Identifiers for Organizations

For ARS, the institution that provided medical care to the patient and submitted a sample to a laboratory for microbiological diagnostics ("sample submitter" or "treating institution") must always be shown. No information about the individual doctor is collected for ARS.

Two profiles are created for these organizations in the ARS-FHIR specification; a distinction is made between

• Hospital locations
• Medical practices and other organizations

In addition to specifying the type of organization, it is essential to specify an identifier for the organization. The identifier must uniquely describe the organization in the data sender's data for an unlimited period of time.

The following regulations for the definition of organization identifiers for ARS have been developed on the basis of the complex requirements of surveillance, data senders and interoperability.

Identifiers for hospitals and hospital locations

The aim is to use external identifiers for hospitals.

The location directory of the Institute for the Hospital Remuneration System (InEK) is a central database for recording and managing all hospitals in Germany. Private clinics and rehabilitation facilities are not included. The contents of the InEK site directory are publicly available for searching and downloading (in XML format); all that is required is user registration. The directory and further information can be found here: https://krankenhausstandorte.de/

The following two levels from the InEK location directory are relevant for ARS:

• Hospital (identifier: Main-IK)
• Hospital location (identifier: InEK site ID)

The location ID is assigned by InEK and is particularly resilient to administrative changes such as a change of provider.

The more detailed level of hospital locations is preferrable for ARS for both content-related and organizational reasons.

Priority 1: InEK site ID

To be used if the organization to be mapped clearly corresponds to a location from the InEK location directory. When assessing uniqueness, non inpatient clinic locations (e.g. day clinics) can be ignored.

Example:

"identifier": [ 
    { 
        "system": https://demis.rki.de/fhir/NamingSystem/InekStandortId", 
        "value": "779992" 
    } 
]

Priority 2: Main-IK

To be used if the organization to be represented corresponds to a hospital listed in the InEK location directory and represents all locations from that directory.

Example:

"identifier": [
    {
        "system": "http://fhir.de/sid/arge-ik/iknr",
        "value": "260709999"
    }
]

Priority 3: Internal Identifier

In all cases where a unique assignment to a hospital or a location from the InEK location directory is not possible, an internally defined identifier—constructed according to a specified rule by the data sender—must be used. This generally applies to preventive and rehabilitation facilities, private clinics, and also to ambiguous cases involving hospitals.

The internal identifier consists of two parts:

• DEMIS ID (5 digits) of the data sender (i.e., NOT the DEMIS ID of the hospital being represented, but the DEMIS ID of the laboratory, central IT system, or hospital that is transmitting the ARS data to DEMIS)
• Sequential number for the represented hospital (6 digits, left-padded with zeros). This sequence number is assigned by the data sender and must be unique and stable within the sender’s data scope.

The DEMIS ID is issued by the DEMIS coordination office and should already be available for many reporting laboratories and hospitals. New DEMIS IDs can be requested from the DEMIS office. It is also possible to obtain a DEMIS ID for a central IT system within a hospital or laboratory network.

Example:

"identifier": [
    {
        "system": "https://demis.rki.de/fhir/sid/InternalOrganizationId",
        "value": "39999000001"
    }
]

Identifier for Medical Practices and Other Specimen Submitters

Internal Identifier

This must be used for all organizations to be represented that are not hospitals.

The internal identifier consists of two parts:

• DEMIS ID (5 digits) of the data sender (i.e., NOT the DEMIS ID of the medical practice or submitter being represented, but rather the DEMIS ID of the laboratory, central IT system, or hospital that transmits the ARS data to DEMIS)
• Sequential number for the medical practice or submitter being represented (6 digits, left-padded with zeros). This sequence number is assigned by the data sender and must be unique and stable within the scope of the sender’s data.

The DEMIS ID is issued by the DEMIS coordination office and is already available to many reporting laboratories and hospitals. New DEMIS IDs can be requested from the DEMIS office. It is also possible to obtain a DEMIS ID for a central IT system within a hospital or laboratory network.

Example:

"identifier": [
    {
        "system": "https://demis.rki.de/fhir/sid/InternalOrganizationId",
        "value": "39999000001"
    }
]

Examples:

Scenario: the laboratory "BioLab360 GmbH" would like to transmit its data to ARS. The laboratory supplies several hospitals and doctors' surgeries and must enter suitable identifiers for each of these sample senders. The laboratory has the DEMIS ID 39999.

The following examples are based on the fictional excerpt from the InEK site directory for the "Schwarzwald-Kliniken" hospital Basic identifier for hospitals and hospital sites.

Haupt-IK	Krankenhaus	Standort-ID	Standort
260709999	Schwarzwald-Kliniken	779990	Hauptstandort
260709999	Schwarzwald-Kliniken	779991	Hauptstandort - Tagesklinik
260709999	Schwarzwald-Kliniken	779992	Standort Süd
260709999	Schwarzwald-Kliniken	779993	Standort Ost

Example 1: “Schwarzwald-Kliniken, location south”

The organization “Schwarzwald-Kliniken, Standort Süd” clearly reponds to a location from the InEK location directory, therefore use location ID 779992.

Example 2: “Schwarzwald-Kliniken, main location”

The “Schwarzwald-Kliniken, Hauptstandort” organization contains all data for the location, including the day clinic. As the non-inpatient facility entries in the InEK location directory for ARS can be ignored when selecting the identifier, the location ID 779990 can be used.

Example 3: “Schwarzwald-Kliniken”

The “Schwarzwald-Kliniken” organization contains all data from all locations. The main IC 260709999 can therefore be used.

Example 4: "Schwarzwald-Kliniken, Locations South and East"

The organization "Schwarzwald-Kliniken, Locations South and East", does not clearly correspond to either a single location or to an entire hospital listed in the InEK location directory. Therefore, neither a location ID nor the main institutional code (IC) can be used. Instead, a proprietary identifier such as 39999000001 is used. This consists of the DEMIS ID "39999" of the data sender (in this case, the laboratory "BioLab360 GmbH", not the Schwarzwald-Kliniken) and the sequential number "000001" for the specimen submitter. The sequential number for the submitter is assigned by the data sender and must be unique and stable within the scope of the sender's data.

Example 5: "Praxis Dr. Müller"

The organization "Praxis Dr. Müller" is a medical practice. For ARS, a proprietary identifier must always be used for such cases, for example: 39999000002. This consists of the DEMIS ID "39999" of the data sender (here: "BioLab360 GmbH") and the sequential number "000002" for the specimen submitter. The sequential number is assigned by the data sender and must be unique and stable within the sender’s dataset.