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

Data Element
Identifier
Description

An identifier for the patient
Submitted By: Sarah Gaunt / Lantana Consulting Group
Data Element Information
Use Case Description(s)
Use Case Description Electronic case reporting requires Patient identifier.
Estimate the breadth of applicability of the use case(s) for this data element This data is exchanged as part of the extensive implementation of electronic case reporting in the US. Target is nationwide, currently 5400+ sites are reporting. There are between 56 and 2400 public health agencies using this data. Electronic case reporting is also cited in the Cares Act regulations.
Link to use case project page http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436; http://hl7.org/fhir/us/ecr/;
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • 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) FHIR US Core
https://www.hl7.org/fhir/us/core/
Additional Specifications https://www.hl7.org/fhir/us/core/
Current Use Extensively used in production environments
Supporting Artifacts This data is exchanged as part of the extensive implementation of electronic case reporting in the US. Target is nationwide, currently 5400+ sites are reporting. There are between 56 and 2400 public health agencies using this data. Electronic case reporting is also cited in the Cares Act regulations.
http://hl7.org/fhir/us/ecr/; http://www.hl7.org/implement/standards/product_brief.cfm?product_id=436
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 Electronic Case Reporting: Target is nationwide, currently 5400+ sites are reporting. There are between 56 and 2400 public health agencies using this data.
Potential Challenges
Restrictions on Standardization (e.g. proprietary code) None
Restrictions on Use (e.g. licensing, user fees) None
Privacy and Security Concerns No concerns over and above the typically privacy and security considerations associated with any health related data.
Estimate of Overall Burden This data element is straightforward in nature and should not present a large burden to implement provided the EHR system is capturing the data.
ASTP 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 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 2 - Use cases apply to most care settings or specialties.

Comment

Submitted by BLampkins_CSTE on

CSTE Comment - v6

CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.

Submitted by Riki Merrick on

APHL requests inclusion of this critical element in V6

APHL recommends to add this element to V6 as this is a critical element for linking patients within organizations, and every organization assigns some form of patient identifier to their patients. It is also called out in CLIA regulation 42 CFR 493.1291(c)(1) = "For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number." (https://www.ecfr.gov/current/title-42/part-493/section-493.1291#p-493.1291(c)(1)) and in §493.1241(c)(2) = "The patient's name or unique patient identifier." (https://www.ecfr.gov/current/title-42/part-493/section-493.1241#p-493.1241(c)(2)) 
APHL also recommends to include the assigning authority with ANY identifier data element (in all HL7 products this is part of the various supported identifier type data type). Thus we propose to update the definition to: "Alphanumeric value that should uniquely identify the patient over time - at minimum within one organization, ideally at the national level), including a means to identify the organization or system that assigned it."
If ONC wants to support generic identifiers, then the elements should also include the identifier type Patient Identifier Type (https://www.healthit.gov/isp/taxonomy/term/3661/level-2), to be able to differentiate what is being shared. 

Submitted by BLampkins_CSTE on

CSTE Comment - v5

CSTE recommends renaming this data element to Patient Identifier. Also, it is very important to include 2 other data elements to provide data critical to supporting the usability of the patient identifier data element. These include the Type of Patient Identifier (which would detail whether the identifier is, for example, a medical record number, a Medicare number, a social security number, a laboratory patient identifier) and the Patient Identifier Assigning Authority (which would provide information on which organization has assigned the identifier - for example, which health care organization, which governmental agency etc.).

  1. The patient identifier field is incredibly helpful for person matching and deduplication which currently requires a huge amount of manual effort at STLT public health agencies to manage the many potential duplicates across and within data streams (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.

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 Consolidated Comment for USCDI v5

  • CDC continues to recommend this data element for USCDI v5.
  • NACCHO Comment: 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.

Submitted by nedragarrett_CDC on

Unified Comment from CDC

  • General Comment: 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 pairs per patient (approach 1). 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: 333224444, Identifier System: http://hl7.org/fhir/sid/us-ssn.
     
  • If ONC does not choose to incorporate approach 1, (Identifier + Identifier System), 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. (approach 2) We believe that allowing for both approaches would be confusing, so we recommend choosing one or the other.

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