De-Identification Handbook
2.0.0-comment - ballot

De-Identification Handbook, published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 2.0.0-comment built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.DeIdHandbook/ and changes regularly. See the Directory of published versions

## Download and Analysis

You can also download:

- this entire guide,
- the definition resources in json, xml, or ttl
- the example resources in json, xml or ttl format.

The source code for this Implementation Guide can be found on IHE ITI DeIdentification Handbook Github Repo

#### Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (ihe.iti.deid.r4) and R4B (ihe.iti.deid.r4b) are available.

#### Dependency Table

IG | Package | FHIR | Comment
--- | --- | --- | ---
De-Identification Handbook | ihe.iti.deid#2.0.0-comment | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#7.1.0 | R4 | Automatically added as a dependency - all IGs depend on HL7 Terminology
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.2.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.3.0 | R4 | Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
Basic Audit Log Patterns (BALP) | ihe.iti.balp#1.1.4 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.5.0 | R4 |
International Patient Summary Implementation Guide | hl7.fhir.uv.ips#2.0.0 | R4 |
International Patient Access | hl7.fhir.uv.ipa#1.1.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.2.0 | R4 |
SMART App Launch | hl7.fhir.uv.smart-app-launch#2.0.0 | R4 |
IHE FHIR Profile: Occupational Data for Health (ODH) - International | ihe.pcc.odh#1.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.1.0 | R4 |
FHIR Extensions Pack | hl7.fhir.uv.extensions.r4#5.1.0 | R4 |
PHINVads | us.cdc.phinvads#0.12.0 | R4 |
Vital Records Common Library (VRCL) FHIR Implementation Guide | hl7.fhir.us.vr-common-library#2.0.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#6.0.2 | R4 |
US Core Implementation Guide | hl7.fhir.us.core#5.0.1 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#3.1.0 | R4 |
Bulk Data Access IG | hl7.fhir.uv.bulkdata#2.0.0 | R4 |
VSAC | us.nlm.vsac#0.7.0 | R4 |
Structured Data Capture | hl7.fhir.uv.sdc#3.0.0 | R4 |
VSAC | us.nlm.vsac#0.19.0 | R4 |
Vital Records Death Reporting (VRDR) FHIR Implementation Guide | hl7.fhir.us.vrdr#3.0.0 | R4 |
HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1, STU 1.3 (Standard for Trial Use) | hl7.fhir.us.odh#1.3.0 | R4 |
HL7 Terminology (THO) | hl7.terminology.r4#5.0.0 | R4 |
FHIR Tooling Extensions IG | hl7.fhir.uv.tools.r4#1.1.2 | R4 | for example references

Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)

Package hl7.fhir.uv.extensions.r4#5.3.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, May 16, 2026 18:32+1000+10:00)

Package ihe.iti.balp#1.1.4 The Basic Audit Log Patterns (BALP) Implementation Guide is a Content Profile that defines some basic and reusable AuditEvent patterns. This includes basic audit log profiles for FHIR RESTful operations to be used when there is not a more specific audit event defined. A focus is enabling Privacy centric AuditEvent logs that hold well formed indication of the Patient when they are the subject of the activity being recorded in the log. Where a more specific audit event can be defined it should be derived off of these basic patterns. (built Fri, Oct 31, 2025 12:53-0500-05:00)

Package hl7.fhir.uv.ipa#1.1.0 This IG describes how an application acting on behalf of a patient can access information about the patient from an clinical records system using a FHIR based API. The clinical records system may be supporting a clinical care provider (e.g. a hospital, or a general practitioner), or a health data exchange, including a national health record system. (built Wed, Mar 19, 2025 14:34+0000+00:00)

Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00)

Package ihe.pcc.odh#1.0.0 This IG covers the specific data that covers past or present jobs, usual work, employment status, retirement date and combat zone period for the subject. It also includes the past or present jobs and usual work of other household members. This IG is International scope. (built Wed, Dec 4, 2024 15:44-0600-06:00)

Package hl7.fhir.uv.bulkdata#2.0.0 FHIR based approach for exporting large data sets from a FHIR server to a client application (built Fri, Nov 26, 2021 05:56+1100+11:00)

Package hl7.fhir.uv.sdc#3.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. This includes two components: * Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains. *Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)

Package hl7.fhir.us.core#5.0.1 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Wed, Jun 22, 2022 19:44+0000+00:00)

Package hl7.fhir.us.odh#1.3.0 HL7 FHIR Profile: Occupational Data for Health (ODH), Release 1.3 (Standard for Trial Use) This Implementation Guide is a reconciled version, containing changes in response to comments received in the Sept. 2018 ballot. It has been updated to FHIR R4.0.1. Introduction and Guidance This Implementation Guide (IG) contains profiles to implement support for Occupational Data for Health (ODH). ODH describes structured work information primarily designed to facilitate clinical care, including population health and value-based care. ODH also can be used to support public health reporting. ODH is not designed to support billing activities. This set of FHIR profiles is specified as a composition resource, but it is not intended to be used as a stand-alone composition. Rather, the desired content should be included in broader IGs and available as a response to requests for ODH information. Some use cases may leverage only a subset of the ODH profiles, and these should be specified within those work products. For instance, in the Vital Records Death Reporting (VRDR) IG, the data requirements for work information are limited to those in the Usual Work profile. While this profile is specified for the US Realm, the design is intended to also support international needs. Three of the referenced value sets—Occupation, Industry, and Supervisory Level— are necessarily US specific. The remaining three value sets—Work Schedule, Employment Status, and Work Classification—use international concepts. Input is requested regarding whether these should be specified as ‘extensible’, ‘required’ (using ‘text only’ where a concept does not yet exist such as a new occupation), or as an ‘example’ for those US specific concepts. Background The majority of adults in the U.S. spend more than half their waking hours at work. Therefore, health and work are inextricably inter-related. For example, the management of chronic conditions requires taking the patient’s work environment into consideration. Work-related conditions are often first brought to the attention of a primary care provider. Some conditions related to exposure to hazards in the workplace can have a long latency, requiring knowledge of a person’s work history for recognition, diagnosis, and treatment. The recognition of new conditions related to previously unknown workplace hazards has often come from astute clinicians, which requires knowledge of the patient’s work. ONC has indicated recognition of the value of work information for health care. The incorporation of ODH into Electronic Health Records (EHRs) and other health IT systems presents an opportunity to improve health in relation to work. ODH provides a structure and standardization for work information that can be used across systems to take advantage of system tools for clinical decision support, population health, and public health. Research has been conducted and guidance is available to support clinicians, and the use of ODH by health IT systems can support identification of patients that would benefit the most from this knowledge. Scope The Occupational Data for Health (ODH) FHIR IG covers information about a patient’s work, including some voluntary work, or a patient’s household members’ work. ODH is designed for the social history section of a medical record, to facilitate clinical care in multiple disciplines and delivery environments. ODH can be used for clinical decision support, population health activities and value-based care, and public health reporting. The scope of the work information in ODH includes: • Employment Status • Retirement Date • Combat Zone Period • Past or Present Job for the patient or a household member, which includes: o Past or Present Job Occupation o Past or Present Job Industry o Work Classification o Work Schedule, which includes:
    - Weekly Work Days

    - Daily Work Hours
o Job Duty o Occupational Hazard o Employer name o Employer address o Related Subject (when it is Past or Present Job of a household member of the person) o Start/End Dates • Usual Work of the patient or a household member, which includes: o Usual Occupation o Usual Industry o Usual Occupation Duration o Related Subject (when it is Usual Work of a household member of the person) o Start Date Known Issues and Limitations This IG includes more extensive occupational data than typically collected in current systems. The content and structure of this IG is intended to inform clinical care, support population health, and contribute to public health activities. While there may be some overlap with administrative and billing information maintained by some systems, the information in this IG is not designed to support billing and administrative needs. While multiple retirement dates are supported, the retirement date is not linked to any specific job, or usual occupation. Credits Co-Editor: Lori Reed-Fourquet e-HealthSign, LLC lfourquet@ehealthsign.com Co-Editor: Rob Hausam Hausam Consulting rob@hausamconsulting.com Co-Editor: Mark Kramer MITRE Corporation mkramer@mitre.org This set of FHIR profiles was produced and developed through the efforts of a project of the National Institute of Occupational Safety and Health (NIOSH), the U.S. federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is a part of the U.S. Centers for Disease Control and Prevention (CDC). NIOSH consulted stakeholders in clinical care, public health, health IT, health informatics and U.S. government agencies to develop ODH. The HL7® Public Health and Emergency Response Work Group sponsored development of this set of FHIR profiles. Co-sponsoring HL7® Work Groups were Orders and Observations (OO), Patient Administration (PA), and Clinical Quality Initiative (CQI). The following individuals provided subject matter expertise for this set of FHIR profiles: Genevieve Barkocy Luensman, NIOSH; Eileen Storey, Professional Services Partners, formerly NIOSH; Margaret S. Filios, NIOSH; Christina Socias-Morales, NIOSH; Lauren Brewer, NIOSH; Barbara Wallace, Professional Services Partners. Authors Name Email/URL HL7 International - Public Health http://www.hl7.org/Special/committees/pher (built Wed, Mar 22, 2023 12:13+1100+11:00)

Package hl7.fhir.uv.tools.r4#1.1.2 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

#### Globals Table

There are no Global profiles defined

#### IP Statements

This publication includes IP covered under the following statements.

- The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  - Unified Code for Units of Measure (UCUM): Bundle/430e32bc-be3e-4c42-a17b-461ea4f402d4, Bundle/78f68a27-c439-4cd5-9ca2-ebc882468ade, Bundle/80c516fd-9c84-4924-875b-bf0048979ae1, Bundle/e817cefe-a7c4-487a-8116-be23cf865f3f and Bundle/fc7b32fe-13b1-42e9-bca1-ff805587d072
- These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
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  - DICOM Controlled Terminology Definitions: AuditEvent/ex-auditDeIdentification-source, AuditEvent/ex-auditReIdentification-source and AuditPrivacyDeIdentificationSource
- These codes are excerpted from ISO Standard, TS 21089-2017 - Health Informatics - Trusted End-to-End Information Flows, Copyright by ISO International. Copies of this standard are available through the ISO Web Site at www.iso.org.
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  - ISO 21089-2017 Health Record Lifecycle Events: AuditEvent/ex-auditDeIdentification-source, AuditEvent/ex-auditReIdentification-source, AuditEventSubtypeDeidentify and AuditPrivacyDeIdentificationSource
- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  - LOINC: Bundle/430e32bc-be3e-4c42-a17b-461ea4f402d4, Bundle/6603561c-2888-4355-9df4-23675f6eb458... Show 4 more, Bundle/78f68a27-c439-4cd5-9ca2-ebc882468ade, Bundle/80c516fd-9c84-4924-875b-bf0048979ae1, Bundle/e817cefe-a7c4-487a-8116-be23cf865f3f and Bundle/fc7b32fe-13b1-42e9-bca1-ff805587d072
- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  - SNOMED Clinical Terms&reg; (SNOMED CT&reg;): AuditEvent/ex-auditDeIdentification-source, AuditPrivacyDeIdentificationSource... Show 6 more, Bundle/430e32bc-be3e-4c42-a17b-461ea4f402d4, Bundle/6603561c-2888-4355-9df4-23675f6eb458, Bundle/78f68a27-c439-4cd5-9ca2-ebc882468ade, Bundle/80c516fd-9c84-4924-875b-bf0048979ae1, Bundle/e817cefe-a7c4-487a-8116-be23cf865f3f and Bundle/fc7b32fe-13b1-42e9-bca1-ff805587d072