Improving identity assurance and patient match quality through interoperable Digital Identity and Patient Matching capabilities (PSS in Confluence)

Description

Patient Identity Management in Healthcare today relies primarily on Patient Matching approaches with the relatively newer trend of Digital Identity Management picking up momentum, especially in the last year. While these two approaches have been largely considered distinct and separate, there is an opportunity to develop guidance on how implementers and organizations can leverage their Patient Matching and Digital Identity capabilities together to improve match quality and overall identity assurance in FHIR transactions.

The Operation-patient-match - FHIR v4.0.1 (https://www.hl7.org/fhir/operation-patient-match.html) today is primarily focused on Patient matching within an organization frequently using a Master Patient Index approach. This project will develop artifacts to profile the Patient match operation for use across organizations, incorporating elements of identity verification and the use of digital identities in workflows and information exchange. These workflows include exchanges between patients and organizations, with or without the use of an intermediary.

The information exchanged and resultant matching must meet the following requirements:

- Consistent with regulatory requirements for Patient Access and other permitted purposes, etc.

- May occur as part of a synchronous workflow

- Meets practical business needs of providers/payers/vendors that require patient identity confidence in their workflows

Existing SMART authentication workflows with OpenID Connect enable some information about the fhirUser to be conveyed, but there are gaps which limit a responder's ability to perform a high quality match. Additionally, registration and check-in practices achieve some level of identity assurance today, but this could be better characterized, variability harmonized, and stronger assurance could be indicated when appropriate.

This project is intended to develop artifacts (FHIR implementation guides, guidance documentation, reference implementations, etc.) to inform and or/execute a cross organizational or internal patient match via FHIR when requested for a permitted purpose or authorized by the Patient directly or by the Patient’s delegate. This will include identity verification guidance, best practice matching recommendations, and match workflow examples, to enable those who are requesting a match in health records to securely share or make discoverable attributes such as verified address(es), email address, mobile number, date of birth, facial photo, and possibly other attributes and identifiers. The IG may incorporate elements from other industry best practices, as this group will seek to harmonize identity and matching efforts already under way elsewhere in the industry and in the broader global community.

Representative Use Case: A patient holds physical and/or electronic pieces of identity evidence, which can be used to verify their unique identity and generate a corresponding digital identity. Applications could also bind authenticators to such identities and leverage best practice methods for authentication and proof of possession. These digital identities could be used as alternatives to the physical identity evidence and deployed in increasingly digital workflows. This IG would provide a reference for practices that can be used across organizational boundaries to communicate about these digital identities and associated attributes, enabling their best use and increasing confidence in cross organizational matching while preserving patient privacy and data security.

The effort will focus on the US Realm, intending to be compatible with NIST 800-63-3.

Misc Notes
2025 December: TSC approved an STU Publication Request for HL7 FHIR Implementation Guide: Identity Matching, Edition 2 - US Realm for 2 years 2023 May: TSC approved STU Publication Request for HL7 FHIR Implementation Guide: Identity Matching, Release 1 - US Realm for 2 years 2022 February: LSaele: For 1717 we need to update from STU ballot at forward. We will ballot this in May 2022 for STU1. Other Stakeholders: Public Health Organizations, Trust networks/HIEs, Consumer and Privacy Advocates, state agencies, federal agencies Other Vendors: Medical Device (including wearables) Other Providers: Care Delivery, Care Management and Care Coordination Organizations, Social Services, Community Health Services