Data used to categorize individuals for identification, records matching, and other purposes.

Data Element
Medical Record Number
Description

The unique identifier assigned by the provider to reference a single patient
Submitted By: Mark Roberts / Leavitt Partners
Data Element Information
Use Case Description(s)
Use Case Description Administrative and financial transactions are a critical part of health care provisioning and management. There is a need for health care consumers to get access this health data to be able to make better care decisions and manage their health care journey. Making Member data available to consumers will enable them to have greater visibility into the costs associated with their health care, identify potential errors, and enable them to plan for their future health care needs taking financial costs into account.
Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR 164.524) and requests their digital health information (adjudicated claims and encounter data) from a HIPAA covered entity (CE) – health insurance company or payers via an application or other third-party data steward.
Estimate the breadth of applicability of the use case(s) for this data element All health care insurers (>1,800), third-party application developers, and all consumers of the health care system (>320M)
Link to use case project page http://hl7.org/fhir/us/carin-bb/
Healthcare Aims
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes.
http://hl7.org/fhir/us/carin-bb/artifacts.html#5
Additional Specifications HL7® FHIR® US Core Implementation Guide v3.1.1 based on FHIR R4
Current Use Extensively used in production environments
Supporting Artifacts This was part of the CMS Patient Access and Interoperability Rules, which went into effect July 1, 2021. CMS has suggested that industry consider using the CARIN for Blue Button Implementation Guide for the Patient Access API.
https://www.cms.gov/about-cms/health-informatics-and-interoperability-group/faqs
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts While it is not known how many consumers have requested this data electronically, this information is communicated broadly today through other forms. This data is now being required to be communicated electronically through the CMS Patient Access API for which the regulation has suggested that industry consider using the CARIN for Blue Button Implementation Guide for the Patient Access API, we expect this data will be exchanged broadly throughout the health care sector.
https://www.cms.gov/about-cms/health-informatics-and-interoperability-group/faqs
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) Some codes, but not all, are linked to proprietary code standards that may require a license.
Restrictions on Use (e.g. licensing, user fees) Licensed Industry Standard Code Systems

This IG includes value set bindings to code systems that reference industry standard codes which require implementers to purchase a license before the coded concepts can be used. The following information summarizes the set of licensed Code Systems required by this IG and provides links to the information about where to go to obtain a license:

• AMA CPT: The CPT procedure and modifier codes are owned by the American Medical Association.
• X12: CARC (Claim Adjustment Reason Codes are owned by X12..
• NUBC: The NUBC secretariat is the American Hospital Association..
• NUCC: National Uniform Claim Committee (NUCC) is presently maintaining the Taxonomy code set. The codes are free and publically available for download and use. If the use however is “For commercial use, including sales or licensing, a license must be obtained”. It would be appropriate for an app developer to file the license form just like they would for any other code set; however, there is no fee.
• NCPDP: Retail Pharmacy data standards are defined by the NCPDP .
• 3M APR-DRG: AP-DRGs and APR-DRGs are owned by 3M. Use of AP-DRGs and APR-DRGs require a license.

Code Systems Not Requiring Licenses

This IG includes value set bindings to code systems that are industry standard codes available for use without licenses. The following information summarizes the set of Code Systems required by this IG that are available for use:

• ICD-CM Diagnosis Codes (ICD-10-CM): International Statistical Classification of Diseases and Related Health Problems (ICD). This IG will use version 10. The ICD-10-CM code set is maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) for use in the United States. It is based on ICD-10, which was developed by the World Health Organization (WHO) and is used internationally a medical classification.
• ICD-Procedure Codes (ICD-PCS): The ICD-10-PCS code set is owned by CMS..
• DRGs.:MS-DRGs are owned by CMS. MS-DRGs are used for the Medicare population.
• HCPCS Level II Procedure and Modifier Codes: Primarily include non-physician products, supplies, and procedures not included in CPT. They are owned by CMS and are available for use.
• NDC (National Drug Codes): The US Federal Drug Administration (FDA) Data Standards Council assigns the first 5 digits of the 11 digit code..
• RARCCodes: The RARC codes are owned by CMS.
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.
Estimate of Overall Burden The data elements in this class are already held by health care payers, anticipated burden of collection of data would be negligible. The CMS rule and Patient Access API already require CMS covered payers to share this data electronically. Many payers covered by the CMS rule have or are already considering making this data available in the same fashion for other lines of business.
ONC Evaluation Details
Each submitted Data Element has been evaluated based on the following 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
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment This data element is a specialize use of an existing Level 2 data element Identifier in the Patient Demographics/Information data class https://www.healthit.gov/isa/taxonomy/term/2711/level-2.

Comment

Submitted by BLampkins_CSTE on

CSTE Comment - v5

CSTE requests the inclusion of medical record number, which is a very important data element for public health, in USCDI v5 in one of two ways. The preference would be to include it in the Patient Identifier data element, with the associated metadata elements required - which would be Type of patient identifier AND Assigning authority for patient identifier. Transmission of this information to public health in both case and laboratory reports is important for the following reasons:


1. It is incredibly helpful for person deduplication which currently requires a huge amount of manual effort at STLT public health agencies to manage the many potential duplicates (even with the best algorithms and automation for patient deduplication, often health department staff spend countless hours deduplicating partially matched patient records).
2. It is critical for identifying patients for follow-up - as in when medical information is sought as part of a case investigation or when additional demographics or contact information are needed in order to quickly reach a patient, or when lab results are needed from a hospital.
3. For any type of automated or semi-automated query of an HIE or another clinical repository (as will hopefully be possible through TEFCA), MR number will be invaluable in narrowing the query and ensuring the returned results pertain to the correct individual - this will save an enormous amount of time and frustration
4. For any bidirectional data exchange it would be invaluable to the receiving health care org to be able to use medical record to route the data to the correct medical record.


CSTE also recommends adding the two additional variables mentioned above to go with the identifier data element - one is the assigning authority (e.g., for a medical record it would be the name of the health care facility using the medical record system) and the other is the type of identifier (e.g., medical record, laboratory patient identifier, SSN, etc.)

Submitted by nedragarrett_CDC on

CDC's Comment for draft USCDI v5

CDC supports the inclusion of this data element in USCDI v5 as it is an element that may be necessary for calculation of our digital quality metrics from FHIR data.

Submitted by nedragarrett_CDC on

CDC's comment on behalf of NACCHO for USCDI v5

Support - LHDs will also be able to use this to attribute encounter level information to a person-level, which is what is used for prevention analysis and program creation.
Having this element and the "identifier" element is going to be confusing for LHDs who will receive this data. There needs to be clarification made between the two and what their use cases are. Right now, they are not very clear in their submissions.

Submitted by nedragarrett_CDC on

CDC's Consolidated Comment for USCDI v5

  • Including the "Medical Record Number" as a standardized data element in the v5 USCDI is a critical step toward ensuring precise and reliable patient identification within the healthcare system. Serving as a unique identifier, the Medical Record Number is a cornerstone for patient-centric care. It enables healthcare providers to accurately match patients with their health information across various points of care. This becomes increasingly significant in a complex and interconnected healthcare landscape, where patients often engage with multiple providers across different facilities and systems. By utilizing a standardized Medical Record Number as a common thread linking a patient's encounters and health data, healthcare providers are better positioned to access consolidated and comprehensive medical records. This, in turn, supports informed clinical decision-making based on a complete view of the patient's history, current conditions, and previous treatments. Moreover, the use of the Medical Record Number as a standardized identifier is instrumental in reducing errors related to patient identification—a critical factor in patient safety. Misidentification errors can lead to severe consequences, including incorrect diagnoses, inappropriate treatments, and unnecessary procedures, all of which are avoidable with precise identification methods. The implementation of the "Medical Record Number" in the USCDI v5 would mark a significant advancement towards a more integrated, efficient, and safe healthcare system. We strongly advocate for the inclusion of the "Medical Record Number" data element in the USCDI v5 due to its potential to fundamentally enhance patient identification processes, significantly reduce the occurrence of identification errors, and ensure that healthcare providers have immediate and reliable access to complete and consolidated patient medical records.
  • CSTE Comment: CSTE strongly agrees with CDC's recommendation for this data element. 

Submitted by nedragarrett_CDC on

CDC's comment on behalf of CSTE

Medical record number (Level 2); CSTE strongly recommends that medical record number be moved into USCDI v3. This element is critical to include in eCR and ELR and is used heavily for person matching and deduplication as well as when requesting additional clinical information on a case of reportable disease.

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • NOTE - This comment supports the promotion of the Data Class Patient Demographics - Data Element Identifier to USCDI V3 as well as the additional Data Element of Identifier System, including the allowance of multiple instances of Identifier/ Identifier System per patient. We believe that this will allow needed flexibility to accommodate use and exchange of the variety of patient identifiers in current use in the US. An example of this approaches is: Identifier: 3A456B789, Identifier System: http://AcmeHealth//fhir/id/MRN.  If ONC does not choose to incorporate this approach (Identifier + Identifier) in USCDI V3, we recommend allowing for the following Patient Demographic Data Class Data Elements in USCDI V3: Medicare Patient Identifier, Medical Record Number and Social Security Number. In the event that Social Security Number is not included in USCDI V3 as a supported Patient Demographic Identifier, the use of Medical Record Number will be critical to accurately identify patients to provide appropriate patient care and complete public health surveillance.
     
  • General Comment: Medical Record Number is a ubiquitous patient identifier in most healthcare organizations in the US and in the EHR and HIT systems that support those organizations. This data element is requested by and exchanged with ancillary systems within an organization, business partners outside of the organization, public health, research projects and other use cases as a primary or secondary means to positively identify patients. 

Submitted by maria.michaels… on

Specific Identifier(s) or general Identifier?

MedMorph supports the addition of Medical Record Number, but is concerned with having a general Identifier element (level 2) as well as Medicare Patient Identifier (level 2), and Patient Social Security Number (level 1). What is the intention of Identifier - is it a placeholder for a national identifier of some sort for a patient? We recommend that USCDI either take a general approach with Identifier Type, Identifier System, and Identifier Value OR be specific with Medical Record Number, Medicare Patient Identifier and Social Security Number elements (and remove the Identifier element).

Submitted by nedragarrett_CDC on

Recommendations for Updated Submission

We've reviewed and submitted comments in regards to the submission for Patient Medical Record Number and stand to see that we have slightly differing data element submissions, though this was the previous submission marked as it's duplicate. We recommend re-visiting our submission and comparing it to the above submission seen here.

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