HIT Think

Why the movement toward a patient identifier is only a start

In a landmark decision by the House last week, the ban for a national patient identifier was overturned. While the amendment still needs approval by the Senate to become law, it nevertheless was a victory for industry groups such as AHIMA and CHIME in a fight that’s been two decades in the making.

When Congress dismissed the concept of a universal identifier in the early 1990s, healthcare’s IT infrastructure for data exchange was still relatively immature. Today, however, in the wake of digitization, healthcare organizations are inundated with data, and widespread information sharing across settings remains an elusive goal.

While the transmission and capture of a single patient identifier across thousands of disparate systems could take decades for full adoption, it does represent a turning point in addressing the U.S. healthcare system’s patient-matching crisis. As the foundation for patient safety and interoperability, patient identification issues are financially crippling—costing our nation’s healthcare system $6 billion annually.

Over the years, many industry leaders and experts have pointed to other countries that have instituted unique patient identifiers. While such identifiers have improved the state of patient matching, the results in countries such as England and Scotland, which have long had a mandated identifier, shows it alone is not enough to achieve total integration across health and social care services.

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For example, older health system applications in England still cannot store valid National Health Service (NHS) numbers or connect in real-time to query the Patient Demographic Service for the NHS number. Furthermore, systems continue to have multiple NHS numbers applied to one patient and demographic inaccuracies.

In fact, even with the NHS number in place, an external enterprise master patient index (EMPI) is routinely needed to help manage patient identifiers. Utilized by multiple NHS trusts, the platform allows social care data, which often does not include an NHS number, to be married together with healthcare data. Leaders estimate it will take 10 to 15 years to get social care system—which were never designed to manage an NHS number—integrated into the program. It also uses the EMPI to resolve cases in which individuals are issued more than one NHS number.

In Scotland, the Community Health Index (CHI) number is leveraging an EMPI to replace the mainframe-based Community Health Identifier. Here, the EMPI provides quality control over the core patient information by providing duplicate detection services, enforcing data capture workflows, and allowing all systems to easily connect to a demographic lookup service using the latest messaging standards. In addition, the EMPI maintains relationship data so that the association between a patient and a general practitioner in Scotland can be centrally managed.

Because the U.S. healthcare system is much larger in scope and far more complex than that of the U.K., we can expect difficulties in implementing a unique patient identifier to be proportionally greater.

That is not to say that pursuing a national patient identifier isn’t a laudable goal. But we shouldn’t assume that a single identifier will be silver bullet solution. Rather, we should treat a unique identifier as just another strong indicator of identity that, in conjunction with other demographics as well as biometric data, can assist with matching. A national patient identifier would be an important piece of the overall identity puzzle, but it would not be definitive.

The real challenge of identity management and piecing together a longitudinal health record revolves around standards for data capture and integration of demographics and associated identifiers across multiple systems. Because systems weren’t designed to communicate with one another, and because they store their data through fragmented architecture, an excessive proliferation of identifiers occurs. The result is unreliable demographic information, triggering further harm in data synchronization and integrity.

Instead of looking at a national patient identifier as the definitive answer for solving our patient identification issues, we should not lose sight of a pragmatic, multi-faceted approach to improving patient matching—one that relies on a combination of probabilistic algorithms for connecting identifiers, processes and standards for data capture, biometric and identity verification tools and consumer involvement for managing their demographic information.

As we begin to embrace these and other technological innovations into the patient identification equation, we will increase our ability to accurately identify a patient at any time, in any care setting, and set the stage for safe, coordinated and informed decision-making.

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