2247 lines
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<span class="a2a_kit a2a_kit_size_32 addtoany_list" data-a2a-url="https://www.nibib.nih.gov/programs/radx-tech-program/mars/deduplication" data-a2a-title="RADx® MARS: Identifying Unique Test Results for Purposes of De-duplication"><a class="a2a_button_email"><span class="a2a_svg a2a_s_a2a a2a_s_email a2a-box"><img src="/themes/custom/nibib/assets/img/email-a2a.svg" border="0" alt="Facebook" width="27" height="27"></span></a><a class="a2a_button_facebook"><span class="a2a_svg a2a_s_a2a a2a_s_facebook a2a-box"><img src="/themes/custom/nibib/assets/img/facebook-a2a.svg" border="0" alt="Facebook" width="27" height="27"></span></a><a class="a2a_button_linkedin"><span class="a2a_svg a2a_s_a2a a2a_s_linkedin a2a-box"><img src="/themes/custom/nibib/assets/img/linkedin-a2a.svg" border="0" alt="Facebook" width="27" height="27"></span></a><a class="a2a_button_twitter"><span class="a2a_svg a2a_s_a2a a2a_s_x a2a-box"><img src="/themes/custom/nibib/assets/img/x-a2a.svg" border="0" alt="Facebook" width="27" height="27"></span
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<article data-history-node-id="127276" about="/programs/radx-tech-program/mars/deduplication" typeof="schema:WebPage" class="page node--basic-page node--type-page">
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<div property="schema:text" class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2>Problem statement</h2>
|
||
<p>Applications may be configured to send test results to multiple <strong>intermediary</strong> destinations, which may then relay the results to common <strong>final</strong> destinations. The final destinations may then have duplicates of the same test results. Test results need to be "de-duplicated" to avoid erroneously counting the same test result multiple times.</p>
|
||
<p>For instance, a mobile application may send a test result to APHL and to USDS Report Stream. APHL then relays the result to a specific State (e.g. Michigan State). The State health system and Report Stream then relay the result to HHS Protect. Data analysts in the HHS Protect Team need to know how to identify the duplicates</p>
|
||
<h2>Key elements to encoding test results in the HL7v2 message</h2>
|
||
<h3>An App is assigned a unique App-specific identifier (Assigner OID)</h3>
|
||
<p>These identifiers can be assigned by an authorized entity. For the purposes of mobile applications reporting COVID testing results, APHL has set up a mechanism to assign these identifiers. The identifiers are included in multiple locations of the HL7v2 message, and <strong>all can be the same value</strong>:</p>
|
||
<table border="1" width="85%">
|
||
<caption><em><strong>Table 1: App-specific identifiers assigned by authorized entity. All can have the same value.</strong></em></caption>
|
||
<thead>
|
||
<tr>
|
||
<th scope="col">Field</th>
|
||
<th scope="col">HL7v2 Element</th>
|
||
</tr>
|
||
</thead>
|
||
<tbody>
|
||
<tr>
|
||
<td>Sending system OID</td>
|
||
<td>MSH-3.2</td>
|
||
</tr>
|
||
<tr>
|
||
<td>Sending facility ID</td>
|
||
<td>MSH-4.2</td>
|
||
</tr>
|
||
<tr>
|
||
<td>Filler Order Number Assigner OID</td>
|
||
<td>OBR-3.3</td>
|
||
</tr>
|
||
<tr>
|
||
<td>Filler Order Number Assigner OID</td>
|
||
<td>ORC-3.3</td>
|
||
</tr>
|
||
<tr>
|
||
<td>Patient ID Assigner</td>
|
||
<td>PID-3.4.2</td>
|
||
</tr>
|
||
<tr>
|
||
<td>Specimen ID Assigner OID</td>
|
||
<td>SPM-2.2.3</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p> </p>
|
||
<h3>The App creates an identifier for each user</h3>
|
||
<p>It is the responsibility of the App developer to create an ID for each user of the App. This ID needs to be unique to the App, but does not need to be globally unique.</p>
|
||
<table border="1">
|
||
<caption><em><strong>Table 2: Patient ID generated by each App is unique to App but need not be globally unique</strong></em></caption>
|
||
<thead>
|
||
<tr>
|
||
<th>Field</th>
|
||
<th>HL7v2 Element</th>
|
||
</tr>
|
||
</thead>
|
||
<tbody>
|
||
<tr>
|
||
<td>Patient ID</td>
|
||
<td>PID-3.1</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p> </p>
|
||
<h4>Acceptable scenario:</h4>
|
||
<table border="1">
|
||
<caption><em><strong>Acceptable scenario: Two Apps assign same ID to same person or different IDs to same person</strong></em></caption>
|
||
<thead>
|
||
<tr>
|
||
<th> </th>
|
||
<th scope="col">Person A</th>
|
||
<th scope="col">Person B</th>
|
||
</tr>
|
||
</thead>
|
||
<tbody>
|
||
<tr>
|
||
<td>App 1</td>
|
||
<td>ID: 1</td>
|
||
<td>ID: 2</td>
|
||
</tr>
|
||
<tr>
|
||
<td>App 2</td>
|
||
<td>ID: 1</td>
|
||
<td>ID: 2</td>
|
||
</tr>
|
||
<tr>
|
||
<td>App 3</td>
|
||
<td>ID: 2</td>
|
||
<td>ID: 3</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p> </p>
|
||
<h4>Unacceptable scenario:</h4>
|
||
<table border="1">
|
||
<caption><em><strong>Unacceptable scenario: Same App assigns same ID to two persons</strong></em></caption>
|
||
<thead>
|
||
<tr>
|
||
<th> </th>
|
||
<th scope="col">Person A</th>
|
||
<th scope="col">Person B</th>
|
||
</tr>
|
||
</thead>
|
||
<tbody>
|
||
<tr>
|
||
<td>App 1</td>
|
||
<td>ID: 1</td>
|
||
<td>ID: 1</td>
|
||
</tr>
|
||
<tr>
|
||
<td>App 2</td>
|
||
<td>ID: 2</td>
|
||
<td>ID: 2</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p> </p>
|
||
<h3>The App creates an identifier for each instance of a test taken</h3>
|
||
<p>It is the responsibility of the App developer to create an ID for each instance of a test taken. This Specimen ID is unique not to the type of test taken, but to each instance of the test taken (each sample provided). This ID needs to be unique to the App, but does not need to be globally unique.</p>
|
||
<table border="1">
|
||
<caption><em><strong>Table 3: Specimen ID generated by App is unique to each instance of test taken</strong></em></caption>
|
||
<thead>
|
||
<tr>
|
||
<th scope="col">Field</th>
|
||
<th scope="col">HL7v2 Element</th>
|
||
</tr>
|
||
</thead>
|
||
<tbody>
|
||
<tr>
|
||
<td>Specimen ID</td>
|
||
<td>SPM-2.2.1</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<h2>Test result de-duplication process</h2>
|
||
<p>Sending and receiving systems should abide by these rules:</p>
|
||
<ol>
|
||
<li>Sending systems should create an internally unique ID for each patient and specimen (Tables 2,3)</li>
|
||
<li>Sending systems should never re-use IDs over time</li>
|
||
<li>Receiving systems should store app-specific identifiers (Table 1) in addition to the patient and specimen IDs (Tables 2,3)</li>
|
||
</ol>
|
||
<p>Assuming these rules are followed, two test results arriving in a destination system can be determined to have originated from the same source and same event when the two test results have the same:</p>
|
||
<ol>
|
||
<li>Specimen ID assigner AND</li>
|
||
<li>Specimen ID</li>
|
||
</ol>
|
||
<p>For example, the following messages can be determined to be from the same test result even though they were sent from different intermediary systems:</p>
|
||
<table border="1">
|
||
<caption><em><strong>Although sent through different intermediary systems, these two messages represent the same result</strong></em></caption>
|
||
<thead>
|
||
<tr>
|
||
<th scope="col">Same patient, same testing instance</th>
|
||
<th scope="col">Intermediate System Source of message in HHS Protect</th>
|
||
<th scope="col">Specimen ID Assigner OID<br>(SPM-2.2.3)</th>
|
||
<th scope="col">Specimen ID<br>(SPM-2.2.1)</th>
|
||
</tr>
|
||
</thead>
|
||
<tbody>
|
||
<tr>
|
||
<td>App A sends result to:</td>
|
||
<td>State health system</td>
|
||
<td>A</td>
|
||
<td>1</td>
|
||
</tr>
|
||
<tr>
|
||
<td>App A sends result to:</td>
|
||
<td>CDC ReportStream</td>
|
||
<td>A</td>
|
||
<td>1</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
</div>
|
||
|
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|
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</div>
|
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</article>
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