ASTM E1714-07
(Guide)Standard Guide for Properties of a Universal Healthcare Identifier (UHID)
Standard Guide for Properties of a Universal Healthcare Identifier (UHID)
SIGNIFICANCE AND USE
Recent experience with computer-based patient records (CPRs) has revealed many valuable potential benefits, but it has also become apparent that the effective application of this technology creates some new problems. CPRs offer the option for lifelong linkage of all records on a patient, from birth to death. Such longitudinal record linkage would make the patient’s entire past health history retrievable. This could make possible a quantum leap in the clinical practice of health care, but a reliable patient identifier is essential to make large-scale regional and nationwide record linkage feasible. The design of a patient identifier system is not a simple task. Incorrect record linkage would create confusion, at least, or possibly cause serious consequences. To gain the benefits from such an identifier, it must be used by all relevant organizations. A universal patient identifier system must resist unauthorized access to confidential clinical data.
Furthermore, the creation of personal identifiers for the entire population must be a cost-effective process in light of ongoing fiscal constraints. The creation and administration of personal identifiers for the entire population must be accomplished at a cost that is widely accepted as affordable and justified. Last, but not least, a time pressure exists. The solution to the patient identifier challenge should use technology to facilitate rapid deployment of the system to permit the expeditious implementation of CPRs. A companion document, Guide E 2553, provides the implementation strategy concerning how to actually implement the UHID system.
SCOPE
1.1 This guide covers a set of requirements outlining the properties required to create a universal healthcare identifier (UHID) system. Use of the UHID is expected to initially be focused on the population of the United States but there is no inherent limitation on how widely these identifiers may be applied.
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.
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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Designation:E1714 −07 AnAmerican National Standard
Standard Guide for
1
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. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (´) indicates an editorial change since the last revision or reapproval.
1. Scope 3.1.1 clinical record linkage—individual unit records linked
for the purpose of documenting the sequence of events or care,
1.1 This guide covers a set of requirements outlining the
or both, for a specific patient.
properties required to create a universal healthcare identifier
(UHID) system. Use of the UHID is expected to initially be 3.1.2 discriminating power of an identifier— the capability
focused on the population of the United States but there is no of an identifier to reduce the possible global population to a
inherent limitation on how widely these identifiers may be smaller number. For example, sex identification reduces the
applied. populationsizetoapproximatelyhalf.Dateofbirthreducesthe
population size to approximately one of 25 000 in the United
1.2 This guide sets forth the fundamental considerations for
States. The smaller the population size covered by an identifier
a UHID that can support at least four basic functions effec-
(that is, the greater the discriminating power), the better that
tively:
identifier is.
1.2.1 Positive identification of patients when clinical care is
rendered; 3.1.3 encounter—an instance of direct interaction, regard-
1.2.2 Automated linkage of various computer-based records less of the setting, between a patient and a practitioner vested
onthesamepatientforthecreationoflifelongelectronichealth with primary and autonomous responsibility for diagnosing,
evaluating, treating, or some combination thereof, the patient’s
care files;
1.2.3 Provision of a mechanism to support data security for condition or providing social worker services (See Guide
E1384).(Encountersdonotincludeancillaryservices,visits,or
the protection of privileged clinical information; and
1.2.4 The use of technology for patient records handling to telephone contacts.)
keep health care operating costs at a minimum.
3.1.4 episode of care—a chain of events over a period of
1.3 This standard does not purport to address all of the
time during which clinical care is provided for an illness or a
safety concerns, if any, associated with its use. It is the clinical problem (See Guide E1384).
responsibility of the user of this standard to establish appro-
3.1.5 healthcare identifier—a tag for the identification of an
priate safety and health practices and determine the applica-
individual created for exclusive use of the health care system.
bility of regulatory limitations prior to use.
3.1.6 identifier—a datum, or a group of data, that allows
2. Referenced Documents
positive recognition of a particular individual.
2
2.1 ASTM Standards: 3.1.7 management organization—an organization respon-
E1384 Practice for Content and Structure of the Electronic
sible for the management and oversight of the UHID system
Health Record (EHR) and its operations.
E2553 Guide for Implementation of a Voluntary Universal
3.1.8 occasion of service—a specified identifiable instance
Healthcare Identification System
of an act of service involved in the care of patients or
consumers (See Guide E1384).
3. Terminology
3.1.9 permanent identifier—a characteristic feature of an
3.1 Definitions:
individual that generally does not change over time, such as
sex, date of birth, place of birth, or fingerprint.
1
This guide is under the jurisdiction of ASTM Committee E31 on Healthcare
3.1.10 private universal health care identifier (PUHID) —a
Informatics and is the direct responsibility of Subcommittee E31.25 on Healthcare
Data Management, Security, Confidentiality, and Privacy.
UHID that has been encoded in order to disidentify the person
Current edition approved Aug. 15, 2007. Published September 2007. Originally
associated with that UHID.
approved in 1995. Last previous edition approved in 2000 as E1714 – 00. DOI:
10.1520/E1714-07.
3.1.11 prospective record linkage—successive documenta-
2
For referenced ASTM standards, visit the ASTM website, www.astm.org, or
tion of clinical encounters so that all records are linked during
contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM
the process of care to ensure the continuity of patient care.
Standards volume information, refer to the standard’s Document Summary page on
the ASTM website. Linkage is performed at the unit record level and occurs during
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