The NK1 segment is giving me trouble. Specifically, field 5, the address. I created a sample message with this as the NK1.5 content:

123 EASY ST^Arlington^VA^22207

The NK1 segment is listed as NK1.5.2 as being “other designation”, not the city, thus throwing off my address conversion. I have no means to identify subcomponent 2 as the city, I’m “stuck” with it being “other designation.”

It looks like the NK1 segment in the logs doesn’t follow the standard… (surprise, surprise;). In fact, based on the HL7 standard, the address would be stored in NK1.4 and city in NK1.4.3. It appears to be a naming issue within the data. You can modify the HL7 profile/specification that Cloak uses so the HL7 reference profile represents the data you’re working with (as opposed to trying to conform to the official HL7 specification). In other words, you can change the specification to remove the “other designation” field in the HL7 profile.

To do this, you would need either Caristix Conformance or Reader software. Reader is a free download available here.

Here’s the procedure:
1. Open Conformance or Reader.
2. Make a copy of “HL7 v2.6” profile in “New Folder”.
3. Rename the profile to something that make sense to you.
4. Browse to the NK1 segment and expand it.
5. Browse to NK1.5 and expand it.
6. Delete the “other designation” field.
7. Save the profile.

8. Go back to Cloak.
9. From the menu bar, go to Tools, Options, Reference Profile.
10. In the list of profiles, select the profile you just modified.
11. Click OK. The NK1.4.2 field name is now city.

Is there a means by which the names in a message can be de-identified, i.e. patient, physician, etc., without it being the SAME across the message? For example, using the names.xls spreadsheet (which is such a time-saver… oh man!), I’ve replaced the patient and the caregiver names. However, in my PV1 segment, I’m finding that all the caregivers are the same name as the patient.

You can use Excel files in Cloak to generate replacement data. For instance, I might have an Excel file listing cities and zip codes. Cloak will manage de-identification so that when a replacement zip code is chosen at random, you get a city associated with the zip code. That way, the data still make sense. The same technique lets you build an Excel file with names and genders, so that Cloak provides female first names to female patients.

If you use the same Excel column to cover several fields, the same row (so, in this case, the same value) will be used.

To get a different name, you can do one of two things:
1. Open the Excel file and add a column with names (such as physician names, for instance). This way the patient will have the physician listed on that current row.
2. Copy the Excel file; change the copied file so you have two different files for patient names and physician names. This way the association between patient and physician is going to be random once you set the de-identification generator type parameters.

Read more about using Excel files to generate replacement data in Cloak.

Here’s what one of our users at a major HIT vendor had to say about Caristix technology when he was interviewed for the article:

What problems have you solved using Caristix products and what impact has that had on your organization?

We are seeking ways to continuously improve our customer enablement process for our product. An activity in that process is understanding the customer environment. The Caristix Conformance product assist the SME knowledge of their environment and not to rely on outdated documentation and assumptions. Conformance gives us (and the customers) a great visual of their environment.

With this improved visibility, we reduced the rationalization logistic interactions – a lengthy Q/A process (i.e. what systems are involved in the project? what data comes from that system? <<…implementation period…>> Are you sure? Well, we’re seeing this type of data and it does not agree with the initial statements. Are there any more surprises? etc.). This form of interaction occurs over weeks or months and creates much re-work as information becomes known. Knowing upfront the true reality not only mitigates loss time (and financial expenditures), but also improves customer satisfaction and overall product experience.

Read the rest of the article on HIStalk.