Establishing Patient Identification
- Correct patient identification is vital for patient safety and the maintenance of patient confidentiality.
- States have been implementing two methods of establishing patient identification.
Protected Health Information
The HIPAA Privacy Rule protects most individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, on paper, or oral. The Privacy Rule calls this information protected health information (PHI)2. Protected health information is information, including demographic information, which relates to:
- the individual’s past, present, or future physical or mental health or condition,
- the provision of health care to the individual, or
- the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. Protected health information includes many common identifiers (e.g., name, address, birth date, Social Security Number) when they can be associated with the health information listed above.
There are several sources for identifying a patient in HL7 messaging standards.
- IHE (Integrating the Healthcare Enterprise)
- Standards of Practice for Patient Identification – Association of Surgical Technologists
- HL7 Version 2.x messages
- HL7 Version 3 – CCD messages
- HL7 FHIR
IHE (Integrating the Healthcare Enterprise)
IHE is a profiling organization. IHE provides Integration Profiles and Technical Frameworks that can be used for guidance in identifying Patient Identification.
IHE IT Infrastructure Domain Profiles
IHE defines the Patient Identifier Domain as a single system or a set of interconnected systems that all share a common identification scheme (an identifier and an assignment process to a patient) and issuing authority for patient identifiers.
There are three IHE profiles that support Patient Identification.
- Patient Identifier Cross Referencing (PIX)
- Cross-Community Patient Discovery (XCPD)
- Patient Identifier Cross Referencing for HL7v3 (PIXv3)
Patient Identifier Cross Referencing (PIX)
The Patient Identifier Cross Referencing (PIX) profile supports the cross-referencing of patient identifiers from multiple Patient Identifier Domains. HL7 V2.x is the message format. Supports determination of matching patient identifiers (ADT^A01, A04, A05, A08, A31, A40; Q23)
Cross-Community Patient Discovery (XCPD)
The Cross-Community Patient Discovery (XCPD) profile supports the means to locate communities which hold patient relevant health data.
Patient Identifier Cross Referencing for HL7v3 (PIXv3)
The Patient Identifier Cross Referencing for HL7v3 (PIXv3) profile provides cross-referencing of patient identifiers from multiple Patient Identifier Domains. HL7 V3 is the message format.
|Actor and Transactions|
Patient Information Reconciliation (PIR)
This profile coordinates reconciliation of the patient record when images are acquired for unidentified (e.g. trauma), or misidentified patients.
Nuclear Medicine Image (NMI)
This profile specifies how Nuclear Medicine images and result screens are created, exchanged, used and displayed.
Scheduled Workflow (SWF)
This workflow integrates the ordering, scheduling, imaging acquisition, storage and viewing activities associated with radiology exams.
Scheduled Workflow establishes a seamless flow of information that supports efficient patient care workflow in a typical imaging encounter. It specifies transactions that maintain the consistency of patient information from registration through ordering, scheduling, imaging acquisition, storage and viewing as shown in the following figure.
Anatomy of a Dicom file
As we already know a DICOM file storing one image contain the image data and data belonging to the patient and data (name, age, etc.) belonging to the examination (date of acquisition, manufacturer, etc.) and identifiers: the study UID, the series’ UID’s, and the image UID’s.
The software that interprets the image will have to be able to find, first of all, the part of the DICOM file containing the image; also all of the identifiers and the other data contained in the DICOM file. The DICOM standard has a special pair of characters, the parentheses and the comma: ’(’ and ’)’ and ’,’. Now, numbers of 2×4 hexadecimal digits enclosed by the these parentheses and separated by the comma uniquely identify a specific DICOM field or data. For instance this tag:
(0010,0010) is the identifier of the patient’s name – „ten-ten is the patient name” as DICOM experts would say. The last thing that we have to learn is that the data, in this case the patient name is enclosed by a pair of the tag shown above:
Here is a decoded segment of the DICOM information found in a DICOM file:
Dicom-File-Format for Patient Identification
The following table defines the attributes relevant to identifying a patient
|Attribute Name||Tag||Attribute Description|
|Patient\’s Name||(0010,0010)||Patient\’s full name|
|Patient ID||(0010,0020)||Primary identifier for the patient.|
|Other Patient IDs||(0010,1000)||Other identification numbers or codes used to identify the patient.|
|Other Patient IDs Sequence||(0010,1002)||A sequence of identification numbers or codes used to identify the patient, which may or may not be human readable, and may or may not have been obtained from an implanted or attached device such as an RFID or barcode.|
|Type of Patient ID||(0010,0020)||The type of identifier in this item.|
Enumerated Values: TEXT RFID
BARCODE | | Other Patient Names | (0010,1001) | Other names used to identify the patient. | | Patient\’s Birth Name | (0010,1005) | Patient\’s birth name. | | Patient\’s Mother\’s Birth Name | (0010,1060) | Birth name of patient\’s mother. | | Medical Record Locator | (0010,1090) | An identifier used to find the patient\’s existing medical record (e.g., film jacket). | | Referenced Patient Photo Sequence | (0010,1100) | A photo to confirm the identity of a patient. Only a single Item is permitted in this Sequence. |
Standards of Practice for Patient Identification – Association of Surgical Technologists
Standard of Practice I
The use of two patient identifiers improves the reliability of the patient identification process and decreases the chance of performing the wrong procedure on the wrong patient. Additionally, the use of two patient identifiers is necessary in the instances of a name patient alert because two (or more patients) have the same name that can be spelled the same, close to being spelled the same and/or pronounced the same.
NOTE: The patient’s room number should not be used as a patient identifier; room numbers are not person-specific identifiers, since patients can be moved from room to room
Standard of Practice II
All patients undergoing a surgical procedure should wear an identifying marker.
HL7 Version 2.x messages
HL7 PID Segment
The HL7 PID segment is found in every type of ADT message (i.e. ADT-A01, ADT-A08, etc.) and contains 30 different fields with values ranging from patient ID number, to patient sex, to address, to marital status, to citizenship. The PID segment provides important identification information about the patient and, in fact, is used as the primary means of communicating the identifying and demographic information about a patient between systems.
The HL7 standard allows for several different types of patient identification numbers in the first four fields of the PID segment.
|PID-1:||Set ID – Patient ID – a number to identify the transaction|
|PID-2:||Patient ID (External ID) – the patient identifier number used by one or more outside institutions (i.e. a physician’s office that is referring the patient)|
|PID-3:||Patient ID (Internal ID) – the primary, unique patient identifier number used by the facility|
|PID-4:||Alternate Patient ID – an alternate, additional, temporary or pending patient identification number|
The PID segment is shown in red.
HL7 Version 3 – CCD
The Continuity of Care Document (CCD) is built using HL7 Clinical Document Architecture (CDA) elements and contains data that is defined by the ASTM Continuity of Care Record (CCR). It is used to share summary information about the patient within the broader context of the personal health record.
|CDA Template Types|
|Source: HL7 Organization|
Record Target Section
The recordTarget element of the header identifies the patient associated with the document and contains no narrative component.
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