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Unique Identifiers (including allowed uses)

Healthcare Informatics Standards Board hisbiii.htm

Unique Identifiers (including allowed uses)

• Individuals
• Employers
• Health Plans
• Health Care Providers

Purpose & Scope

The purpose of the Unique Health Identifiers is to uniquely identify Individuals, Employers, Health Plans and Health Care Providers within the health care system.

a. Individuals

Current practice consists of Medical Record Numbers issued and maintained by individual provider organizations which is also known as Master Patient Index (MPI). HIS vendors have begun to develop software to facilitate cross reference to MPIs across an enterprise often known as Corporate MPI.

1.1. Unique Identifier Standards for Individuals:

1.1.1. UHID by ASTM

ASTM is the only Standards Development Organization that has developed and published standards in this area. Other options listed below are candidate identifiers frequently discussed by industry experts.

1.2. Other Unique Identifier Options for Individuals:

1.2.1. Social Security Number (SSN)

1.2.2. Biometrics IDs

1.2.3. Directory Service

1.2.4. Personal Immutable Properties

1.2.5. Patient Identification System based on existing Medical Record Number and Practitioner Prefix

1.2.6. Public Key - Private Key Cryptography Method

Employers, Health Plans and Health Care Providers

None of the Standards Developing Organizations have developed standards in the area of identifying employers, health plans and health care providers. However, HCFA and several other organizations have developed identifiers in this area with input from Federal and state agencies that administer health programs and other stake holders of the industry including standards developing organizations (SDOs).

b. Employers:

2.1 Unique Identifier Standards for Employers:

None Exists

2.2 Unique Identifier Options for Employers:

2.1.1. PAYERID

c. Health Plans:

3.1 Unique Identifier Standards for Health Plans:

None Exists

3.2 Unique Identifier Options for Health Plans:

3.2.1. PAYERID

d. Health Care Providers:

4.1. Unique Identifier Standards for Health Care Providers:

None Exists

4.2. Unique Identifier Options for Health Care Providers:

4.2.1. National Provider Identifier

4.2.2. Unique Physician Identifiers (UPIN)

4.2.3. NABP Pharmacy Number (NABP#)

4.2.4. Health Industry Number (HIN)

Individuals

Unique Identifier Standards for Individuals:

1.1.1. UHID by ASTM

Category/Classification of Standard

Unique Identifiers (including allowed uses) for Individuals

II. Standard Development Organization (SDO): ASTM

III. ANSI Accreditation, ANSI Accreditation applied for or not

ANSI Accredited

ANSI Accredited

IV. Name of the Standard

Standard Guide for Properties of a Universal Health

Identifier (UHID) "E1734"

V. Contact for more information

Name: Terry Luthy

Address: ASTM 100 Barr Harbor Drive

West Conshohocken, PA 19428

E-mail: tluthy@local.astm.org

Phone: 610-832-9737

Fax: 610-832-9666

VI. Description of Standard

The UHID Scheme consists of a sequential identifier, a delimiter, check digits and an encryption scheme to support data security. This Standards Guide covers a set of requirements outlining the properties of a national system of Universal Health Identifier (limited to the population of United States). It includes positive identification of patients, automated linkage of various computer-based records, mechanism to support data security of privileged clinical information and the use of technology to keep health care operating cost at a minimum.

VII. Readiness of Standard

The Guide provides a detailed implementation sample for the UHID and evaluates the implementation against the criteria outlined by the standards. The method is being implemented by two (2) VA hospitals in Florida.

VIII. Indicators of Market Acceptance

ASTM E1714 is an approved American National Standard. Regarded as an ideal standards guide for the Unique Patient Identifier. The VA hospital network (VISN) is planning to expand the implementation of ASTM Standards based identifier. More than 350 copies of the standards have been distributed.

IX. Level of Specificity

The UHID Scheme consists of a sequential identifier, a delimiter, check digits and an encryption scheme to support data security. It supports multiple encrypted IDs for an individual.

X) Relationship With Other Standards

N/A

XI) Identifiable Costs

ASTM Standards volume 14.01 for Health care informatics that include this Standards Guide can be purchased for a nominal fee.

1.2. Other Unique Identifier Options for Individuals:

1.2.1. Social Security Number (SSN)

I. Description of Standard

The original scope of SSN was to function as a Social Security Account Number (SSAN). Its scope since the 1935 legislation has been expanded. It is now in use as a personal identifier in a wide area of applications including use by local, state and federal authorities, financial institutions, and numerous consumer organizations.

II. Readiness of Standard

Strength: The existing SSA structures, trained personnel, detailed standard procedural guidelines, cost economies, rapid implementation etc. are all in favor of the use of SSN as a valid patient identifier.

Weakness: Many organizations including those who support the use of SSN as a Health Identifier have identified several serious defects that must be fixed before it can be used as a valid Unique Health Identifier. Examples are:

1. Not unique

2. No exit control

3. Lack of check-digits

4. Significant error level

5. Privacy & confidentiality risks

6. Lack of legal protection

6. Lack of capacity for future growth

7. Lack of mechanism for emergency use and timely issue.

8. Provision for non citizens, etc.

The Computer-based Record Institute (CPRI) supports a modified SSN with important changes to the process of issue of SSN including check-digits, encryption scheme, a trusted authority, and legislative measures, etc..

III. Contact for more information:

Social Security Administration

6401 Security Blvd, Baltimore, MD 21235

IV. Indicators of Market Acceptance

Used by VA hospitals and Medicare Administration as a patient identifier. Used by many health care organizations as part of the patient demographic information.

V. Identifiable costs: Expenditure borne by the Government.

1.2.2. Biometrics IDs

I. Description of Standard

Several sophisticated methods of biometrics identification methods have been proposed, including finger print, retinal pattern analysis, voice pattern identification and DNA analysis.

II. Readiness of Standard

Law enforcement and Immigration departments use some of the biometrics identification methods. However, the necessary standards, procedures, and guidelines are non-existent for use in health care. Some of the concerns relating to this option are organ transplant, amputation and diseases affecting organs e.g. retinopathy.

III. Contact for more information:

N/A

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs: Considered very expensive. Specific details not available.

1.2.3. Directory Service

I. Description of Standard

This method is proposed by Dr. William L. McMullen of Mitre Corporation. It will use existing patient identifiers to provide linkages to records of individuals across systems. The system includes social characteristics (name, SSN, address, driver license etc.) human characteristics (finger print, retina scan etc.) and other groupings such as sex, race, DOB, etc. The directory service would reconcile interactively and heuristically the proper association of the patient identification data at the current point of care with any one of the other prior points of care. This step would be supported by automated capabilities that would facilitate locating the other patient records for which a record linkage is valid. The current point of care location would then be linked with any of the other selected point of care locations by electronically exchanging their network addresses.

II. Readiness of Standard

N/A

III. Contact for more information:

The Mitre Corporation

7525 Colshire Drive

McLean, VA 22102-3481

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs: Considered expensive. Specific

details not available.

1.2.4. Personal Immutable Properties

I. Description of Standard

Dr. Paul Carpenter and Dr. Chris Chute of Mayo Clinic have proposed a model Unique Patient Identifier (UPI) which consists of a series of three universal immutable values plus a check digit. The three values are a seven-digit date of birth field, a six-digit place of birth code, a five-digit sequence code (to identify the individual born on the same date in the same geographic area) and 4) a single-check digit. For emergency situations the use of temporary UPI with the prefix "T" is recommended.

II. Readiness of Standard

N/A

III. Contact for more information:

Dr. Paul Carpenter or Dr. Chris Chute

Mayo Clinic

Rochester, MN 55905

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs: N/A

1.2.5. Patient Identification System Based on Existing Medical Record Number

and Practitioner Prefix:

I. Description of Standard

Medical Records Institute proposes the use of existing provider institution generated medical record number with a provider number prefix. The solution requires consensus on a practitioner identification system but eliminates the cost of creating, implementing and maintaining nationwide (patient) numbering system. The unique practitioner ID would identify the location of the patient database, and the medical record number would identify the patient's record within that database. The solution also includes the patient designation of a practitioner of choice to be the curator who functions as the gateway for the linking and updating of information.

II. Readiness of Standard

N/A

III. Contact for more information:

Medical Records Institute

567 Walnut Street, P.O. Box 600770

Newton, MA 02160

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs: N/A

1.2.6. Public Key - Private Key Cryptography Method

3. Cryptography-based health care identifiers:

Dr. Peter Szolovits, Massachusetts Institute of Technology proposes a Health care Identifier System based on public-key cryptography method. Anyone who wants to use this method needs to acquire two keys that allow arbitrary messages to be encoded and decoded. These two keys contain mathematical functions that are inverses of each other. The method consists of a patient private-key and a organizational (provider) public-key together generating and maintaining IDs that are both organization specific as well as unique to individual patients within that organization. The ID can be revealed to other institutions or practitioners only with the private-key of the patient. Both centralized and decentralized controls are possible. Under the decentralized scheme the patient has the ultimate control over the degree to which the lifetime collection of medical information is made available to others. Under the centralized scheme an umbrella organization (trusted authority) handles all patient private-keys via an ID Server, and the patient will have the public-key.

At the request of authorized institutions the ID Server will generate Patient ID with the use of both the patient's private-key and public-key. Under both schemes, the use of smart card and computer are required.

II. Readiness of Standard

N/A

III. Contact for more information:

Dr. Peter Szolovits

Massachusetts Institute of Technology

Laboratory for Computer Science

545 Technology Square

Cambridge MA 02139

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs: N/A

Employers

2.1 Unique Identifier Standards for Employers:

None Exists

2.2 Unique Identifier Options for Employers:

2.1.1. PAYERID

I. Description of Standard

The PAYERID has a nine numeric digit identifier which includes a 6-digit base number, a 2-digit suffix and a check digit. For those plans and employers requiring many different numbers the ID is issued as a 6-digit base number, a 2-digit suffix and a check digit. For those not requiring different numbers, it is issued in the form of one or more 8-digit numbers with a check-digit. The PAYERID was planned a national identification system to facilitate health care claims. In view of the HIPAA 1996 Legislation, HCFA will be proposing PAYERID as the standard health identifier for both health plans and employers.

II. Readiness of Standard

HCFA's Schedule for implementing PAYERID is listed below.

Notice of Proposed Rule Making (NPRM) February '97

Voluntary use of PAYERID for Medicare Claims April '97

Publish Final Regulation July '97

Require for Medicare January '98

Require for Industry July '99

III. Contact for more information:

Robert Moore

HCFA

7500 Security Blvd.

Baltimore, MD 21244

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs: N/A

Health Plans

3.1 Unique Identifier Standards for Health Plans:

None Exists

3.2 Unique Identifier Options for Health Plans:

3.2.1. PAYERID

Same as 2.2.1 above.

Health Care Providers

4.1. Unique Identifier Standards for Health Care Providers:

None Exists

4.2. Unique Identifier Options for Health Care Providers:

4.2.1. National Provider Identifier (NPI)

I. Description of Standard

The NPI is an eight-position alphanumeric identifier. The eighth position is an International Standards Organization-approved check digit, which will allow a calculation to detect keying or transmission errors. The National Provider System will assign the NPI and will also assign two-position alphanumeric location identifiers to indicate practice locations of the provider. Neither the NPI nor the location identifiers will have embedded intelligence. That is, information about the provider, such as the type of provider or state where the provider is located, will not be conveyed by the NPI. This information will be recorded in the system, but will not be part of the identifier. Individual and group providers will receive location identifiers for their office practice locations. Individuals and groups will not receive location identifiers for the hospitals or other organization providers where they practice, since these organization providers will receive their own NPIs. The NPIs of individual providers who are members of a group will be linked to the NPI of the group. The relationships defined among organization providers differ, depending upon the specific business rules of different health programs. The National Provider System will enumerate organization providers at the elemental level, so that different health programs can link these providers according to their program-specific business rules. Each organization provider in a separate location will receive a separate NPI. Each member of an organization chain and each part of an organization provider that needs to be identified will receive a separate NPI. The National Provider System will have a query facility that will link organization providers that have a common Employer Identification Number. Organization providers will have only one active location identifier.

II. Readiness of Standard

HCFA's schedule for implementation of NPI is listed below.

Notice of Proposed Rule Making Published in

Federal Register 02/21/97

Final Regulation Published in Federal Register 07/02/97

NPIs Issued to Medicare Providers No Later Than 08/01/97

Required Use of NPI for Medicare claims 12/01/97

III. Contact for more information

Robert Moore

HCFA

7500, Security Blvd.

Baltimore, MD 21244

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs

None

4.2.2. Unique Physician Identifier Number (UPIN)

Description of Standard

HCFA created UPIN as required by COBRA to identify physicians who provide services for which payment is made under Medicare. UPIN is a six-place alphanumeric identifier. The UPIN Registry is the carrier that maintains the UPIN. A total of 704,926 UPINs have been assigned to 2,088,309 physicians.

Readiness of Standard

UPIN addresses only a small segment of the provider community i.e. physicians with dedicare practice. HCFA's current proposal of National Provider File/NPI replaces UPIN with NPI.

Contact For More Information

Robert Moore

HCFA

7500, Security Blvd.

Baltimore, MD 21244

Indicators of Market Acceptance

N/A

Identifiable costs

None

4.2.3. National Association of Boards of Pharmacy Number

(NABP Number)

I. Description of Standard

Each licensed pharmacy in the United States is assigned a unique seven-digit number by the National Council for Prescription Drug Programs (NCPDP), in cooperation with the National Association of Boards of Pharmacy. The purpose of this system is to enable a pharmacy to identify itself to all third-party processors by one standard number. The first two digits of the NABP Number denotes state designation. The second group four digits identify the pharmacy and assigned sequentially from 0001 up. The last digit is a check-digit.

II. Readiness of Standard

NABP Number is currently in use by pharmacies in United

States.

III. Contact for more information

Noe Gomez

NCPDP/NABP

4201 North 24th Street, Suite 365

Phoenix, AZ 85016

IV. Indicators of Market Acceptance

NABP Number is currently in use by pharmacies in United

States.

V. Identifiable Costs

None

4.2.4. Health Industry Number (HIN)

I. Description of Standard

HIN is used as an identifier for contract administration in the health industry supply chain, as a prescriber identifier for claims processing and for market analysis applications. It enumerates prescriber by location, provider establishments and other entities in the health industry supply chain. The Identifier includes a "base HIN" consisting of seven (7) character identifier and a two (2) character suffix to identify the location of the prescriber.

II. Readiness of Standard

HIN has been in use since 1987 in the health industry

supply chain and in state-administered claims processing.

III. Contact for more information

Robert A. Hankin, Phd, President,

HIBCC

5110 North 40th Street, Suite 250

Phoenix, AZ 85018

IV. Indicators of Market Acceptance

According to HIBCC, HIN is endorsed or being implemented by the following:

American Hospital Association (AHA)

American Medical Association (AMA)

American Nurses Association (ANA

American Society for Automation in Pharmacy (ASAP)

American Veterinary Distributors Association (AVDA)

Animal Health Institute (AHI)

Centers for Disease Control & Prevention (CDC)

Health Industry Distributors Association (HIDA)

Health Industry Group Purchasing Association (HIGPA)

Health Industry Manufacturers Association (HIMA)

Healthcare Information and Management Systems Society (HIMSS)

National Wholesale Druggists' Association (NWDA)

Pharmaceutical Research and Manufacturers Association (PhRMA)

State of Tennessee, TennCare Program

US Department of Defense (DoD), Defense Personnel Support Center (DPSC)

V. Identifiable Costs

There is no cost to entities enumerated on the database.

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