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Tuesday, January 3, 2017

Can a fetus have an MRN?

There has been some interesting discussion on HL7 PHER list related to birth and death reporting for newborns.  During the discussion the issue has been raised a number of times of whether a fetus / stillborn baby could have a medical record number.

From a technology perspective, there is no reason why this could not occur.  Some EHR's do have a requirement that a valid date be entered for DOB of a patient (how they handle John/Jane Doe's who cannot be identified I don't know), but that challenge can be overcome by some simple procedural expedients.

It's really more of a workflow/policy question/social issue.  You can assign an identifier to anything. There's no reason NOT to assign one to a fetus if necessary, as far as the technology is concerned. The real issues are those of workflow and policy, and policy are certainly influenced by current social issues.  Issuance of a medical record number for some could be used as validation of the "lifely-hood" of a fetus, which raises a number of legal questions that deeply concern policy people.

Policy can be both a great enabler and a great destroyer of interoperability.  HIPAA is both a blessing and a curse in this space: many would argue that the administrative simplification brought about by establishing standardization of transactions and code certainly improved interoperability in the EDI world, even though there is still a long way to go. However, that same law and subsequent regulation also caused the creation of local enforcement policies which to this day are still used to disenfranchise patients.

So, don't get confused between policy and technology.  If you needed an ID to be associated with a fetus for birth and death reporting, certainly it could be resolved using an MRN, AS FAR AS THE TECHNOLOGY GOES.  It isn't the limits on technology which are stopping anyone from doing so.