Always thought that was elegant (the attach not using the time as the seed).
Of course, it's always possible for something to do something stupid, like weak rng.
You wouldn't be publishing patient visits publically, the only folks that'd legitimatly see that record would be those which access to that visit, and they'd most likely need to know the time of said visit. This access should be controlled via AuthN, AuthZ and audited.
You'd also generally do a lot of time-based lookups on this data; what visits do I have today, this week, and so on. You might also want an additional DateTime field for timezones and offsets, but the v7 is probably better than v4 for this usecase.
Dates are specifically cited as potential vectors for de-anonymization. For example, you can't disclose that "Bob H presented to the clinic on October 10th" because that's a lot of information that can be used to find out who Bob H is.
Here's a practical example of what I'm talking about. Suppose you have an app for physicians that allows them to message each other to discuss a case. They can share relevant information for diagnostic purposes, e.g., "34y/o male from the southern Louisianna presented with a rash." They share de-identified photos and chat about ddx, treatment protocol, etc. All of that is cool. However, if the record of that visit is identified with a UUIDv7, and that ID is used as part of the URL you've exposed the time of the visit, and that would be a problem.
In most cases this forms a compliance matter rather than an open attack vector, but it nevertheless remains that one has to answer any question along the lines "did you minimise the privacy surface?" in the negative, or at least, with a caveat.
Whether creation date is PHI…I could see the argument being yes, since it correlates to medical information (when someone sought treatment, which could be when symptoms present.)
The only thing that seems to be protected is ‘reason for appointment’, and not all systems do that.
Everyone signs paperwork to authorize this when they first engage with the medical providers!
