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, guidelines, 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 appropriate 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 patient 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 result, 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 framework 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-technical 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 patient’s healthcare record 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 identified 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 domain”.

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 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.

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PDF Pages	PDF Title
6	Foreword
7	1 Scope 2 Normative references
8	3 Terms and definitions
10	4 Patient identity management 4.1 General 4.2 Concepts 4.2.1 Patient Identity
11	Figure 1 — Definition of the qualified identity 4.2.2 Patient identifier domain Figure 2 — Representation of the Patient Identity Source
12	4.2.3 Examples of patient identifier domain Figure 3 — Identifier domains linked to one person 4.3 Identity management process 4.3.1 General 4.3.2 Care provision use case
13	Figure 4 — Care process in hospital
14	4.3.3 The identity management process
15	Figure 5 — Patient identity management process 4.3.4 Patient Identifier Domain Policy
16	4.3.5 Basic process actions 4.3.5.1 General 4.3.5.2 Search on the object identifier Figure 6 — Search of Patient identity process based on Identifier
17	4.3.5.3 Search on the traits Figure 7 — Search of patient identity process by traits 4.3.6 Identity utilization or referencing action 4.3.7 Identity maintenance action
18	Figure 8 — Maintenance process Figure 9 — Life cycle of the status of the patient identity
19	4.3.8 Methods of deleting patient identity 4.4 Identification anomalies 4.4.1 General 4.4.2 Homonymy 4.4.3 Duplicates 4.4.4 Collision
20	4.5 Exceptions 4.5.1 General 4.5.2 Non-identified patient 4.5.3 Patient with uncertain traits 4.5.4 New-born 4.5.5 Identification under anonymity
21	4.5.6 Intentional use of multiple identities
22	5 Cross-reference patient identity management 5.1 General 5.2 Concepts 5.2.1 Cross-referencing identifier domain 5.2.1.1 General 5.2.1.2 Federation model 5.2.1.3 Correlation model
23	Figure 10 — Architecture model 5.2.2 Sharing medical information between healthcare providers
24	5.3 Identity cross-reference management process 5.3.1 General Figure 11 — Cross referencing patient identity management process
25	5.3.2 Cross reference Patient identifier Domain policy 5.3.3 Identities matching action
26	5.3.4 Identities Query action 5.3.5 Maintenance action 5.3.5.1 General 5.3.5.2 Notification of updates and events
27	5.3.5.3 Update the link between two or more identities 5.3.5.4 Logical removal of the link between identities 5.3.5.5 Checking the cross reference manager actor 6 Recommendations 6.1 General
28	6.2 Use Case 1: Within a healthcare organization 6.2.1 Healthcare providers — Organizational requirements 6.2.2 Software suppliers
29	Figure 12 — Distribution of patient identity source in the hospital systems 6.2.3 Insurance providers
30	6.3 Use Case 2: Healthcare coordination 6.3.1 General 6.3.2 Between healthcare providers
31	Figure 13 — Some examples of architecture within cross referencing domain
32	6.3.3 Software suppliers 6.4 Use case 3: Cross-border, the Europe case 6.4.1 General
33	6.4.2 Organizational requirements 6.4.3 Information system
34	Figure 14 — Sequence diagram for a request to identity between country
35	Annex A (informative) Policy charter of the patient identifier domain A.1 Policy Charter of the Patient Identifier Domain
38	Annex B (informative) Norms, standards and other references B.1 General B.2 ISO/TS 22220:2011, Identification of subject of Healthcare B.3 IHE and profiles supporting Patient identification B.3.1 General
39	B.3.2 IHE-PAM-Patient administration management B.3.3 IHE-PDQ-Patient Demographic Query
40	B.3.4 IHE-PIX-Patient Identification Cross Referencing B.4 Netc@ard for eHIC: Electronification of Healthcare Insurance Card
41	Figure B.1 — Architecture of Exchange of Insurance information between countries
42	B.5 FIDIS Future of Identity in the Information Society
43	Bibliography

Status	Definitive
Pages	46
Publication Date	2014-06-30
ISBN	978 0 580 64182 4
Standard Number	PD CEN/TR 15872:2014
Title	Health informatics. Guidance on patient identification and cross-referencing of identities
Identical National Standard Of	CEN/TR 15872:2014
Descriptors	Machine-readable materials, Personal health, Quality control, Magnetic stripes, Performance, Magnetic storage, Medical technology, Health services, Identity cards, Data processing, Integrated circuit cards, Data transfer, Physical properties of materials, Electronic data interchange, Information exchange, Data representation, Patients
Publisher	BSI
Committee	IST/35
ICS Codes	35.240.80 - IT applications in health care technology


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