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
Data Element Description Provider submitted information that can be included on the claim.
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.
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 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

Medical Record Number - CSTE Comment

CSTE requests the inclusion of medical record number, which is a very important data element for public health, in USCDI v7 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,  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.
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 CDC_DSMH_WG on

CDC's comment for inclusion in USCDI v7

CDC recommends inclusion of Medical Record Number in USCDI v7. The inclusion of a Medical Record Number (MRN) element where allowable given HIPAA and PII in USCDI v7 would strengthen patient identification and data linkage across healthcare systems, particularly for immunization tracking and public health reporting. The medical record number is an identifier that is unique to a patient within a set of medical records, not necessarily unique within an application.

MRNs are widely used across EHR systems as consistent, organization-level identifiers that support patient identification and record management. Furthermore, the MRNs are transmitted via messaging to IIS as part of the HL7 message exchange’s PID-3 field. Their inclusion in data exchange improves record accuracy, reduces duplicate records, and enhances overall data integrity.

Standardizing the representation and exchange of MRN would improve interoperability between healthcare providers and public health systems, including IIS. This would support more accurate monitoring of immunization coverage, identification of under-vaccinated populations, and more effective responses to outbreaks and vaccination campaigns.

We strongly support the inclusion of Medical Record Number in USCDI v7, with clear guidance on standardized capture and exchange to ensure consistent and reliable use across systems.

Submitted by CDC_DSMH_WG on

CDC's comment for inclusion in USCDI v7

a. An important goal of the National Health Care Surveys’ data modernization effort is to reduce redundancy and reporting burden. To that end, the National Health Care Surveys are collaborating with other programs to repurpose data that is already being collected from ambulatory and hospital-based settings. This requires linking to other existing data sets using unique IDs such as MRN, etc. National Hospital Care Survey 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.). The more unique IDs we have access to, the more accurate and reliable the matching process will be resulting in improved data quality available for decision making. Having these unique IDs will also be critical as the National Health Care Surveys explore leveraging the TEFCA framework to facilitate interoperability with QHINS which require patient and organizational matching across the complex health care ecosystem. In summary, having critical IDs results in overall cost savings in the health care and public health ecosystem while potentially improving patient outcomes.

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: All EHR files submitted to NHCS lack medical record number (MRN).

Submitted by CDC_DSMH_WG on

CDC's comment for proposed inclusion in USCDI v7

 National Hospital Care Survey (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: All EHR files submitted to NHCS lack medical record number (MRN).

Submitted by CDC_DSMH_WG on

CDC's Comment for draft USCDI v6

The integration of the "Medical Record Number" as a standardized data element in USCDI v6 is essential for bolstering public health efforts, particularly in the realm of immunization. As a unique identifier, it ensures that vaccination records are accurately matched to individual patients, which is crucial for effective immunization programs.

Standardizing the Medical Record Number enhances the ability of public health authorities to monitor immunization coverage, assess vaccine effectiveness, and identify pockets of under-vaccinated populations. This capability is especially important for coordinating responses to vaccine-preventable disease outbreaks and managing mass vaccination campaigns during pandemics.

Furthermore, precise patient matching enabled by a consistent Medical Record Number helps prevent duplicate immunization records and ensures that individuals receive vaccines according to recommended schedules. It also facilitates accurate reporting to immunization information systems (IIS), supporting real-time public health decision-making and resource allocation.

Inclusion of the "Medical Record Number" in USCDI v6 promises to significantly improve the accuracy of patient identification for immunizations, thereby enhancing public health surveillance capabilities and ensuring successful implementation of national immunization strategies. Urgent consideration for this inclusion is recommended to strengthen overall public health initiatives.

Submitted by CDC_DSMH_WG on

CDC's Comment for draft USCDI v6

The integration of the "Medical Record Number" as a standardized data element in USCDI v6 is essential for bolstering public health efforts, particularly in the realm of immunization. As a unique identifier, it ensures that vaccination records are accurately matched to individual patients, which is crucial for effective immunization programs.

Standardizing the Medical Record Number enhances the ability of public health authorities to monitor immunization coverage, assess vaccine effectiveness, and identify pockets of under-vaccinated populations. This capability is especially important for coordinating responses to vaccine-preventable disease outbreaks and managing mass vaccination campaigns during pandemics.

Furthermore, precise patient matching enabled by a consistent Medical Record Number helps prevent duplicate immunization records and ensures that individuals receive vaccines according to recommended schedules. It also facilitates accurate reporting to immunization information systems (IIS), supporting real-time public health decision-making and resource allocation.

Inclusion of the "Medical Record Number" in USCDI v6 promises to significantly improve the accuracy of patient identification for immunizations, thereby enhancing public health surveillance capabilities and ensuring successful implementation of national immunization strategies. Urgent consideration for this inclusion is recommended to strengthen overall public health initiatives.

Submitted by CDC_DSMH_WG on

Medical Record Number

The integration of the "Medical Record Number" as a standardized data element in USCDI v6 is essential for bolstering public health efforts, particularly in the realm of immunization. As a unique identifier, it ensures that vaccination records are accurately matched to individual patients, which is crucial for effective immunization programs.

Standardizing the Medical Record Number enhances the ability of public health authorities to monitor immunization coverage, assess vaccine effectiveness, and identify pockets of under-vaccinated populations. This is especially important in coordinating responses to vaccine-preventable disease outbreaks and managing mass vaccination campaigns during pandemics.

Furthermore, precise patient matching enabled by a consistent Medical Record Number helps prevent duplicate immunization records and ensures that individuals receive vaccines according to recommended schedules. It also facilitates accurate reporting to immunization information systems (IIS), supporting real-time public health decision-making and resource allocation.

CDC strongly supports the inclusion of the "Medical Record Number" in USCDI v6 as it promises to significantly improve the accuracy of patient identification for immunizations, thereby enhancing public health surveillance capabilities and ensuring successful implementation of national immunization strategies.

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 points out that this is…

APHL points out that this is called out as one type of unique patient identifier in CLIA 42 CFR 493.1241(d) = "The patient's chart or medical record may be used as the test requisition or authorization but must be available to the laboratory at the time of testing and available to CMS or a CMS agent upon request." (https://www.ecfr.gov/current/title-42/part-493/section-493.1241#p-493.1241(d))
APHL supports the comment to elevate to the next version as submitted by CSTE in April 2024 "CSTE Comment - v5" (https://www.healthit.gov/isp/comment/13957) - this is a critical data element for matching records. 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 uniquely identifies the patient's health record 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.

Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.

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.)

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