V2CxIssue

CX Issue

Problem

The question was triggered by one of our ballot comments. In US death reporting, the decedent is identified by name, sex, DOB, and Social Security Number. In some cases, the SSN is not known, and we need a convention for saying so. Here is the comment:

Existing Wording:

Description/Comment: Field used to convey all types of patient/person identifiers. It is expected that Social Security Number will be provided if it is available. . The value "99999999" should be used for persons who do not have a social security number. Also used to support identifiers for the death certificat

Proposed Wording:

Description/Comment: Field used to convey all types of patient/person identifiers. It is expected that Social Security Number will be provided if it is available. Also used to support identifiers for the death certificate.

Comment:

If the simple non-mention of Patient Identifier Type "SS" is not sufficient indicaton that the patient has non SSN then the the use of a "flavor of null" value set should be considered.

Disposition (deferred)

The 2003 coding specifications only supports the 0's and 9's being transmitted to NCHS. However, some jurisdictions are sending blanks in place of unknown. NCHS will explore supporting the Null Flavor in the CX datatype definition.

Note that one jurisdiction indicated that the SSN is null by default, i.e. not even a null flavor when they receive data from the provider organization. In that jurisdiction, the SSN is not used even for matching purposes so it is generally not sent. This jurisdiction supports conforming to the standard while requiring a null flavor for SSN. Also, noted that the HL7 null flavors can provide much more detail about why an SSN is missing, especially when reporting between jurisdictions or to NCHS.

So, given that SSN is important, and may not be known, we would like a way to convey that SSN is not known in the message. This also applies to two observations we have using the CX data Type.

Mead