|Submitted By: Joel Andress / Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||Medicare beneficiary identifiers (MBI) are a standard patient identifier for Medicare patients across the United States. These patient identifiers are submitted with patient-level data to CMS for quality measure reporting, both for eCQMs and for claims-based measures.
Although an all-payer unique identifier is not yet available, Medicare beneficiary identifiers are fully standardized and available and assist with patient identification and matching, which is a good first step for patient identification.
|Estimated number of stakeholders capturing, accessing using or exchanging||All Medicare beneficiaries have an MBI and all 4,000+ hospitals and providers reporting measure data to CMS currently have access to and are required to report this patient identification information.|
|Link to use case project page||https://www.cms.gov/Medicare/New-Medicare-Card|
|Use Case Description||For providers responsible for the care of a patient population, the ability to transfer and share information from encounters with their Medicare beneficiaries from providers outside of their network supports optimal quality of care.|
|Estimated number of stakeholders capturing, accessing using or exchanging||Hospital and outpatient providers participating in alternative payment models for Medicare beneficiaries, which is a growing stakeholder group.|
|Maturity of Use and Technical Specifications for Data Element|
|Applicable Standard(s)||MBI format specifications: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf
HL7 Identifier type value set, see MC (http://hl7.org/fhir/R4/v2/0203/index.html)
|Additional Specifications||HL7 FHIR US Core Implementation Guide STU3 based on FHIR R4, Patient Profile require a Patient ID. This profile already required to exchange other patient demographic information included in USCDI v1: https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html|
|Current Use||This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders|
Patient Medicare identifiers routinely captured in EHR systems, claims data and is used by hospitals, providers, and other healthcare stakeholders for submission to CMS for quality measurement reporting.
Widely available in EHR systems to support Patient FHIR resource:
|Number of organizations/individuals with which this data element has been electronically exchanged||5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.|
Medicare patient IDs electronically exchanged with CMS for quality measure reporting via QRDA files and other electronic exchange platforms; required as part of submission for Medicare beneficiaries included in the measures.
Provider-payer data exchange and member-mediated information exchange are also occurring, and include FHIR Patient profile with a patient ID, being testing in HL7 Connectathons.
|Restrictions on Standardization (e.g. proprietary code)||Standard patient IDs only available for Medicare beneficiaries; no unique identifier for all-payer patients.|
|Restrictions on Use (e.g. licensing, user fees)||N/A|
|Privacy and Security Concerns||This data, like any patient data, should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data. MBI is a unique randomly generated ID with “non-intelligent” characteristics, which replaced the HIC Number, based on SSN.|
|Estimate of Overall Burden||No/low burden anticipated, as Medicare identifiers already in wide use among stakeholders caring for Medicare beneficiaries. Patient FHIR US Core profile also required by the US Core Capability Statement and required for exchange of other patient demographic data included in USCDI version 1; a patient ID is required for inclusion in this profile. Therefore, all stakeholders complying with ONC CEHRT requirements will have ID data ready for exchange in standards.|
|Other Implementation Challenges||N/A|
|ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 4 criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
|Maturity – Standards/Technical Specifications||Level 1/2 - Must be represented by a vocabulary standard or an element of a published technical specification|
|Maturity - Current Use||Level 2 - Used at scale in more than 2 different production environments|
|Maturity - Current Exchange||Level 2 - Demonstrates exchange between 4 or more organizations with different EHR/HIT systems|
|Breadth of Applicability - # Stakeholders Impacted||Level 2 - Used by a majority of patients, providers or events requiring its use|