ClinicalIdentifier

A specialized identifier for clinical and healthcare contexts that extends Identifier with healthcare-specific system classifications. Supports national health IDs (INS, NPI, NHS Number), provider registries (RPPS, ADELI), institutional identifiers (MRN, IPP), and facility registries (FINESS).

Overview

ClinicalIdentifier provides healthcare-specific identification capabilities beyond the base Identifier. It adds the clinicalSystem field to specify which healthcare identification scheme issued the identifier, and an assigner to track the responsible organization. This enables accurate patient matching, provider verification, and secure health information exchange across systems and borders.

Key Concepts

Identifier Categories

Clinical identifiers serve different purposes:

National Patient Identifiers

France - INS (Identité Nationale de Santé)

• 13-digit national health identifier
• Issued by CNAM (health insurance)
• Used across all French healthcare systems

United Kingdom - NHS Number

• 10-digit identifier (formatted as XXX XXX XXXX)
• Assigned at birth or registration with NHS
• Essential for UK healthcare access

United States - No national patient ID

• Uses MRN (Medical Record Number) per institution
• Patient matching relies on demographics

Canada - Provincial IDs

• OHIP (Ontario Health Insurance Plan)
• Each province has its own system

Australia - IHI (Individual Healthcare Identifier)

• 16-digit national identifier
• Part of My Health Record system

Provider Identifiers

France

• RPPS - Répertoire Partagé des Professionnels de Santé (shared provider registry)
• ADELI - Legacy provider registration system

United States

• NPI - National Provider Identifier (10-digit, required for billing)

Institutional Identifiers

• MRN - Medical Record Number (facility-specific patient ID)
• IPP - Identifiant Permanent du Patient (permanent patient ID within institution)
• NDA - Numéro de Dossier Administratif (administrative file number)

Facility Identifiers

• FINESS - Fichier National des Établissements Sanitaires et Sociaux (French facility registry)

Assigner Organization

The assigner field tracks which organization issued the identifier:

• National agencies (CNAM, NHS England, CMS)
• Regional health authorities
• Individual healthcare facilities
• Insurance organizations

Use Cases

Patient Matching

When matching patients across systems:

1. Query by national identifier (INS, NHS Number) first
2. Fall back to institutional ID (MRN) within same facility
3. Use demographic matching when no shared identifier
4. Document source system and identifier type

Provider Verification

When verifying healthcare professionals:

1. Look up NPI (US) or RPPS (France) in national registry
2. Verify credentials and active status
3. Confirm specialty and practice location
4. Cache verification results with timestamp

Health Information Exchange

When exchanging clinical data:

1. Include patient's national identifier if available
2. Map institutional IDs between systems
3. Validate identifiers against authoritative sources
4. Handle identifier conflicts with matching algorithms

Insurance Claims

When submitting claims:

1. Include patient's insurance identifier
2. Use provider NPI for billing provider
3. Include facility FINESS/NPI as applicable
4. Validate format requirements by payer

Cross-Border Care

For EU patients under EHIC:

1. Use national identifier from home country
2. Map to local temporary identifier
3. Exchange data using EU standards
4. Track original and local identifiers

Related Entities

Enums

clinicalSystem