Early appropriations bill offers hope for patient identifier advocates

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The most recent budget plan developed by the House Appropriations Committee subcommittee on Labor, Health and Human Services, and Education offers a ray of hope for organizations that are pushing for the institution of a unique identifier for patients.

That’s because the proposed legislation doesn’t prohibit the Department of Health and Human Services from examining issues related to patient matching.

That’s seen as a big step forward for HHS. Since 1999, Congress has prohibited HHS from using funds to establish a unique patient identifier, as a result of pressure from privacy advocates. The ban has been specifically inserted into each appropriations bill since then, and the current bill contains the same prohibition on HHS spending public funds to develop an identifier.

But for Fiscal Year 2017, Congress may be giving HHS room to work on private efforts to develop an identifier.

“The Committee encourages the Secretary, acting through the Office of the National Coordinator for Health Information Technology and CMS, to provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information,” the House legislation states.

In the bill, the committee acknowledges that lack of a consistent patient data matching strategy presents challenges to the safe and secure exchange of electronic health information, particularly with the HITECH Act’s mandate to adopt electronic health records to facilitate data exchange.

The appropriations process is still in continuing, and it’s not sure whether the language authorizing development of a national patient identifying strategy will remain in the bill that’s eventually passed by the House and Senate. The language banning HHS from spending public money on a national identifier is also is in the Senate appropriations bill, but the Senate does not include language matching the House’s bill.

But the fact that the House bill’s new language is being considered is important, says Leslie Krigstein, vice president of congressional affairs at the College of Healthcare Information Management Executives, a professional group representing health information technology professionals. This is the first time that Congress acknowledges that the lack of an identifier may affect safety and health information exchange, she says, adding that, “Acknowledging the problem is significant.”

CHIME is conducting a national competition, featuring a $1 million top prize to find a viable and scalable solution to ensure accurate patient identity matching. The organization surveyed members in 2012 and found 20 percent of respondents attributed at least one adverse medical event to identification or patient-matching problems.

The challenge for industry stakeholders will be to work with HHS and gain the confidence of Congress on any matching solution reached. Until now, HHS has faced restrictions on patient matching/identification; from the agency’s standpoint, any form of national identifier would have to support initiatives in multiple federal programs, including Medicare, Medicaid, TriCare and the Bureau of Prisons.

The way Krigstein reads the proposed legislation language, HHS can’t do national identifier work, but can talk to those doing the work. Technical assistance from HHS, Krigstein speculates, could include deciding how to capture current identifiers, such as the Medicare beneficiary identifier, which currently uses beneficiaries’ Social Security number. Many data fields for many programs will need to be modified, contingent on the final form of a national identifier.

The most pertinent language on the unique patient identifier is on page 108 of the appropriations bill, available here.

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