In 1995, ASTM published the "Standard Guide for Properties of Universal Healthcare Identifier (UHID)". It covers a set of requirements outlining the properties of UHID. It includes altogether thirty (30) characteristics required of a UHID candidate and a temporary identifier provision for emergency use. These characteristics are used here for the evaluation of the seven (7) Unique Patient Identifier options and the seven (7) alternatives. The ASTM characteristics are included in Appendix-A for ready reference.
Though the ASTM Standard Guide is the first effort to conceptualize a Unique Patient Identifier and define its characteristics, its purpose was limited. According to section 9.1, the purpose of the Guide is limited to the conceptual characterization of a UHID, without any involvement in implementation methodology, cost, or policy decisions. It does not include administrative and technology infrastructures requirements, the content of the identification data base (repository), or the structure of the repository. Therefore, the ability of a candidate identifier to meet ASTM characteristics indicates only an intention to meet them in concept.
In addition, the thirty (30) ASTM conceptual characteristics, such as assignable and accessible, address the identifier's format, content, etc. applicable to the point of issue of the identifier (i.e. by a Central Trusted Authority). Healthcare organizations that use the Unique Patient Identifier need to maintain an accurate and up-to-date data base of patient identification information as well. They must also verify the identity of individuals and their information, and control and facilitate the access to patient care information based on Unique Patient Identifier. Since, the ASTM Guide does not address these operational characteristics, in order to fully evaluate the Unique Patient Identifier options beyond a conceptual level, it is necessary to verify their compliance with both the ASTM Standard Guide and other functional and operational capabilities required in live day-to-day patient care environment. Therefore, this analysis includes evaluation of each option's compliance with the following criteria:
For the sake of convenience the ASTM characteristics are grouped by the six categories listed below:
a. Functional Characteristics
b. Linkage of Lifelong Health Record
c. Patient Confidentiality and Security
d. Compatibility with Standards and Technology
e. Design Characteristics
f. Reduction of Cost and Enhanced Health Status
In order to analyze the strengths and weaknesses of each option beyond the conceptual level, the following operational characteristics are used:
a. Currently operational vs a concept
b. Existing infrastructure vs infrastructure not in existence, not addressed not required, etc.
c. Readiness of the required technology
d. Timeliness
e. Adequacy of identification information to support identification functions
As described earlier, there are six (6) basic components that are integral parts of the Unique Patient Identifier. The identifier itself is one of the six components and the remaining five (5) provide the required functional capabilities, administrative and technology infrastructures, and security protection. The six (6) components are:
a. Identifier (numeric, alphanumeric, etc.) Scheme
b. Identification Information
c. Index
d. Mechanism to protect, mask or encrypt the identifier
e. Technology Infrastructure
f. Administrative Infrastructure.
The following are functional requirements at both conceptual and operational levels needed for a Unique Patient Identifier:
i. Identification of individuals
a. For delivery of care
b. For administrative functions
ii. Identification of information
a. Coordination of multi-disciplinary care processes
b. Organization of patient information and medical record keeping
c. Manual and automated linkage of lifelong health records
d. Aggregation of health information for analysis and research
iii.. Support the protection of privacy, confidentiality & security
a. Access Security
b. Judicious Design
c. Content-free Identifier
d. Mask/Hide/Encrypt/Protect/Disidentify
iv. Improve health status and help reduce cost through enhanced access to information and care.