Change to the meaning of an OID for Quebec patient identifier

In the OID Registry, the description for 2.16.840.1.113883.4.56 has been updated as follows:

This was already in the description:
A unique number assigned by the province of Quebec, Canada to patients
or clients who come into contact with their jurisdictional healthcare system.

This has been added.
Please note that there is an issue with this OID because it is being used for multiple purposes.
- Within Quebec it is used for NIU
- outside of Quebec, this is used for PHN

A new OID (2.16.124.10.101.1.60.100) has been registered for PHN - This is the OID that Quebec currently uses for the PHN. Any net new implementation should use the new OID to represent PHN.

Work is being done to engage Quebec regarding the likely future deprecation of this OID (2.16.840.1.113883.4.56) and replacement with a new OID to represent the NIU.


If you want to see the change in the registry, here is the link www.hl7.org/oid/index.cfm?Comp_OID=2.16.840.1.113883.4.56

The OID 2.16.124.10.101.1.60.100 has now been registered with HL7.org

I am just waiting for HL7 to provide me with the Edit Key for 2.16.840.1.113883.4.56 so that I can update the description of that OID as previously discussed.

Thank you to all who attended the HL7 Canada meeting today.
The outcome of the discussion on changing the meaning of the OID 2.16.840.1.113883.4.56 is as as follows:

Current state is that the OID 2.16.840.1.113883.4.56 is used within Quebec for their NIU and outside Quebec as the Quebec PHN. (note that PHN = RAMQ = NOM).

The OID 2.16.124.10.101.1.60.100 will be registered to represent the PHN. This is the OID that Quebec currently uses to represent PHN.

The OID Registry Entry for 2.16.840.1.113883.4.56 will be updated such that the definition details what is happening currently - the OID is being used with two separate meanings.
- It will be noted that this OID will be deprecated eventually
- Guidance will be added to indicate that going forward, the newly registered OID (2.16.124.10.101.1.60.100) should be used to represent PHN.

Anibal Jodorcovsky and Daniel Berezeanu have volunteered to follow up with the Quebec jurisdiction regarding this issue. Ideally, the QC jurisdiction will agree to retire the OID 2.16.840.1.113883.4.56 and agree to register a new and distinct OID for the Quebec NIU. They will communicate with Dean Matthews and any updates will be posted to this thread.

Just to add a couple things:
- Alberta is also using the existing OID for its defined use - Quebec PHN.

- Changing the OID used for us is not a real issue - either proposed solution will require us to start using a new OID.
- Repurposing the existing OID is very high risk - for Quebec. Every time you get a message using the existing OID, you will need to verify that it is using the correct value (the non-PHN) - no matter the source (internal or external to the province). The risk is that someone doesn't see/get informed about the change in use and continues uing it for its original purpose,a nd Quebec system receives it...
- Unless for some reason you are actually storing the OID in your database (why??), changing the OID used should only affect your messages - and thats a one time change that will require a bit of a transition period. It shouldn't directly affect your 10,000,000 records, only the messages you send and receive.

Re-using the existing OID is a bad idea - mostly for Quebec because you will be the one that has to verify every message to see if its using the OID under its new purpose. Everyone else will have switched to the new OID for Quebec PHN, and if they see the old OID, they can reject the value/flag it as an error.

This is reason we created 2 new OIDs in a similar situation - that way we know the values using either of the new OIDs should be following the new definitions, and we ignore values using the old OID because we couldn't be sure which one it is indicating.

We will be having a special meeting of the HL7 Canada Community to discuss this issue.
Please mark your calendar for April 19 at 1PM ET.

The meeting coordinates can be found under the Events section of the HL7 Canada community.

Quebec will not make any changes on their side as their system is working. Their provincial systems (patient registry, DIS, etc) would have 10 of millions of records, every connected system (hospital, clinic, pharmacy, lab etc.) all would have 10 of thousands of records. The amount of work, and coordination required to change a single OID would be huge, changing 2 OIDs would nearly double the effort. A transition phase would be needed where both old and new OIDs would be supported, if that would even be possible.

This work and cost would gain them nothing, except to align with the OID registry.

If we don't update the registry we are in alignment with how other jurisdictions and systems uses it for a few thousand records, but not in alignment with the actual jurisdiction whose identifier it represents, and would be used on 10 of millions of records.

If we do update it we would be in alignment with the jurisdiction which the identifiers are for, but may cause some work for other jurisdictions and systems (if they choose to change).

Point of service systems (pharmacy management, EMR etc) that are in multiple provinces are designed to use the identifiers provided to them in the integration specs provided to them by the jurisdiction. So if QC says use OID x for the QC PHN and NB says to use OID y for the QC PHN each jurisdiction will get the OID they want with no problems.

These are QC identifiers so they should be considered the source of truth.

Think of the OID registry as a phone book. We use it to look up John's number and call it. Joe answers and say that it is his number and gives us John's new number. Do we tell them that they are wrong and the phone book is right and they need to switch phones, or is the phone book updated to match reality.

One option that we could consider is to update the existing OID's description to state that it is used as the NIU in Quebec and as the NAM/PHN outside of Quebec. if someone is looking for a QC PHN/NAM OID for a new system they should use the other OID. We then register the new NAM/PHN OID.