Identity Matching Process

Initiating a Patient360 retrieval with $p360-retrieve triggers the following sequence:

1. Patient Discovery

When Patient360 performs record retrieval, it initiates patient discovery transactions across connected networks to locate candidate patient records.

• Carequality, CommonWell, eHealth Exchange (eHX), and TEFCA (if enabled) support ITI-55 (Patient Discovery) transactions.
• Some networks may also require additional discovery transactions, depending on their capabilities.
• Patient discovery uses the demographics you submit in the $p360-retrieve request along with any available identifiers, such as medical record numbers (MRNs) or payer/member IDs.

2. Candidate Evaluation and Matching

Candidate records returned from external networks are evaluated using Health Gorilla’s identity resolution engine. This process applies deterministic and probabilistic matching logic to assess whether each external patient record corresponds to the submitted patient.

Factors used in matching include:

• Core demographics (name, date of birth, gender)
• Address and contact information
• Identifiers such as MRNs and national patient identifiers (NPIs) (if present)
• Historical linkage confidence (prior matches for the same patient)

Matching thresholds and rules are optimized to minimize false matches while allowing appropriate retrieval across diverse source systems.

Enrollment and Retrieval Behavior

For most networks, including Carequality, eHealth Exchange (eHX), and TEFCA, Health Gorilla performs patient discovery and retrieval dynamically within the $p360-retrieve process. No manual enrollment is required or exposed.

For CommonWell, Health Gorilla performs patient discovery and auto-enrollment as part of the retrieval process. You do not need to perform separate enrollment transactions; Patient360 manages this automatically based on your retrieval request.

Important:

• Enrollment behavior is network-specific and handled internally by Patient360. No public FHIR enrollment operations or $cw-* client calls are required.
• You can optimize matching confidence by submitting complete and accurate patient demographics in your $p360-retrieve request.
• Health Gorilla records metadata about identity resolution and matching results, which is included in the resulting FHIR Bundle.
• If identity confidence is low, the system will not retrieve records for the candidate to prevent incorrect linkage.

Summary

Patient360 handles identity matching and enrollment automatically as part of each $p360-retrieve operation.

• Patient discovery transactions are performed for each connected network.
• Returned candidates are evaluated with advanced identity resolution logic.
• CommonWell auto-enrollment is managed automatically during retrieval.
• No separate $cw-search or enrollment APIs are required or exposed to clients.

By submitting high-quality patient demographics and following best practices for matching, you can maximize the accuracy and completeness of Patient360 record retrievals.