Data used to categorize individuals for identification, records matching, and other purposes.
USCDI V1
USCDI V2
USCDI V3
USCDI V4
Level 2
Level 1
Level 0
Data Element
Medical Record Number
Description
The unique identifier assigned by the provider to reference a single patient
Submitted By: Mark Roberts / Leavitt Partners
Data Element Information
Use Case Description(s)
Use Case Description
Administrative and financial transactions are a critical part of health care provisioning and management. There is a need for health care consumers to get access this health data to be able to make better care decisions and manage their health care journey. Making Member data available to consumers will enable them to have greater visibility into the costs associated with their health care, identify potential errors, and enable them to plan for their future health care needs taking financial costs into account. Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR 164.524) and requests their digital health information (adjudicated claims and encounter data) from a HIPAA covered entity (CE) – health insurance company or payers via an application or other third-party data steward.
Estimate the breadth of applicability of the use case(s) for this data element
All health care insurers (>1,800), third-party application developers, and all consumers of the health care system (>320M)
5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts
While it is not known how many consumers have requested this data electronically, this information is communicated broadly today through other forms. This data is now being required to be communicated electronically through the CMS Patient Access API for which the regulation has suggested that industry consider using the CARIN for Blue Button Implementation Guide for the Patient Access API, we expect this data will be exchanged broadly throughout the health care sector. https://www.cms.gov/about-cms/health-informatics-and-interoperability-group/faqs
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)
Some codes, but not all, are linked to proprietary code standards that may require a license.
Restrictions on Use (e.g. licensing, user fees)
Licensed Industry Standard Code Systems
This IG includes value set bindings to code systems that reference industry standard codes which require implementers to purchase a license before the coded concepts can be used. The following information summarizes the set of licensed Code Systems required by this IG and provides links to the information about where to go to obtain a license:
•AMA CPT: The CPT procedure and modifier codes are owned by the American Medical Association. •X12: CARC (Claim Adjustment Reason Codes are owned by X12.. •NUBC: The NUBC secretariat is the American Hospital Association.. •NUCC: National Uniform Claim Committee (NUCC) is presently maintaining the Taxonomy code set. The codes are free and publically available for download and use. If the use however is “For commercial use, including sales or licensing, a license must be obtained”. It would be appropriate for an app developer to file the license form just like they would for any other code set; however, there is no fee. •NCPDP: Retail Pharmacy data standards are defined by the NCPDP . •3M APR-DRG: AP-DRGs and APR-DRGs are owned by 3M. Use of AP-DRGs and APR-DRGs require a license.
Code Systems Not Requiring Licenses
This IG includes value set bindings to code systems that are industry standard codes available for use without licenses. The following information summarizes the set of Code Systems required by this IG that are available for use:
•ICD-CM Diagnosis Codes (ICD-10-CM): International Statistical Classification of Diseases and Related Health Problems (ICD). This IG will use version 10. The ICD-10-CM code set is maintained by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) for use in the United States. It is based on ICD-10, which was developed by the World Health Organization (WHO) and is used internationally a medical classification. •ICD-Procedure Codes (ICD-PCS): The ICD-10-PCS code set is owned by CMS.. •DRGs.:MS-DRGs are owned by CMS. MS-DRGs are used for the Medicare population. •HCPCS Level II Procedure and Modifier Codes: Primarily include non-physician products, supplies, and procedures not included in CPT. They are owned by CMS and are available for use. •NDC (National Drug Codes): The US Federal Drug Administration (FDA) Data Standards Council assigns the first 5 digits of the 11 digit code.. •RARCCodes: The RARC codes are owned by CMS.
Privacy and Security Concerns
This data, like any patient data should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data.
Estimate of Overall Burden
The data elements in this class are already held by health care payers, anticipated burden of collection of data would be negligible. The CMS rule and Patient Access API already require CMS covered payers to share this data electronically. Many payers covered by the CMS rule have or are already considering making this data available in the same fashion for other lines of business.
ONC Evaluation Details Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1 Maturity - Current Standards
Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2 Maturity - Current Use
Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3 Maturity - Current Exchange
Level 0 - Data element is electronically exchanged in limited environments, such as connectathons or pilots.
Criterion #4 Use Case(s) - Breadth of Applicability
Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment
This data element is a specialize use of an existing Level 2 data element Identifier in the Patient Demographics/Information data class https://www.healthit.gov/isa/taxonomy/term/2711/level-2.
Comment
Submitted bynedragarrett_CDC on 2023-10-02
CDC's comment on behalf of NACCHO for USCDI v5
Support - LHDs will also be able to use this to attribute encounter level information to a person-level, which is what is used for prevention analysis and program creation. Having this element and the "identifier" element is going to be confusing for LHDs who will receive this data. There needs to be clarification made between the two and what their use cases are. Right now, they are not very clear in their submissions.
Submitted bynedragarrett_CDC on 2023-09-15
CDC's Consolidated Comment for USCDI v5
Including the "Medical Record Number" as a standardized data element in the v5 USCDI is a critical step toward ensuring precise and reliable patient identification within the healthcare system. Serving as a unique identifier, the Medical Record Number is a cornerstone for patient-centric care. It enables healthcare providers to accurately match patients with their health information across various points of care. This becomes increasingly significant in a complex and interconnected healthcare landscape, where patients often engage with multiple providers across different facilities and systems. By utilizing a standardized Medical Record Number as a common thread linking a patient's encounters and health data, healthcare providers are better positioned to access consolidated and comprehensive medical records. This, in turn, supports informed clinical decision-making based on a complete view of the patient's history, current conditions, and previous treatments. Moreover, the use of the Medical Record Number as a standardized identifier is instrumental in reducing errors related to patient identification—a critical factor in patient safety. Misidentification errors can lead to severe consequences, including incorrect diagnoses, inappropriate treatments, and unnecessary procedures, all of which are avoidable with precise identification methods. The implementation of the "Medical Record Number" in the USCDI v5 would mark a significant advancement towards a more integrated, efficient, and safe healthcare system. We strongly advocate for the inclusion of the "Medical Record Number" data element in the USCDI v5 due to its potential to fundamentally enhance patient identification processes, significantly reduce the occurrence of identification errors, and ensure that healthcare providers have immediate and reliable access to complete and consolidated patient medical records.
CSTE Comment:CSTE strongly agrees with CDC's recommendation for this data element.
CSTE agrees with CDC's recommendation for this data element.
Submitted bynedragarrett_CDC on 2022-09-27
CDC's Consolidated Comment for USCDI v4
CDC continues to recommend inclusion of this high priority data element in USCDI v4
Submitted bynedragarrett_CDC on 2022-04-28
CDC's comment on behalf of CSTE
Medical record number (Level 2); CSTE strongly recommends that medical record number be moved into USCDI v3. This element is critical to include in eCR and ELR and is used heavily for person matching and deduplication as well as when requesting additional clinical information on a case of reportable disease.
NOTE - This comment supports the promotion of the Data Class Patient Demographics - Data Element Identifier to USCDI V3 as well as the additional Data Element of Identifier System, including the allowance of multiple instances of Identifier/ Identifier System per patient. We believe that this will allow needed flexibility to accommodate use and exchange of the variety of patient identifiers in current use in the US. An example of this approaches is: Identifier: 3A456B789, Identifier System: http://AcmeHealth//fhir/id/MRN. If ONC does not choose to incorporate this approach (Identifier + Identifier) in USCDI V3, we recommend allowing for the following Patient Demographic Data Class Data Elements in USCDI V3: Medicare Patient Identifier, Medical Record Number and Social Security Number. In the event that Social Security Number is not included in USCDI V3 as a supported Patient Demographic Identifier, the use of Medical Record Number will be critical to accurately identify patients to provide appropriate patient care and complete public health surveillance.
General Comment: Medical Record Number is a ubiquitous patient identifier in most healthcare organizations in the US and in the EHR and HIT systems that support those organizations. This data element is requested by and exchanged with ancillary systems within an organization, business partners outside of the organization, public health, research projects and other use cases as a primary or secondary means to positively identify patients.
Submitted bymaria.michaels… on 2021-04-06
Specific Identifier(s) or general Identifier?
MedMorph supports the addition of Medical Record Number, but is concerned with having a general Identifier element (level 2) as well as Medicare Patient Identifier (level 2), and Patient Social Security Number (level 1). What is the intention of Identifier - is it a placeholder for a national identifier of some sort for a patient? We recommend that USCDI either take a general approach with Identifier Type, Identifier System, and Identifier Value OR be specific with Medical Record Number, Medicare Patient Identifier and Social Security Number elements (and remove the Identifier element).
Submitted bynedragarrett_CDC on 2020-12-10
Recommendations for Updated Submission
We've reviewed and submitted comments in regards to the submission for Patient Medical Record Number and stand to see that we have slightly differing data element submissions, though this was the previous submission marked as it's duplicate. We recommend re-visiting our submission and comparing it to the above submission seen here.
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As a seasoned expert in health informatics and data interoperability, I've delved into various facets of healthcare data standards, particularly those related to patient identification and record matching. My experience extends to the evaluation of data elements, use cases, and technical specifications within the realm of health information exchange.
In the provided article, the focus revolves around the data element "Medical Record Number" and its significance in categorizing individuals for identification, records matching, and other healthcare purposes. The terminology used, such as USCDI V1, USCDI V2, USCDI V3, USCDI V4, Level 2, Level 1, and Level 0, denotes different versions and levels of the U.S. Core Data for Interoperability (USCDI) standards, reflecting the evolution and maturity of data exchange standards in the healthcare domain.
Let's break down the key concepts mentioned in the article:
USCDI Versions (V1, V2, V3, V4):
These represent different iterations of the U.S. Core Data for Interoperability standards, showcasing the evolution and updates in healthcare data standards.
Level 2, Level 1, Level 0:
These levels likely refer to the maturity or implementation levels of specific data elements within the USCDI framework. Level 2 suggests a higher maturity or adoption compared to Level 0.
Data Element - Medical Record Number:
This is a unique identifier assigned by healthcare providers to reference a single patient. It plays a crucial role in patient identification and record matching across different healthcare systems.
Use Case Description:
The use case described involves administrative and financial transactions in healthcare. It emphasizes the importance of making health data available to consumers for better decision-making, cost management, and planning for future healthcare needs.
Applicable Standards and Specifications:
The article mentions various standards such as NUBC, CPT, HCPCS, HIPPS, ICD-9, ICD-10, DRGs, NDC, POS, NCPDP codes, and X12 codes. Additionally, it refers to the HL7® FHIR® US Core Implementation Guide v3.1.1 based on FHIR R4 as a technical specification.
Current Use and Supporting Artifacts:
The data element is extensively used in production environments, aligning with the CMS Patient Access and Interoperability Rules effective from July 1, 2021.
Extent of Exchange:
The data element has been tested at scale between multiple production environments, indicating broad adoption and use in the healthcare sector.
Potential Challenges:
Challenges include restrictions on standardization, with some codes linked to proprietary standards requiring licenses for use.
Privacy and Security Concerns:
Emphasizes the need for secure exchange of patient data, with existing processes governed by CMS and ONC.
ONC Evaluation Details:
The ONC evaluates the data element based on criteria such as maturity, current use, current exchange, and breadth of applicability. The Medical Record Number is classified as Level 2 for Maturity - Current Standards.
Comments and Recommendations:
Comments from the CDC highlight the importance of the Medical Record Number as a standardized data element for patient identification, supporting precise and reliable patient matching across healthcare systems.
In conclusion, the article provides a comprehensive overview of the Medical Record Number data element, its use cases, standards, challenges, and evaluations within the broader context of healthcare data interoperability.
It is a common practice that medical record numbers contain six digits. The six digits are then further subdivided into three parts by the use of a hyphen, thus making it easier to read. For example, rather than reading 123451; you would read 12-34-51.
A medical record number (MRN) is a unique identifier assigned to a patient in an electronic health record (EHR), practice management, or healthcare IT system. The MRN is used to keep track of medical history, diagnoses, treatments, and other important information related to patient care.
The MRN enables medical records/history to be tracked for all periods of enrollment. Note: The MRN should be used as the "Member ID" when submitting bills or encounter data.
In general, every hospital system assigns its own unique identifier (known as a medical record number) to each patient whose medical record it maintains.
The MRN can be assigned in many ways, but in most cases, it's generated by the Healthcare Information Technology (HIT) system. Once assigned, the MRN will not change and remains unique to that patient, much like a social security number.
PHI is health information in any form, including physical records, electronic records, or spoken information. Therefore, PHI includes health records, health histories, lab test results, and medical bills. Essentially, all health information is considered PHI when it includes individual identifiers.
A unique patient identifier (UPI) is a method for standardizing patient identification. Individuals are assigned a unique code, and that code, rather than a Social Security Number, name, or address, is what is used by healthcare organizations to identify and manage patient information.
KP Southern California medical record numbers (MRN) are 12 digits in length; they include a 2 digit prefix with a 10 digit MRN. Enter all 12 digits, including leading zeros. For example, enter 000123456789. KP Colorado medical record numbers (MRN) are 9 digits in length and may contain spaces.
The MRN number usually consists of 18 characters. The first two characters represent the country code of the Member State in which the application was filed. The following 16 characters are a unique combination of numbers and letters that identify the respective customs declaration.
Patients do not have a universal MRN as they are provided separately by different healthcare systems. An MRN will not change throughout all of the care received within a health system - unlike an account (called a HAR in Epic) or visit number (called a CSN in Epic).
A Medical Representative (MR) is an individual who works for a pharmaceutical company and is responsible for promoting and selling prescription drugs to healthcare professionals, such as doctors, nurses, and pharmacists.
The difference between a medical number and an account number is that a medical number always stays the same. It is a personal permanent number given to the patient. An account number is assigned to a patient every time they come to the hospital, it does not stay the same.
Protected health information (PHI) is any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.
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