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$member-match operation for HealthLake - AWS HealthLake
UsageSupported ParametersExamplesResponse ParametersMatching AlgorithmsBehaviorAuthorizationError Handling

$member-match operation for HealthLake

AWS HealthLake now supports the $member-match operation for Patient resources, enabling healthcare organizations to find a member's unique identifier across different healthcare systems using demographic and coverage information. This operation is essential for achieving CMS compliance and facilitating secure payer-to-payer data exchange while maintaining patient privacy.

This operation is particularly useful when you need to:

  • Enable secure healthcare data exchange between organizations

  • Maintain patient continuity of care across different systems

  • Support CMS compliance requirements

  • Facilitate accurate member identification across healthcare networks

Usage

The $member-match operation can be invoked on Patient resources using the POST method:

POST [base]/Patient/$member-match

Supported Parameters

HealthLake supports the following FHIR $member-match parameters:

Parameter Type Required Default Description
MemberPatient Patient Yes — Patient resource containing demographic information for the member to be matched
CoverageToMatch Coverage Yes — Coverage resource that will be used for matching against existing records
CoverageToLink Coverage No — Coverage resource to be linked during the matching process
Consent Consent No — Consent resource for authorization purposes

Examples

POST Request with Parameters

POST [base]/Patient/$member-match
Content-Type: application/fhir+json

{
  "resourceType": "Parameters",
  "parameter": [
    {
      "name": "MemberPatient",
      "resource": {
        "resourceType": "Patient",
        "name": [
          {
            "family": "Jones",
            "given": ["Sarah"]
          }
        ],
        "gender": "female",
        "birthDate": "1985-05-15"
      }
    },
    {
      "name": "CoverageToMatch",
      "resource": {
        "resourceType": "Coverage",
        "status": "active",
        "beneficiary": {
          "reference": "Patient/1"
        },
        "relationship": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code": "self",
              "display": "Self"
            }
          ]
        },
        "payor": [
          {
            "reference": "Organization/payer456"
          }
        ]
      }
    },
    {
      "name": "Consent",
      "resource": {
        "resourceType": "Consent",
        "status": "active",
        "scope": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/consentscope",
              "code": "patient-privacy"
            }
          ]
        },
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code": "IDSCL"
              }
            ]
          }
        ],
        "patient": {
          "reference": "Patient/1"
        },
        "performer": [
          {
            "reference": "Patient/patient123"
          }
        ],
        "sourceReference": {
          "reference": "Document/someconsent"
        },
        "policy": [
          {
            "uri": "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition-hrex-consent.html#regular"
          }
        ]
      }
    }
  ]
}

Sample Response

The operation returns a Parameters resource containing the matching results:

{
  "resourceType": "Parameters",
  "parameter": [
    {
      "name": "MemberIdentifier",
      "valueIdentifier": {
        "system": "http://hospital.org/medical-record-number",
        "value": "MRN-123456"
      }
    },
    {
      "name": "MemberId",
      "valueReference": {
        "reference": "Patient/patient123"
      }
    },
    {
      "name": "matchAlgorithm",
      "valueString": "DEMOGRAPHIC_MATCH"
    },
    {
      "name": "matchDetails",
      "valueString": "Demographic match: DOB + Name"
    },
    {
      "name": "matchedFields",
      "valueString": "given,birthdate,gender,family"
    }
  ]
}

Response Parameters

The response includes the following parameters when a match is found:

Parameter Type Description
MemberIdentifier Identifier The unique identifier for the matched member
MemberId Reference Reference to the Patient resource
matchAlgorithm String Type of match algorithm used (EXACT_MATCH, STRONG_MATCH, or DEMOGRAPHIC_MATCH)
matchDetails String Detailed information about the matching process
matchedFields String List of specific fields that were successfully matched

Matching Algorithms

The $member-match API employs a multi-tiered matching approach to ensure accurate member identification:

EXACT_MATCH

Uses Patient Identifier combined with Coverage SubscriberId

Provides the highest confidence level for member matching

STRONG_MATCH

Uses Patient Identifier with minimum coverage information

Offers high confidence when exact match criteria are not met

DEMOGRAPHIC_MATCH

Relies on basic demographic information

Used when identifier-based matching is not possible

Behavior

The $member-match operation:

  • Accepts patient demographics, coverage details, and optional consent information as input

  • Returns a unique member identifier that can be used for subsequent interactions

  • Implements multi-tiered matching (exact, strong, demographic) to ensure accurate member identification across different healthcare systems

  • Saves any provided consent information for future authorization purposes

  • Supports secure payer-to-payer data exchange while maintaining patient privacy

  • Complies with CMS requirements for healthcare data exchange

Authorization

The API uses SMART on FHIR authorization protocol with the following required scopes:

  • system/Patient.read

  • system/Coverage.read

  • system/Organization.read (conditional)

  • system/Practitioner.read (conditional)

  • system/PractitionerRole.read (conditional)

  • system/Consent.write (conditional)

Error Handling

The operation handles the following error conditions:

  • 400 Bad Request: Invalid $member-match operation (non-conformant request or missing required parameters)

  • 422 Unprocessable Entity: No matching or multiple matches found