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

Data Element
Patient Identifier Type
Description

Identifies the type of identifier payers and providers assign to patients
Submitted By: Mark Roberts / Leavitt Partners
Data Element Information
Data Element Description Identifies the type of identifier payers and providers assign to patients
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 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) 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 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 CDC_DSMH_WG on

CDC comments for draft USCDI v8

CDC recommends the inclusion of data element patient identifier type in draft USCDI v8. 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 data, etc.) and release them as restricted use data files available through the NCHS Research Data Center (RDC). In addition to producing restricted use data files that link the National Hospital Care Survey and NAMCS to other federal data sources, we have also published example projects to demonstrate the utility of these linked files.  In addition, 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. Recently, the 2019 and 2020 NHCS have been linked with the National Death Index (https://www.cdc.gov/nchs/linked-data/nhcs/restricted-ndi.html). National Hospital Care Survey 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.

While Patient Identifier was added to USCDI V7, Patient Identifier Type was not. The US Core representation of Patient Identifier indicates that Patient Identifier. System and Patient Identifier values are required but Patient Identifier Type is optional and is not implied by the USCDI Patient Identifier data element. As a result, although a patient identifier may be exchanged, the information necessary to consistently determine what that identifier represents may not be available. Additional clarity and conformance may be needed by standards focus testing to ensure that the Patient Identifier.System is included and by more explicitly representing Patient identify type in USCDI. This would reinforce the requirement, reduce ambiguity in implementation, and promote more consistent exchange across systems.

For CDC/NHCS, patient identifiers may include Medical Record Numbers (MRNs), Social Security Numbers (complete or partial), Patient Control Numbers (PCNs), or other locally assigned identifiers.  Since some of the patient identifiers such as SSN are only provided partially, having the patient identifier type more explicitly stated as required is of particular importance. When the identifier type is not provided, the receiving system may be unable to reliably distinguish among these identifiers or determine how they should be used in patient matching.

Including Patient Identifier Type as a distinct USCDI data element would provide semantic context for the identifier and improve consistent interpretation across sending and receiving systems. This could support more reliable patient matching across the broader health care and public health interoperability ecosystem which remains an ongoing problem across systems and programs. This could reduce the risk of incorrect patient-to-encounter linkage and improve the quality and accuracy of downstream analysis.

Identifier context could potentially also be established through the assigning authority. For example, an identifier assigned by the Social Security Administration could provide context for identifying an SSN. However, Assigning Authority is also not currently available as a USCDI data element. In the absence of either Identifier Type or Assigning Authority, receiving systems may have insufficient information to appropriately characterize a Patient Identifier.

Therefore, adding Patient Identifier Type to USCDI would address a specific interoperability gap by ensuring that exchanged patient identifiers include sufficient semantic information for receiving systems to understand and appropriately use them.

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

Patient Identifier Type is encompassed in the patient ID structure. The ID has an issuing authority and type associated with it. Link in the C-CDA IG to the Patient Identifier Type:  II: InstanceIdentifier (V3 Data Type) - Clinical Document Architecture v2.0.1-sd.

Description of what DHCS currently receives in production: The majority of EHR files submitted for NAMCS and National Hospital Care Survey 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 BLampkins_CSTE on

Patient Identifier Type - 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 Type - 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, health department staff spend countless hours deduplicating partially matched patient records).
2. It is critical for identifying patients as part of public health 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 melanie.kourba… on

Assigning Authority

APHL supports the addition of this very important data element for public health (see previous comment on USCDI V6: https://isp.healthit.gov/comment/14142) but points out that in order to be useful across organizations the system that created the identifier, HL7 calls this the assigning authority, needs to also be included. Thus, APHL recommends including the assigning authority with this and ANY other identifier data element (in all HL7 products this is part of the various supported data types for identifiers). APHL proposes to update the definition to: " Sequence of characters assigned by an organization to uniquely refer to a patient over time, including a means to identify the organization or system that assigned it."

Submitted by CDC_DSMH_WG on

CDC's comment for inclusion in USCDI v7

a. National Hospital Care Surveys 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. In addition to producing restricted use data files that link the National Hospital Care Surveys and NAMCS to other federal data sources, we’ve also published example projects to demonstrate the utility of these linked files.  In addition, 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. NAMCS and National Hospital Care Surveys will be able to publish additional example projects as data are successfully linked to other data sources . Recently, the 2019 and 2020 NHCS have been linked with the National Death Index (https://www.cdc.gov/nchs/linked-data/nhcs/restricted-ndi.html). National Hospital Care Surveys  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. Patient Identifier Type is encompassed in the patient ID structure. The ID has an issuing authority and type associated with it. Link in the C-CDA IG to the Patient Identifier Type:  II: InstanceIdentifier (V3 Data Type) - Clinical Document Architecture v2.0.1-sd (https://hl7.org/cda/stds/core/2.0.1-sd/StructureDefinition-II.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 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.

Patient Identifier Type is encompassed in the patient ID structure. The ID has an issuing authority and type associated with it. Link in the C-CDA IG to the Patient Identifier Type:  II: InstanceIdentifier (V3 Data Type) - Clinical Document Architecture v2.0.1-sd.

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).

Submitted by CDC_DSMH_WG on

CDC's Comment for draft USCDI v6

CDC is requesting that Patient Identifier Type be 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.

Submitted by BLampkins_CSTE on

CSTE recommends Patient…

CSTE recommends Patient Identifier Type be included with Patient Identifier, in addition to Patient Identifier Assigning Authority. The Patient Identifier Assigning Authority would provide information on which organization has assigned the identifier - for example, which health care organization, which governmental agency, etc.

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