Health care delivery reorganization innovative outcome: universal computerized patient identification

Twenty-three large employers in the Minneapolis/St. Paul area formed the business health care action coalition group (BHCAC) to obtain medical care for their employees and families. Requirements of BHCAC included: 1) detailed reporting of outcomes of both preventive and standard health care, 2) development and successful implementation of practice guidelines, and 3) development of a functioning automated medical record. The coalition was contracted to meet these requirements. A nonprofit foundation--the Institute for Clinical Systems Integration (ICSI)--was formed and the data standards committee created. To ensure registration information transmitted by network would be attached to the correct patient's computer file; a standardized registration data set was agreed upon to be recorded in a uniform manner. This innovative change has allowed, encouraged, and required that clinical data be transferable electronically among organizations. The following are the ICSI data standard requirements for ICSI member organizations: the Health Level 7 (HL7) is to be used for data transmission [1]. Fields to be used include: 1) Social Security Number (SSN): The SSN was chosen as the patient identifier for the reasons listed in [2]. Record the official SSN assigned by the Social Security Administration; record a pseudo-SSN if a social security number is not available following the Veterans Administration (VA) Hospital algorithm. 2) Name: Use the American National Standards Institute (ANSI) Healthcare Informatics Standards Planning Panel (HISPP) and Message Standards Developers Subcommittee (MSDS) Standard for representation of a person's name [3]; completely record all of the person's legal name (including any punctuation, hyphenated and double last names); nicknames and appellations are to be recorded separately; salutations and suffixes are optional, but must be placed in separate computer fields from other name parts. 3) Gender: Allowable values include FEMALE, MALE, OTHER, UNKNOWN. 4) Date of Birth: Include the day, month, year (including century); permitted is approximate or estimated birth dates provided they are indicated as such. Use the ANSI HISPP MSDS standard for date representation [4]. 5) Address: Record at least one address; multiple addresses desirable identified by type or usage (i.E., home, business, office). Allow two or more lines for street, city, U.S. state or Canadian Province; identify by standard two-letter postal abbreviation--zip code (at least 5-digits, preferably 9) or postal code and country. 6) Home ID or Medical Record Number (MRN): Record if different than Social Security Number.