VUHID System
The goal of the Global Patient Identifiers, Inc. (GPII) Voluntary Universal Healthcare Identification (VUHID) project is to make unique healthcare identifiers available to any patient who uses the services of a regional health information organization (RHIO) or health information exchange (HIE) to:
- enable error-free linkages of clinical information across provider sites;
- enhance patient control over the privacy their information;
- improve the quality of medical care and the efficiency of its delivery;
- reduce medical errors related to mis-identification of patients;
- decrease incidents of healthcare-related identity theft;
- and help control healthcare costs as a result of these impacts.
VUHID is based on two ASTM International E 31 standards (ASTM VUHID standard E2553 and ASTM VUHID standard E1714) to make globally-unique healthcare identifiers available to any person who wishes to have one. These identifiers can be used to establish patient identity to any physician participating in a RHIO or HIE using the VUHID network. The identifier can be used to link medical records across provider sites to ensure that physicians and other caregivers have a complete picture of each patient's medical history on which to base sound clinical decision-making.
VUHID supports two types of identifiers:
- An open voluntary identifier (OVID) which is given to each participant to link demographic records that may reside in several patient registration systems across the RHIO/HIE;
- And anonymous private voluntary identifiers (PVIDs) that can be used to tag sensitive medical information to control 1) which caregivers have access to that information and 2) who can identify the person associated with that clinically sensitive information.
The VUHID system works with enterprise master person index systems (EMPIs) in RHIOs/HIEs. This interaction supports accurate, secure patient identification, using open and private identifiers to provide qualitative and quantitative benefits to consumers and providers of healthcare services as well as other healthcare stakeholders.
Technical Description
The 32-character VUHID identifier is arranged to look like a large number. Figure 1 shows that each identifier consists of four subcomponents but in clinical use the identifier should always be treated as a single entity.
Figure 1: Structure of a typical VUHID identifier
There are up to 16 initial numeric digits that form what is called the prefix. A single period represents the delimiter between the prefix and the subsequent characters. Following the delimiter are eight check digits and then there are seven privacy class digits.
Open and Private Identifiers
In the case of an open VUHID identifier (OVID), the seven privacy class digits are all zeros. For a private VUHID identifier (PVID), at least one of the privacy class digits is non-zero. Notice that while computer processing of an identifier must always store the full 32 characters, in order to make the display of identifiers more compact, it is permitted to eliminate the display of any leading zeros in the identifier as well as any trailing zero privacy digits (but check digits must always be displayed even if they are zero.) As a result, VUHID identifiers may be displayed with varying lengths from 10 digits upwards but the actual stored identifier is always 32 digits.
By convention, an OVID is printed on a green background and a PVID is printed on a red background. But the real difference is that for an OVID the privacy class digits are all zero while for a PVID there is at least one non-zero privacy class digit.
Identifier Cards
As a patient, you will see your VUHID identifier printed on some sort of identification card. Figure 2 provides an example of what such a card might look like.
Figure 2: An example of an open voluntary identifier card. The VUHID identifier is the number appearing below the patient name
Notice several things about this card. A green background could be used to indicate that this is an open identifier, and that the patient has chosen to make the associated information available to any individual with security access to the EMPI and associated information systems. The bar code and/or a magnetic stripe on the back of the card contains a machine-readable form of the identifier to make it easier to process electronically. The identifier issued to each patient is unique and permanent. Because it is an open identifier that can be used for many purposes, each patient should need only one open voluntary identifier. If a VUHID identifier is lost, erroneously assigned to a patient who already has one or misused, it can be permanently cancelled.
Figure 3: An example of a private voluntary identifier (PVID) card. (Note that you do not write your name on a PVID card.)
Some aspects of medical information need to be kept private. In those instances, patients will be given private voluntary identifiers (PVIDs). PVIDs are very similar to OVIDs in that they are used to link various pieces of clinical information. However, with a PVID only authorized providers (e.g., psychiatrists for psychiatric information) can access that information and know the identity of the patient. In a PVID there are one or more non-zero privacy class digits after the decimal point. Also notice that the patient name does not appear on the card to avoid putting patient identity at risk if the card is lost. A PVID works by allowing healthcare organizations to use the identifier for medical information-processing functions without revealing the identity of the person involved. Because each PVID is associated with very specific clinical data, it is likely that a patient will require multiple PVIDs over time depending on their clinical condition and decisions regarding which parts of their electronic record they want kept private and what types of medical conditions they experience.