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.
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.
I was trying to figure out why this might be coming up, outside of certain groups that have things to "gain" by a fetus having an ID # (especially if most systems decide to use their "Patient #" tracking numbers) in EMR systems. The one current issue that I did think of that might make people think they do need it though is a few states passing laws of late which require mothers to cremate or bury their aborted/stillborn fetuses. If there are some reasons for a hospital to need to track the fetus at that point as a separate "entity" because of that, there may be a reason there. How/where the systems decide to track them though will be an interesting issue.... would a preponderance of usage/standards in that in effect set up some sort of legal angle some would use.
ReplyDeleteKeith you are absolutely right about this being more of a policy issue than a technical issue. I think that one of the factors influencing policy is the current legal debate regarding recognition of a fetus as a person, separate and distinct from its "mother" (the person in who's womb the fetus is developing). Clearly a fetus is an entity and therefore can be assigned an identifier. The question is, should that identifier be a medical record number? Is there a medical record for a fetus? If so, then yes. As a fetus develops there are several medical observation made, such as gender, age, length of the femur, blood type, etc. There is argument for why such observations should be retained in a medical record separate from the mother's medical record. The counter argument is that until birth, when the fetus becomes a person, observations about it should be treated like observations made about parts of the mother, in the same way that observations about her heart, womb, and eyes do not constitute a separate medical record. This is not technical issue, it is entirely policy. Policy changes with time. There was a time in this country when certain members of the human race were not considered persons. But the policy was eventually overturned.
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