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Health Information Technology Standards

Identifiers Standards

Organizations that Develop Identifiers Standards | Tutorials

Identifiers Standards provide a universal method to identify entities such as an individual (consumer), a healthcare provider, a healthcare organization, a payer, or others (clearinghouses, vendors, products, etc).

Identifiers (IDs) are the lexical tokens that name entities. The concept is analogous to that of a "name". Identifiers are used extensively in virtually all information processing systems. Naming entities makes it possible to refer to them, which is essential for any kind of symbolic processing.

A number of national and international standard identifiers have been adopted in healthcare.

In the United States, a National Standard Identifier for Individual and Organization Health Care Providers (National Provider Identifier, NPI) and a National Employer Identification Number (EIN) have been adopted for use in all electronic administrative and financial transactions, i.e., claims, claim payments, eligibility, etc. Proposed regulations adopting a national standard identifier for Health Plans have been released. No national patient identifier standard exists, although many organizations have implemented internal Master Patient Index (MPI) applications.

Identifiers for other important aspects of health care are also in place, such as ingredient identifiers for drugs and biologics and identifiers for medical devices and durable medical equipment.

Identifier Standards
Examples of Standards Development Organizations & Standard Setting Entities Domains
CMS National Provider Identifier (NPI)
CMS Health Plan Identifier (HPID)
FDA/USP Unique Ingredient Identifier (UNII) (drugs, biologics, food, devices)
IRS Employer Identification Number (EIN)
ISO County Identifier, Pharmacy Products Identifier, Health Card Issuer Identifier, Provider Identification
PHII Patient Identifier: Master Patient Index (MPI)

CMS - US Centers for Medicare and Medicaid Services - National Provider Identifier (NPI)

A National Standard Identifier for Individual and Organization Health Care Providers (National Provider Identifier, NPI) is a unique identification number for covered health care providers under the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rule.  The US Centers for Medicare and Medicaid Services (CMS) maintain the NPI registration. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in all electronic administrative and financial transactions adopted under HIPAA (i.e., claims, claim payments, eligibility, etc.). The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards electronic transactions.

CMS - US Centers for Medicare and Medicaid Services - Health Plan Identifier (HPID)

HPID is a unique identification number for health plans under the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rule. The US Centers for Medicare and Medicaid Services (CMS) released a proposed rule that requires all health plans to use HPIDs in all electronic administrative and financial transactions adopted under HIPAA (i.e., claims, claim payments, eligibility, etc.).

FDA/USP Substance Registration System - Unique Ingredient Identifier (UNII)

The overall purpose of the joint U.S. Food and Drug Administration (FDA) / United States Pharmacopeial (USP) Substance Registration System (SRS) is to support health information technology initiatives by generating unique ingredient identifiers (UNIIs) for substances in drugs, biologics, foods, and devices. The UNII is a non- proprietary, free, unique, unambiguous, non-semantic, alphanumeric identifier based on a substance’s molecular structure and/or descriptive information.

IRS - Internal Revenue Service - Employer Identification Number (EIN)

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires that employers have standard national numbers that identify them on standard transactions. The Employer Identification Number (EIN), issued by the Internal Revenue Service (IRS), was selected as the identifier for employers and was adopted effective July 30, 2002.

ISO - International Organization for Standardization

ISO is a network of national standards institutes from 140 countries working in partnership with international organizations, governments, industry, business, and consumer representatives.

ISO 215 Technical Committee on Health Informatics (ISO/TC 215) works on the standardization of health information and communications technology to allow for compatibility and interoperability between independent systems through the following Working Groups: WG 1: Data Structure, WG 2: Messaging and Communications, WG 3: Health Concept Representation, WG 4: Security, WG 5: Health Cards, WG 6: Pharmacy and Medication, WG 7: Devices, WG 8: Business Requirements for Electronic Health Records. The ISO/TC 215 developed standards for Identification of Medicinal Products (pharmaceutical product identifiers (PhPIDs)); country Identifier standards; health cards -- numbering system and registration procedure for issuer identifiers; and provider Identification.

ISO/TC 215 Standards List

PHII - Public Health Informatics Institute - Master Patient Index (MPI)

Master Patient Index (MPI) is an index referencing all patients relating to an area or organization and acting as a source of patient /service user demographic data for other linked services and systems. The terms Patient Master Index (PMI) and Master Person Index are used interchangeably.

PHII, a PHDSC Member, developed The Unique Records Portfolio to help public health practitioners and private providers tackle the challenges of “de-duplication,” that is, the systematic matching and merging of records in an information system to create an accurate, unique health record for each individual. The Portfolio provides a high-level overview, from resource and policy perspectives, on the implications of integrated systems and strategies for record matching, linking, and merging.