Medical Records Identifier
Contents
Purpose
Any person can go into any willing medical provider's office and be identified and get care appropriate to their medial history.
Goals
- There are many cases where a patient presents themselves to a medical provider seeking care. The goal is that they will have some single identifier that they can use to recover their medical history.
- Clearly there will be lots of locations were medical records are retained. That will not change soon. This goal is that a single identifier can mediate access to all EHI.
- There is no assumption that a patient will have only one Medical Records Identifier that can access all of the medical data, or that it remain constant throughout their life. It is assumed that there will be a least one for each patient that will be able to link to all of the medical data. At the start of the program this will not be true, but it should be true for all new data created as well as existing data at their current primary physician's office.
- Clearly there will be some sort of sort of Bootstrapping Identity and Consent that gets patient registered for this service, this paper will consider 3:
- The user has a Medicare number of the form US:CMS:32fs-233ii-9r38 that is already well-known to the medical community.
- The user comes with some Identifier that is not previously know to the provider, perhaps self-issued for cases where they chose to take control of their own medical records recovery.
- The user comes with no usable Identifier. For this use case we consider the case of a homeless child under the age of 13 being registered for school.
Problems
- The big problem with any sort of Self-issued Identifier is Trust where there are no standards or examples of any trust without a history of trusted behavior.
Solutions
Universal Resolver
The US medical community accepts the idea that any registered health care provider can query a Universal Resolver and get a response with data appropriate to their need and authority within 2 minutes for emergency care and within 2 hours for more detailed records.
1 Well-known Patients
The Medicare system is well known to all medical care providers. We have assigned it a prefix of US:CMS for the purposes of this example US:CMS:32fs-233ii-9r38. The states will have a similar system for Medicaid. It will need a similar prefix, for example giving an Identifier of US:WA:MED:2348796529879796. The same would apply to other government programs, for example the VA might have an Identifier of US:DOD:02937495077723. An assumption was made here that the active duty warfighter would get some Identifier that would continue into retirement. It is not a requirement that the provider accept government medical payments, but it is required that they participate in the Universal Resolver for medical information and accept any Medical Records Identifier, including providing any information that they generate themselves.
2 Patients with unfamiliar Identifiers
The Universal Resolver must be extensible so that new entrants to the medical records business have a process by which they can be included in the medical records system. One of the requirements will include the ability and authority to reach out to other medical record centers. It is to be expected that some of these providers will be operating under the authority and control of the patient. For example the following is a Decentralized Identifier that could easily show up in a request for medical records did:sov:WRfXPg8dantKVubE3HX8pw.
3 Dependent patients with no Identifier
All medical practitioners must be capable of reaching out to the medical records for the recovery and addition of data which they are qualified to access. An interesting use case is the public health nurse in a school that is on-boarding homeless children under the age of 13. They must acquire consent and hopefully anecdotal health information from a guardian during the on-boarding process. Under the assumption that the student does not come with a Medical Records Identifier, the nurse will need to provide one that may be the only one the student has until majority. The working assumption is that all such ad-hoc Medical Records Identifiers will be accompanied with some biometric information, such as a face picture.
4 Vulnerable Patients
Any patient with serious health considerations that need to be known to any health care provider prior to initiating medical procedures may acquire a medical bracelet with a Medical Records Identifier that can give emergency responders needed information within 2 minutes.
References
