1、BSI Standards Publication Health informatics Guidance on patient identification and cross-referencing of identities PD CEN/TR 15872:2014National foreword This Published Document is the UK implementation of CEN/TR 15872:2014. The UK participation in its preparation was entrusted to Technical Committe
2、e IST/35, Health informatics. A list of organizations represented on this committee can be obtained on request to its secretary. This publication does not purport to include all the necessary provisions of a contract. Users are responsible for its correct application. The British Standards Instituti
3、on 2014. Published by BSI Standards Limited 2014 ISBN 978 0 580 64182 4 ICS 35.240.80 Compliance with a British Standard cannot confer immunity from legal obligations. This Published Document was published under the authority of the Standards Policy and Strategy Committee on 30 June 2014. Amendments
4、/corrigenda issued since publication Date Text affected PUBLISHED DOCUMENT PD CEN/TR 15872:2014 TECHNICAL REPORT RAPPORT TECHNIQUE TECHNISCHER BERICHT CEN/TR 15872 March 2014 ICS 35.240.80 English Version Health informatics - Guidance on patient identification and cross- referencing of identities In
5、formatique de sant - Guide relatif lidentification des patients et au rfrencement crois des identits Medizinische Informatik - Leitfaden fr die Patientenidentifikation und Kreuzreferenzierung von Identitten This Technical Report was approved by CEN on 17 February 2009. It has been drawn up by the Te
6、chnical Committee CEN/TC 251. CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malt
7、a, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United Kingdom. EUROPEAN COMMITTEE FOR STANDARDIZATION COMIT EUROPEN DE NORMALISATION EUROPISCHES KOMITEE FR NORMUNG CEN-CENELEC Management Centre: Avenue Marnix 17, B-1000 Brussels 2014 CEN
8、 All rights of exploitation in any form and by any means reserved worldwide for CEN national Members. Ref. No. CEN/TR 15872:2014 E PD CEN/TR 15872:2014CEN/TR 15872:2014 (E) 2 Contents Page Foreword 4 1 Scope 5 2 Normative references 5 3 Terms and definitions .6 4 Patient identity management 8 4.1 Ge
9、neral 8 4.2 Concepts .8 4.2.1 Patient Identity .8 4.2.2 Patient identifier domain .9 4.2.3 Examples of patient identifier domain 10 4.3 Identity management process . 10 4.3.1 General . 10 4.3.2 Care provision use case 10 4.3.3 The identity management process 12 4.3.4 Patient Identifier Domain Policy
10、 13 4.3.5 Basic process actions 14 4.3.6 Identity utilization or referencing action 15 4.3.7 Identity maintenance action 15 4.3.8 Methods of deleting patient identity . 17 4.4 Identification anomalies . 17 4.4.1 General . 17 4.4.2 Homonymy 17 4.4.3 Duplicates 17 4.4.4 Collision . 17 4.5 Exceptions .
11、 18 4.5.1 General . 18 4.5.2 Non-identified patient . 18 4.5.3 Patient with uncertain traits . 18 4.5.4 New-born . 18 4.5.5 Identification under anonymity . 18 4.5.6 Intentional use of multiple identities 19 5 Cross-reference patient identity management 20 5.1 General . 20 5.2 Concepts 20 5.2.1 Cros
12、s-referencing identifier domain . 20 5.2.2 Sharing medical information between healthcare providers . 21 5.3 Identity cross-reference management process . 22 5.3.1 General . 22 5.3.2 Cross reference Patient identifier Domain policy . 23 5.3.3 Identities matching action . 23 5.3.4 Identities Query ac
13、tion . 24 5.3.5 Maintenance action. 24 6 Recommendations 25 6.1 General . 25 6.2 Use Case 1: Within a healthcare organization . 26 6.2.1 Healthcare providers Organizational requirements . 26 6.2.2 Software suppliers 26 PD CEN/TR 15872:2014CEN/TR 15872:2014 (E) 3 6.2.3 Insurance providers 27 6.3 Use
14、Case 2: Healthcare coordination 28 6.3.1 General . 28 6.3.2 Between healthcare providers . 28 6.3.3 Software suppliers 30 6.4 Use case 3: Cross-border, the Europe case . 30 6.4.1 General . 30 6.4.2 Organizational requirements 31 6.4.3 Information system . 31 Annex A (informative) Policy charter of t
15、he patient identifier domain 33 A.1 Policy Charter of the Patient Identifier Domain 33 Annex B (informative) Norms, standards and other references 36 B.1 General . 36 B.2 ISO/TS 22220:2011, Identification of subject of Healthcare 36 B.3 IHE and profiles supporting Patient identification . 36 B.4 Net
16、card for eHIC: Electronification of Healthcare Insurance Card . 38 B.5 FIDIS Future of Identity in the Information Society . 40 Bibliography 41 PD CEN/TR 15872:2014CEN/TR 15872:2014 (E) 4 Foreword This document (CEN/TR 15872:2014) has been prepared by Technical Committee CEN/TC 251 “Health informati
17、cs”, the secretariat of which is held by NEN. Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. CEN and/or CENELEC shall not be held responsible for identifying any or all such patent rights. PD CEN/TR 15872:2014CEN/TR 15872:2014 (E
18、) 5 1 Scope This Technical Report addresses the issue of multiple identifiers that may refer to the same person. It describes the management of patient identification and cross-referencing of identities and provides some practical guidance for addressing implementation of standards, reports, guideli
19、nes, methods, etc. The need to identify a person unambiguously is an important component for the interoperability of health information systems. Within healthcare there is an essential requirement for good quality information, not least to uniquely identify an individual to ensure that the appropria
20、te and relevant care can be delivered irrespective of geography, time and situation. To ensure that health care providers have access to information about an individual patient, it is vital that the patient can be reliably identified within a Health Care Information System. Currently, a given patien
21、t may have several identifiers corresponding to different geographical locations, different health care organisations or various specialities. The allocation of multiple identifiers and related processes increases the risk of identification error within one or more information systems and as a resul
22、t, might compromise the safety of a patient. The quality of identification ensures that health care providers have access to patient information, facilitating closer coordination and continuity of care, improving service in terms of prevention and follow-up. Quality will be pursued within the framew
23、ork of: medical care in a hospital information system (HIS): covering all the stages from patient identification to admittance to the health care organization or directly to the care unit or emergency care, through to the issuing of reports by the different health care services (medical and medico-t
24、echnical services); continuity of care; patient mobility. Because electronic heath care records may be updated by several and various healthcare providers over a long period of time, the patient identification needs to be formalized in such a way to ensure that the correct patients healthcare record
25、 is being accessed. In the regions or the countries where a national unique patient identifier is not used, the patient is identified by using patient identifiers for each healthcare system, wherever the patient is registered. Even within an individual healthcare organization, the patient may be ide
26、ntified by a specific identifier for an individual ward or a medical support unit. To ensure the continuity of care and the sharing of patient information, it is necessary to reliably link together the different patient identities within what we will call a “patient identifier cross- reference domai
27、n”. The need to cross-reference identities appears when a healthcare provider wants to access all the healthcare information for one patient and that information is contained in different healthcare systems managed by several healthcare professionals or organisations. In recent years, many research
28、studies and implementations have taken place to try to resolve this issue. This document provides an overview and proposals for the management of the patient identities and the cross referencing of identities and provides guidance for authorities, organisations, project managers and users. 2 Normati
29、ve references The following documents, in whole or in part, are normatively referenced in this document and are indispensable for its application. For dated references, only the edition cited applies. For undated references, the latest edition of the referenced document (including any amendments) ap
30、plies. PD CEN/TR 15872:2014CEN/TR 15872:2014 (E) 6 ISO/TS 22220:2011, Health informatics Identification of subjects of health care 3 Terms and definitions For the purposes of this document, the following terms and definitions apply. 3.1 alias assumed name that can be specifically applied to disguise
31、 identity, which, in a healthcare situation, might be used to protect a famous person receiving treatment or an individual receiving sensitive treatment in, for example, a drug or alcohol rehabilitation unit or sexual health clinic SOURCE: ISO/TS 22220:2011 3.2 collision case in which two or more di
32、fferent patients are represented by the same patient identity EXAMPLE In the cardiology service, the nurse who is consulting the record of Mr Jean Martin, finds that some data are not consistent between then (for example, in the same day, two effort trainings were done). She suspects a collision of
33、two patients. After checking the patient identification server, she detects two Mr Jean Martin; one is born in January 25 th , 1950 and the second on June 25 th , 1950. SOURCE: IHE-PIX 3.3 duplicate case in which several identities represent the same patient in the same patient identifier domain 3.4
34、 federation cross-referencing index index that carries the federative identities within a federation cross-referencing domain 3.5 healthcare provider person or organization who is involved in, or associated with, the delivery of healthcare to a patient, or caring for patient wellbeing 3.6 identifier
35、 sequence of characters which is used by one or more systems to represent a person (a patient) and reference individual information within his care process and which is unique within a Patient Identifier Domain and linked to the traits of the Patient Note 1 to entry: The identifier is called Subject
36、 of Care identifier in ISO/TS 22220. EXAMPLE They are many types of identifiers: Person identifier, Patient identifier, Unit record Number. 3.7 linked identities case in which, for a given patient, several identities (duplicates: see above) were created, which can lead to a clash between them Note 1
37、 to entry: The identification system will have the capability of keeping track of these duplicate identities. After correction, the duplicate identities are linked and one of the identity becomes the primary and the others become “ghost” identities. When new healthcare information is recorded, they
38、will be attached to the Patient Identity Source. PD CEN/TR 15872:2014CEN/TR 15872:2014 (E) 7 EXAMPLE Ms Alice Berthon got married between two stays in hospital. She prefers now to use the name of her husband Mr. Martin. It is possible that within EHRs, she has two records: one with one identifier an
39、d the name of Berthon and a second record with another identifier and the name of Martin. This is a duplication and these need to be kept track of and solved. After correction, the duplicate identities are linked and one of the identities (Miss Berthon) becomes the primary and the others becomes “gh
40、ost” identities. 3.8 Patient Identifier Domain domain in which, in the ideal world, the patient has one and only one Patient identifier and a common identification scheme which is used between systems for sharing healthcare information within the domain, and in which the identifier is assigned by th
41、e assigned authority EXAMPLE 1 Hospital St Vincent is a Patient Identifier Domain. The patient of the Hospital St Vincent is identified at the entrance with one and only identifier. All systems in hospital share the same patient identity delivered by one system: the Patient Identity Source. EXAMPLE
42、2 The Insurance which delivers an Insurance card with identifier is an Insurance Identifier Domain. The country which delivers a citizen card is a citizen Identifier Domain. SOURCE: IHE-PIX 3.9 Patient Identifier Cross-reference Domain domain which consists of a set of Patient Identifier Domains, kn
43、own and managed by a Patient Identifier Cross-reference Manager Actor who is responsible for creating, maintaining and providing lists of identifiers that are aliases of one another across different Patient Identifier Domains Note 1 to entry: The Patient Identifier Cross-reference Domain embodies th
44、e following assumptions about agreement within the group of individual Identifier Domains: they have agreed to a set of policies that describe how patient identities will be cross-referenced across participating domains; they have agreed to a set of processes for administering these policies; they h
45、ave agreed to an administration authority for managing these processes and policies. Two models of implementation of a Patient Identifier cross-reference domain can be managed: Federation Patient Identifier cross-reference domain, where one member of the identities in the Cross Referencing Informati
46、on System is always the federative identity (the Master), Correlation Patient Identifier cross-reference domain, where the Cross Reference manager actor manages a list of identities defined in the cross referenced identification domains where all patient identities are in the same level. EXAMPLE 1 I
47、n England and in the Netherlands, at the country/regional level, the NHS number or the BSN are the federative identifier. When two healthcare providers want to share medical information for a patient, they refer to the NHS number in UK or BSN in the Netherlands. EXAMPLE 2 In a country where the nati
48、onal identifier does not exist, a patient who has several medical records split in several healthcare provider systems, the mechanism to link all the records is based on a correlation model where the list of all patient identifiers linked to the patient identifier domains is available. 3.10 Patient
49、Identity representation of a real person within a Patient Identifier domain (called also Patient identifier Assigning Authority), which, by extension, could also represent a fictional person for some purposes (testing or training) Note 1 to entry: The patient identity is composed of: PD CEN/TR 15872:2014CEN/TR 15872:2014 (E) 8 an identifier, ID; a set of traits, T. EXAMPLE The person named M. Jean Martin is represented in the hospital St Vincent in Paris by the record (sample): “23654, Martin, M., Jean, Male,19500125”. 3.11 Patient I
