Though patient data mismatches remain a significant and growing problem in healthcare, ongoing congressional language in the Department of Health and Human Services appropriations prohibits HHS from using federal agency dollars to create a national unique patient identifier.

“If Congress changes their position on that and gives us authority to do that, we will move forward on it,” said Jodi Daniel, the Office of the National Coordinator’s Director of the Office of Policy Planning, at an April 7 Health IT Policy Committee. “In the meantime, we are acting within our authority.”

The HIPAA law enacted in 1996 mandated a unique individual identifier for healthcare purposes. Because of privacy concerns, Congress later inserted language into the 1999 Omnibus Appropriations Act prohibiting funds made available under HIPAA from being used to adopt a national patient identifier. That language has remained in appropriations bills since, despite concerns that lack of an identifier hampers patient safety and health data exchange.

According to a survey of healthcare CIOs conducted by the College of Healthcare Information Management Executives, error rates due to patient mismatching averaged eight percent and ranged up to 20 percent.  In addition, 19 percent of the respondents indicated that their hospitals had experienced an adverse event during the course of the year due to a patient information mismatch.

Also See: CHIME Issues $1M National Patient ID Challenge

Proponents of a nationwide unique patient identifier argue that it will enable accurate, timely, and efficient matching of patients with their healthcare data, which may be generated in multiple systems. For years, HIMSS has been urging Congress to reconsider its prohibition and to take steps that could lead to a national approach and standards that will facilitate health information exchange, optimize patient-data matching, and enhance patient safety. “Nationwide healthcare transformation is virtually impossible without meaningful, system-wide adoption of EHRs and HIE including a technologically-advanced nationwide patient data matching strategy,” states the organization.  

HIMSS is quick to point out that a national-level patient identity solution “does not mean that every system has to use the same patient identity method but, rather, means national standards and solutions that can be used for exchanging information across systems.” Nor does such a solution  “mean a national identity number or card,” according to the organization,  given that “technological advances now allow for much more sophisticated solutions to patient identity and privacy controls, including patient consent, voluntary patient identifiers, metadata identification tagging, access credentialing, and sophisticated algorithms.”

Last year, HIMSS recommended that the funding provision be changed to expressly require ONC to lead efforts to develop on a priority basis a nationwide consistent patient data matching strategy. But that recommendation fell on deaf ears.

This past week, recommendations were presented at the April 7 HIT Policy Committee meeting on ways to improve patient data matching. Micky Tripathi, co-chair of the Interoperability and Health Information Exchange Workgroup, presented recommendations at the April 7 HIT Policy Committee meeting regarding patient data matching. Tripathi referenced the fact that ONC’s Interoperability Roadmap includes a minimum set of data elements to be used in patient matching and said the workgroup “recognizes the importance of accurate identity matching and reliable resource location as roadmap categories.”

At the same time, he said that “technical standards are necessary but not sufficient to establishing accurate and reliable patient-matching.” According to Tripathi, patient matching requires a combination of technical standards and aligned business processes.

Tripathi also reported that the workgroup believes “there is value in communicating a best practice ‘minimum’ set of standardized data elements for patient-matching.” But, he said “such a set should not be required for patient-matching, nor should it be the basis for defining MU or EHR certification requirements.”

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