Horst Herb wrote:
> Each EMR needs a unique person identifier code, I think nobody will object that. To
>allow exchange of EMRs (portability), these UPICs have to be not only unique but also
>allocated always by the same algorithm. It is obvious, that the chances for
>duplicates will still be high if you don't use a clearinghouse for those UPICs when
>the population is large enough.
The GEHR way of doing this (just for interest) is for OpenEHR Foundation (non-profit
EHR foundation) to register EHR "sources" i.e. computer systems allowed to create GEHR
EHRs. Registering gives the health care facility (HCF) the ability to have one or more
sources, all uniquely identified in a global EHR-source namespace.
Transfer of TRANSACTIONs is allowed in GEHR, where TRANSACTION is part of an EHR.
TRANSACTIONs are identified in the HCF by the triplet:
{EHR-source, hcp, dt_committed}
hcp = health care professional id.
This identifier will be guaranteed to be unique anywhere, assuming that health care
systems do not create transactions where the logged in user is masquerading as a human
being other than the actual user, or it is a batch system using a real human user's
name. Neither of these cases should ever be true (and will be prevented by the GEHR
kernel), so this id seems pretty safe.
When transactions are transferred, the patient id transaction is always transferred,
containing the patient id(s) as well as some demographic information, to enable the
recipient to match the patient. We assume that in some cases there may be different
matching algorithms in use at different places, and simply aim to make GEHR records
contain the primary information used by such algorithms, or human operators.
> Ergo, we need a (P)UPIC, a persistent unique personal identification code. Maybe we
>have to accept something less than perfect, something like a PPUPIC, a persistent
>pseudo-unique p.i.c. This would be a code "as unique as possible" (= duplicates
>unlikely but possible) that can be constructed out of information any patient in any
>country would know. What information should we use? Should be information most of the
>patients would know and at the same time would be discriminant enough to help
>building up the "uniqueness".
>
> * sex: (at date of birth, changes disregarded)
> * date of birth: in some coutries still a problem, but a good candidate
> * country of birth: name of the country at time of birth
> * city of birth: again, some may not know, but a good discriminator
> * name initials: name given at birth, later changes disregarded
> * initials of parents first names: if known
GEHR currently has
- sex
- date of birth
- place of birth (as on passport or birth certificate)
- name (using name "models", e.g. to differentiate between names from various ethic
backgrounds)
- set of unique identifiers, keyed by issuing agency, including the originating HCF
- contact details, a keyed list of "addresses" by purpose ("home", "business weekdays"
etc); where "address" here means anything from phone number to email address.
We expect that in many cases the name+dob+pob and the PIDs will be used successfully;
in some small percentage of cases a human operator will probably do the matching. In a
GP situation this probably won't be a problem. IN a large hospital it might be (which
is when you start to need algorithmic matching).
By the way, the CORBAmed PIDS standard should be considered in this area.
- thomas beale
--
..............................................................
Deep Thought Informatics Pty Ltd
Information and Knowledge Systems Engineering
phone: +61 7 5439 9405
mailto:[EMAIL PROTECTED]
http://www.gehr.org
http://www.elj.com/eiffel/ebs
..............................................................
