Introduction
The purpose of this document is to describe a de-identification approach for COVID ELR messages in two settings:
- Standardized reporting of over-the-counter COVID self-tests
- Capture of metadata from laboratory-performed PCR tests
De-identification supports transmission of ELR messages to HHS Protect and to federally funded entities providing analytics services.
LINK: Workflow diagrams
Principles of de-identification
Self-test and PCR reporting data can be reasonably assumed to fall under HIPAA guidelines. These guidelines and de-identification strategies can be found on the HHS website.
Defining where PHI exists in the ELR message
HL7 v2.5 message elements that are changed in the de-identification process are outlined in the table below. Several elements that are not intended to contain PHI are also removed to address potential inclusion of PHI in these elements erroneously.
| Segment | Component | Title | Change |
|---|---|---|---|
| PID | 3.1 | Patient ID | Modify to "<deidentified>" if PID-3.5 does not equal "PI"; else, no change |
| PID | 5.1 | Patient last name | If empty, no change; else, modify to "<deidentified>" |
| PID | 5.2 | Patient first name | If empty, no change; else, modify to "<deidentified>" |
| PID | 5.3 | Patient middle name | If empty, no change; else, modify to "<deidentified>" |
| PID | 7.1 | Patient DOB | If empty, no change; else, modify to "<deidentified>" |
| PID | 11.1 | Patient street address | If empty, no change; else, modify to "<deidentified>" |
| PID | 11.2 | Patient street address 2 | If empty, no change; else, modify to "<deidentified>" |
| PID | 11.3 | Patient city | If empty, no change; else, modify to "<deidentified>" |
| PID | 13.4 | Patient email | If empty, no change; else, modify to "<deidentified>" |
| PID | 13.6 | Patient phone area code | If empty, no change; else, modify to "<deidentified>" |
| PID | 13.7 | Patient local phone | If empty, no change; else, modify to "<deidentified>" |
| ORC | 3.1 | Filler order number | Remove |
| ORC | 12.1 | Ordering provider ID | Remove |
| ORC | 12.2 | Ordering provider last name | Remove |
| ORC | 12.3 | Ordering provider first name | Remove |
| ORC | 22.1 | Ordering facility street | Remove |
| ORC | 22.2 | Ordering facility street 2 | Remove |
| ORC | 22.3 | Ordering facility city | Remove |
| ORC | 22.4 | Ordering facility state | Remove |
| ORC | 22.5 | Ordering facility zip | Remove |
| ORC | 22.9 | Ordering facility county | Remove |
| ORC | 23.6 | Ordering facility phone area code | Remove |
| ORC | 23.7 | Ordering facility local phone | Remove |
| ORC | 24.1 | Ordering provider street | Remove |
| ORC | 24.2 | Ordering provider street 2 | Remove |
| ORC | 24.3 | Ordering provider city | Remove |
| ORC | 24.4 | Ordering provider state | Remove |
| ORC | 24.5 | Ordering provider zip | Remove |
| ORC | 24.9 | Ordering provider county | Remove |
| OBR | 3.1 | Filler order number | Remove |
| OBR | 7.1 | Observation result date | Remove |
| OBR | 16.1 | Ordering provider ID | Remove |
| OBR | 16.2 | Ordering provider last name | Remove |
| OBR | 16.3 | Ordering provider first name | Remove |
| NTE | 1 | Set ID | Remove |
| NTE | 2 | Source of comment | Remove |
| NTE | 3 | Comment | Remove |
