I recently caught up with Alex Rodriquez, the CIO at St. Elizabeth Healthcare, which serves patients in the northern Kentucky area. The health system was formed in 2008 with the merger of St. Elizabeth Medical Center and two hospitals under the St. Luke’s banner. St. Elizabeth’s is standardizing its clinical IT, using software from Epic. And the merger, Rodriquez recalled, revealed massive duplications in patient identifications. The formerly independent hospitals and their affiliated group practices assigned their own patient identifiers. After doing a data clean-up, St. Elizabeth’s went from 1.6 million patient records to about 750,000. Sometimes duplicate names showed up even within the same health system, as the hospital might use a different identifier than its affiliated group practice. “We now have a common way of identifying patients,” Alex told me.

The lack of a common patient identifier makes data exchange all the more risky. And you may recall that the original HIPAA legislation called for a national patient identifier, correctly anticipating one of the bigger issues in streamlining electronic data exchange. The universal identifier proved to be so controversial that Congress rolled back the requirement, leaving localities to fend for themselves. But I’ve had many CIOs tell me that a universal patient identifier would help ensure not only the accuracy of medical data, but also the safety of delivering it. After all, if you’re flat out in the ED, and the physician depends on a community data exchange for your history, you want to know he’s looking at yours, and not your namesake’s.

Sifting through the massive health reform bill rekindled the many conversations I’ve had with healthcare executives about this issue. It calls for mandatory health insurance for all citizens, who face a penalty if they don’t comply. The immediate questions become: how will the federal government a) enforce this provision, and b) keep tabs on who has purchased insurance and who has not? Seems like one of those simple questions with an invariably complicated answer. And, as I noted in my previous post, some experts are predicting that many people would opt to pay the penalty rather than fork over a larger sum for any premium. The law notes that any penalties would be paid as part of the income tax, and there are apparently—I say apparently because who can really understand the arcane verbiage of the law?—provisions that employers report coverage. Perhaps the tax returns will have one of those check-off boxes like the states do for contributing to various causes: Do you have health insurance? Yes. No. Well, maybe.

But no matter what identifier—or enforcement mechanism--is ultimately chosen, the bill implicitly requires the same thing HIPAA tried to mandate—a national patient identifier. Let’s just hope the auditors get it right, or otherwise I can imagine getting a notice from the IRS about the health insurance that the other Gary Baldwin didn’t buy.


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