ASTM E1714-00
(Guide)Standard Guide for Properties of a Universal Healthcare Identifier (UHID)
Standard Guide for Properties of a Universal Healthcare Identifier (UHID)
SCOPE
1.1 This guide covers a set of requirements outlining the properties of a national system creating a universal health care identifier (UHID). Use of the UHID is expected to be limited to the population of the United States.
1.2 This guide sets forth the fundamental considerations for a UHID that can support at least four basic functions effectively:
1.2.1 Positive identification of patients when clinical care is rendered;
1.2.2 Automated linkage of various computer-based records on the same patient for the creation of lifelong electronic health care files;
1.2.3 Provision of a mechanism to support data security for the protection of privileged clinical information; and
1.2.4 The use of technology for patient records handling to keep health care operating costs at a minimum.
1.3 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.
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An American National Standard
Designation: E 1714 – 00
Standard Guide for
Properties of a Universal Healthcare Identifier (UHID)
This standard is issued under the fixed designation E1714; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision.Anumber in parentheses indicates the year of last reapproval.A
superscript epsilon (e) indicates an editorial change since the last revision or reapproval.
1. Scope States.Thesmallerthepopulationsizecoveredbyanidentifier
(that is, the greater the discriminating power), the better that
1.1 This guide covers a set of requirements outlining the
identifier is.
properties of a national system creating a universal health care
3.1.3 encounter—an instance of direct (face-to-face) inter-
identifier (UHID). Use of the UHID is expected to be limited
action, regardless of the setting, between a patient and a
to the population of the United States.
practitioner vested with primary and autonomous responsibil-
1.2 This guide sets forth the fundamental considerations for
ityfordiagnosing,evaluating,ortreating,orsomecombination
a UHID that can support at least four basic functions effec-
thereof, the patient’s condition or providing social worker
tively:
services. (Encounters do not include ancillary services, visits,
1.2.1 Positive identification of patients when clinical care is
or telephone contacts) (see Guide E1384).
rendered;
3.1.4 encrypted universal health care identifier (EUHID)
1.2.2 Automatedlinkageofvariouscomputer-basedrecords
—a UHID that has been encoded in order to disidentify the
onthesamepatientforthecreationoflifelongelectronichealth
person associated with that UHID.
care files;
3.1.5 episode of care—a chain of events over a period of
1.2.3 Provision of a mechanism to support data security for
time during which clinical care is provided for an illness or a
the protection of privileged clinical information; and
clinical problem (see Guide E1384).
1.2.4 The use of technology for patient records handling to
3.1.6 healthcareidentifier—atagfortheidentificationofan
keep health care operating costs at a minimum.
individual created for exclusive use of the health care system.
1.3 This standard does not purport to address all of the
3.1.7 identifier—a datum, or a group of data, that allows
safety concerns, if any, associated with its use. It is the
positive recognition of a particular individual.
responsibility of the user of this standard to establish appro-
3.1.8 occasion of service—a specified identifiable instance
priate safety and health practices and determine the applica-
of an act of service involved in the care of patients or
bility of regulatory limitations prior to use.
consumers (see Guide E1384).
2. Referenced Documents
3.1.9 permanent identifier—a characteristic feature of an
individual that generally does not change over time, such as
2.1 ASTM Standards:
sex, date of birth, place of birth, or fingerprint.
E1384 Guide for Description for Content and Structure of
3.1.10 prospective record linkage—successive documenta-
an Automated Primary Record of Care
tion of clinical encounters so that all records are linked during
3. Terminology
the process of care to ensure the continuity of patient care.
Linkageisperformedattheunitrecordlevelandoccursduring
3.1 Definitions:
the time the patient is receiving care. For electronic health
3.1.1 clinical record linkage—individualunitrecordslinked
records, prospective record linkage involves linking all patient
forthepurposeofdocumentingthesequenceofeventsorcare,
assessment, diagnostic, treatment, and other information col-
or both, for a specific patient.
lected by all care providers so that the information is available
3.1.2 discriminating power of an identifier— the capability
at the time the patient is being treated. All records for an
of an identifier to reduce the possible global population to a
individual patient will be linked accurately since errors will be
smaller number. For example, sex identification reduces the
discovered and corrected in the process of providing care.
populationsizetoapproximatelyhalf.Dateofbirthreducesthe
3.1.11 retrospective record linkage—matching unit records
population size to approximately one of 25000 in the United
in data files not originally designed to be linked. The purpose
of the linkage is to expand the comprehensiveness of each file
This guide is under the jurisdiction of ASTM Committee E31 on Healthcare
being linked to facilitate evaluations of efficiency and effec-
Informatics and is the direct responsibility of Subcommittee E31.25 on Healthcare
tiveness. Linkage can be performed manually using the actual
Management, Security, Confidentiality, and Privacy.
paper records if the files are small. Linkage is more efficient if
Current edition approved Oct. 10, 2000. Published November 2000. Originally
published as E 1714–95. Last previous edition E 1714–95.
Annual Book of ASTM Standards, Vol 14.01.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
E1714–00
performedprobabilisticallyusingcomputerizeddataifthefiles simpletask.Incorrectrecordlinkagewouldcreateconfusion,at
are large and conditions of uncertainty exist concerning what least, or possibly cause serious consequences. To gain the
should be linked. (H. B. Newcombe was the pioneer developer benefits from such an identifier, it must be used by all relevant
of retrospective probabilistic record linkage. ) Not part of the organizations. A national patient identifier system must resist
process of patient care, this linkage occurs some time after the unauthorized access to confidential clinical data. Furthermore,
patient has been discharged and after the records have been the creation of personal identifiers for the entire population
computerized and merged into data files that may be managed must be a cost-effective process in light of the current fiscal
at the facility, regional, or state level. Not all records that constraints. The creation and administration of personal iden-
should link are expected to link because of missing or tifiers for the entire population must be accomplished at a cost
inaccurate data and missing records. Typical data files linked thatiswidelyacceptedasaffordableandjustified.Last,butnot
retrospectively include birth and death certificates, disease least, a time pressure exists. The solution to the patient
registries with hospital discharge records, emergency medical identifier challenge should use technology to facilitate rapid
services (EMS) crash records, and hospital discharge records deployment throughout the United States to permit the expe-
statewide. ditious implementation of CPRs.
3.1.12 temporary patient identifier—a unique identifier cre-
5. Different Types of Computer-Based Patient Records
ated by an institution to serve as an interim identifier when an
Clinical Event Documentation
individual’s UHID is not available. All information is to be
(1) Single encounter (such as office Record of a single visit
transferred to the UHID when the UHID becomes available.
visit)
3.1.13 universal healthcare identifier (UHID)—ahealthcare
(2) Single episode of care (such as a Records of a series of consecutive clini-
hospitalization) cal activities
identification system designed so that a healthcare identifier
(3) Multiple encounters at same site, String of discrete records
can be assigned to every individual.
linked (such as clinic or longitudinal
3.1.14 universal healthcare identifier computer system—an
office records)
(4) Multiple episodes, same institution String of discrete groups of records
automated system that can perform the functions needed to
(for example, multiple admissions) linked by hospital number
supportaUHID,forexample,verifyingthevalidityofaUHID.
(5) Multiple encounters or episodes, at Unlinked, to be linked in order to
3.1.15 universalhealthcareidentifiersystem—theagencies, different sites form longitudinal health care file
(6) Perinatal records To include parents’ health history, preg-
system, and networks that implement a UHID and conduct
nancy, birth, and puerperal and neo-
associated activities.
natal records
3.1.16 universal healthcare identifier trusted authority—a
(7) Death records Final illness record, to be linked to next
generation’s family history, closing,
computer system and its associated organization that is able
and summary record
andauthorizedtoprovideUHIDservices,suchasgrantingnew
UHIDs and supporting UHID encryption and decryption ser-
6. Criteria and Characteristics of a Universal Health
vices.
Care Identifier
3.1.17 variable identifier—those personal characteristics
6.1 The UHID should meet at least the following criteria
that may change over time such as home address, telephone
(listed in alphabetical order):
number, insurance number, or name.
6.1.1 Accessible—New UHIDs should be available when-
3.1.18 visit—the visit of an outpatient to one or more units
ever and wherever they are required for assignment.
or facilities located in or directed by the entity maintaining the
6.1.2 Assignable—ItshouldbepossibletoassignaUHIDto
outpatient health services (such as a clinic, physician’s office,
an individual whenever it is needed. Assignment will be
hospital, or medical center) (see Guide E1384).Visits provide
performed by a UHID trusted authority after receiving a
acountofthenumberofpatientsseen.Itispossibleforasingle
properly authenticated request for a new UHID.
patient to have more than one encounter and more than one
6.1.3 Atomic—A UHID should be a single data item. It
occasion of service during a visit.
should not contain subelements that have meaning outside the
context of the entire UHID. Nor should the UHID consist of
4. Significance and Use
multiple items that must be taken together to constitute an
4.1 Recentexplorationsofthefeasibilityofcomputer-based
identifier.
patient records (CPRs) have revealed many valuable potential
6.1.4 Concise—The UHID should be as short as possible to
benefits, but it has also become apparent that the effective
minimize errors, the time required for use, and the storage
applicationofhightechnologywillcreatesomenewproblems.
needed.
CPRs offer the option for lifelong linkage of all records on a
6.1.5 Content-Free—The UHID should not depend on pos-
patient, from birth to death. Such longitudinal record linkage
sibly changing or possibly unknown information pertaining to
would make the patient’s entire past health history retrievable. 4
the person.
This could make possible a quantum leap in the clinical
6.1.6 Controllable—The confidentiality of EUHIDs can be
practice of health care, but a reliable patient identifier is
ensured.Onlytrustedauthoritieshaveaccesstoencryptionand
essential to make such a large-scale nationwide record linkage
feasible. The design of a patient identifier system is not a
Including content in the UHID makes it impossible to assign the “correct”
identifier if that information is not known. It also leads to invalid situations if the
Newcombe, H. B., Handbook of Record Linkage, Oxford University Press, information changes; for example, what happens to an identifier based on gender if
Oxford, England, 1988. the person has a sex change procedure?
E1714–00
decryption algorithms and methods and to the linkages be- 6.1.18 Networked—The UHID should be supported by a
tween EUHIDs and UHIDs. networkthatmakesUHIDservicesuniversallyavailablewhere
needed.
6.1.7 Cost-Effective—The UHID system chosen should
6.1.19 Permanent—Once assigned, a UHID should remain
achieve maximum functionality while minimizing the invest-
with that individual. It should never be reassigned to another
ment required to create and maintain it.
person, even after the individual’s death.
6.1.8 Deployable—The UHID should be implementable
6.1.20 Public—The UHID (but not necessarily EUHID) is
using a variety of technologies, including magnetic cards, bar
meant to be an open data item. The individual it identifies
codereaders,opticalcards,smartcards,audio,voice,computer
should be able to reveal it to any person or organization.
data files, and paper.
6.1.21 Repository-Based—A secure, permanent repository
6.1.9 Disidentifiable—It should be possible to create an
shall exist in support of the UHID. The repository should
arbitrary number of UHIDs that can be used to link health
contain UHIDs, patient identification data, EUHIDs, encryp-
information concerning specific individuals but that cannot be
tionanddecryptionmethods,andotherrelevantinformationto
used to identify the associated individual. These are encrypted
support functions such as linkages.
universal healthcare identifiers (EUHIDs). With the exception
6.1.22 Retirement—It shall be possible to retire a UHID or
of disidentification, EUHIDs should have all of the properties
EUHID that is no longer active, for example, when the
attributable to UHIDs, including verification (see 6.1.31). It
associated individual has expired.
should be clear to all users whether a specific identifier
6.1.23 Retroactive—It shall be possible to assign UHIDs to
represents a UHID or an EUHID. The EUHID scheme should
all of the currently existing individuals at the time that the
be capable of generating a large number (at least hundreds) of
UHID system is implemented.
EUHIDs for a single individual. (See Section 8.)
6.1.24 Secure—The creation of EUHIDs, decryption of an
EUHID to reveal the identity of the individual, and mainte-
6.1.10 Focused—The UHID should be created and main-
tained solely for the purpose of supporting health care. Its nance of encryption techniques must be performed in a secure
mannertoensurethatthepoliciesgoverningsuchactivitiesare
form,usage,andpoliciesshouldnotbeinfluencedbytheneeds
enforced.
or requirements of other activities.
6.1.25 Splittable—In the (theoretically never occurring)
6.1.11 Governed—An entity shall exist that is responsible
event that the same UHID is assigned to two individuals, there
for overseeing the UHID system. This agency will determine
must be a mechanism to assign a new UHID to one (or both)
the policies that govern the UHID system, manage the trusted
of these individuals.
authority(ies), and take such actions as are necessary to ensure
6.1.26 Standard—The identifier scheme should be as com-
that the UHIDs (and EUHIDs) can be used properly and
patible as possible with existing and emerging standards such
effectively to support health care.
as those being developed by CEN in Europe.
6.1.12 Identifiable—It shall be possible to identify the
6.1.27 Unambiguous—Whether represented in automated
person associated with a valid UHID. Identifying information
or handwritten form, a UHID should minimize the risk of
may include s
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