been ordered
> with that unique NN number.
> 4) Upon a positive ID, the "NN" code will be set on the list of
> "alternative IDs".
> 5) The field "code" at party model (person) will have the institution
> name as a prefix. This has to do again with the synchronization model
> when having multiple health institutions and a UNIQUE / UNIVERSAL
> person record and patient history.
> Some of these features are already in place and I will push them
> during the weekend to the development branch. I have now a 12-hour
> flight ahead, so I will work a bit on it until Morpheus shows up :)
> Your comments, thoughts are most welcome ! :)

Thinking about exchanging information with external systems (e.g. HL7)
I have been in touch with systems that can't handle non-numeric
patient IDs.
I support the steps mentioned previously, but would suggest to make
the "NN-" part configurable, so that if a hospital is faced with such
issues, they can reconfigure this to be e.g. a "999" prefix.


> All the best
> 1 .-
>> Regards
>> Andrew

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