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

Data Element
Patient Identifier
Description (*Please confirm or update this field for the new USCDI version*)

Sequence of characters assigned by an organization to refer to a patient.

Examples include but are not limited to Medical Record Number.

Submitted By: Sarah Gaunt / Lantana Consulting Group
Data Element Information
Data Element Description An identifier for the patient
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.
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 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

Patient Identifier - CSTE Comment

CSTE is pleased to see the inclusion of Patient identifier in USCDI v7. CSTE also recommends the inclusion of 2 additional data elements to provide data critical to supporting the usability of the Patient Identifier data element. These include the Patient Identifier Type (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.).

Submitted by BLampkins_CSTE on

Patient Identifier - CSTE Comment

CSTE supports the inclusion of Patient identifier in USCDI v7. CSTE also recommends the inclusion of 2 additional 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,  as well as serve to protect patient privacy by reducing or eliminating records returned for a potential patient match. 
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 jessilott on

Patient Identifier

TDH-OIA supports the inclusion of the Patient Identifier data element in v7. TDH-OIA also recommends that ASTP/ONC consider explicitly including the identifiers "type" and "source/assigning authority" as part of this data element. These attributes are critical for distinguishing among multiple identifiers, ensuring correct interpretation, and supporting consistent interoperability across systems.

Submitted by CDC_DSMH_WG on

CDC's comment for inclusion in USCDI v7

CDC supports the inclusion of Patient Identifier in USCDI v7 and the element being added to Patient Demographics/Information. Patient identifier is an important component for related person in a birth event and is used in Health IT standards to properly identify both the mother and baby. During labor and delivery, the mother’s medical record is created or actively available, and after delivery of baby a new patient record is created. For mother and newborn relationships, a patient identifier would support these relationships among electronic medical records, as well as a linkage with birth registration systems. An identifier such as the medical record number for both the mother and infant is also captured within the facility worksheet for live birth certificate.

Sources: RelatedPerson - FHIR v6.0.0-ballot4 (https://build.fhir.org/relatedperson.html); Facility Worksheet for the Live Birth Certificate (https://www.cdc.gov/nchs/data/dvs/facility-worksheet-2016-508.pdf)

Submitted by CDC_DSMH_WG on

CDC's comment for inclusion in USCDI v7

a. In addition to producing restricted use data files that link the National Hospital Care Surveys and National Ambulatory Medical Care Survey (NAMCS) to other federal data sources (e.g. National Death Index, the U.S. Department of Housing and Urban Development, etc.), we’ve also published example projects to demonstrate the utility of these linked files. For example, please find the National Health Statistics Report Number 201 “National Hospital Care Survey Demonstration Projects: Examination of Maternal Health Outcomes by Housing Assistance Status” at https://www.cdc.gov/nchs/data/nhsr/nhsr201.pdf. Another example of work demonstrating the need for these identifiers can be found with the publication of the National Ambulatory Medical Care Survey Health Center Component 2021 & Transformed Medicaid Statistical Information System linked file found here: https://www.cdc.gov/nchs/linked-data/namcs/namcs-hcc-medicaid.html. NCHS will be able to publish additional example projects as data are successfully linked to other data sources.This data element will increase the ability to track unique patients, improving accuracy and quality in these produced datasets.

b. Location of data element in the current HCS CDA IG V1.2: x-path /ClinicalDocument/recordTarget/patientRole/patient/id)

c. This data element is in C-CDA 4.0. Link in the C-CDA IG- https://hl7.org/cda/us/ccda/StructureDefinition-USRealmHeader.html

d. Description of what DHCS currently receives in production: The majority of EHR files submitted for NAMCS and National Hospital Care Surveys have identifier data for patient name (first, middle, and last), date of birth, and patient address. All EHR files submitted to NHCS lack medical record number (MRN) and Health Insurance Claims Number (HIC). In addition, NHCS would like to expand the availability of identifiers to include patient control number (PCN).

Submitted by csnewman on

Add source of identifier

The Patient Identifier description should include the type and source of the identifier (ie which pool of identifiers the ID came from) - note that a single organization may assign multiple different identifier types from multiple different pools of IDs

Submitted by CDC_DSMH_WG on

CDC's comment for proposed inclusion in USCDI v7

National Hospital Care Surveys (NHCS) and National Ambulatory Medical Care Survey (NAMCS) both conduct data linkages to other datasets (e.g. National Death Index, the U.S. Department of Housing and Urban Development, etc.) and publish them as restricted use data files. This data element will increase the ability to track unique patients, improving accuracy and quality in these produced datasets.

Location of data element in the current HCS CDA IG V1.2: x-path /ClinicalDocument/recordTarget/patientRole/patient/id)

This data element is in C-CDA 4.0. Link in the C-CDA IG- https://hl7.org/cda/us/ccda/StructureDefinition-USRealmHeader.html

Description of what DHCS currently receives in production: The majority of EHR files submitted for NAMCS and NHCS have identifier data for Social Security Number (SSN), patient name (first, middle, and last), date of birth, and patient address. All EHR files submitted to NHCS lack medical record number (MRN) and Health Insurance Claims Number (HIC). In addition, NHCS would like to expand the availability of identifiers to include patient control number (PCN).

National Center for Immunization and Respiratory Diseases (NCIRD) propose the inclusion of "Identifier" as a standardized data element in USCDI v7 due to its critical role in enhancing immunization efforts. As a unique identifier, it ensures that vaccination records are accurately matched to individual patients, which is essential for effective immunization programs.
Standardizing the Identifier significantly enhances the ability of public health authorities to monitor immunization coverage, assess vaccine effectiveness, and identify populations that are under-vaccinated. This capability is particularly important for coordinating responses to vaccine-preventable disease outbreaks and managing mass vaccination campaigns during public health emergencies, such as pandemics.
Furthermore, precise patient matching enabled by a consistent Identifier helps prevent duplicate immunization records, ensuring that individuals receive vaccines according to recommended schedules. This is vital for maintaining accurate immunization histories, which are crucial for effective patient care and public health reporting.
The inclusion of the Identifier also facilitates accurate reporting to Immunization Information Systems (IIS), supporting real-time public health decision-making and resource allocation. By ensuring that vaccination data is consistently linked to the correct patient, health authorities can make informed decisions about vaccine distribution and outreach efforts.
Moreover, a standardized Identifier can improve communication and coordination among healthcare providers involved in immunization efforts. It allows for seamless sharing of vaccination records, ensuring that all providers have access to the most current and accurate patient information, which is essential for effective immunization strategies.
The Identifier can also empower patients by enabling easier access to their vaccination records, fostering greater engagement in their own care and encouraging adherence to vaccination schedules. When patients can easily verify their immunization status, they are more likely to seek necessary vaccinations and participate in public health initiatives.
Incorporating the Identifier into health information technology systems will enhance data analytics capabilities, allowing for more effective tracking of vaccination trends and outcomes. This can inform public health strategies and improve the overall quality of immunization services provided to patients.
We strongly advocate for the inclusion of the "Identifier" in USCDI v7, as it promises to significantly improve the accuracy of patient identification for immunizations. Its adoption will enhance public health surveillance capabilities and ensure the successful implementation of national immunization strategies, ultimately leading to better health outcomes for the population.

Submitted by CDC_DSMH_WG on

CDC's Comment for draft USCDI v6

CDC is requesting that Identifier added for consideration to USCDI V6 to inform hospital and ambulatory medical care survey data collection efforts. 

Justification:  National Healthcare Surveys and NAMCS both conduct data linkages to other datasets (e.g. National Death Index, the U.S. Department of Housing and Urban Development, etc.) and publish them as restricted use data files. This data element will increase the ability to track unique patients, improving accuracy and quality in these produced datasets.

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.

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