Why unique patient identifiers are a key missing piece in healthcare
Efficient patient identification is an area plaguing U.S. healthcare. In fact, the Joint Commission has named improving the accuracy of patient identification as the most important national patient safety goal since 2014. However, privacy concerns have been a barrier to their widespread implementation.
Unique patient identifiers are central to eliminating medical errors and costs resulting from slow or inaccurate patient identification and will contribute to better overall care coordination. That’s why the U.S. House of Representatives recently voted in favor of an amendment that would lift a ban on federal funds for the creation of patient identifiers. This will now go to the Senate for voting, and the debate is sure to continue.
But what are patient identifiers, and what are the potential implications of this pending policy?
A nationwide system of patient identification would provide each healthcare customer with a unique patient ID number for providers and payers to use in organizing patient information and coordinating with other institutions on care.
The United States is one of the only places in the world that doesn’t have a central patient identification scheme. The way in which those identifiers are deployed varies significantly from country to country, but the vast majority have responded to the obvious need for the supplier of a service to be able to identify the customer in a common way.
Healthcare is a team sport; providers working to coordinate patient care must be able to ensure they’re talking to and about the same patient. Not only that, but if we believe that looking at data can improve healthcare, then a common way of identifying patients between systems is essential to collect complete data sets to create an accurate picture of the true costs and efficacy of healthcare.
From a patient safety point of view, there is extraordinary benefit in having a patient’s identity linked to a single number associated with their current contact details. Such consistency is a major boon in areas like medication management and clinical safety, particularly in the case of recall events.
For example, last month the pharmaceutical company Allergan issued a world-wide recall of a popular type of breast implant discovered to be linked with a rare form of cancer. The implant was withdrawn from sale in Europe in December 2018. A fully successful recall could take place in the U.K. because authorities were able to use the National Health Service Number to find every single patient who had the implant. From a risk management standpoint, that ability is extremely valuable.
Care coordination and the increased efficiency it brings is another area where unique identifiers could make a massive difference in U.S. healthcare. For example, say a patient is coming in to a provider for orthopedic surgery. With an identifier number, the provider can easily access prior images from an orthopedic lab across town before the surgery to triage care and plan the intervention ahead of time. This ability to connect health systems to share patient data has phenomenal benefit in terms of efficiency, workflow and value optimization.
With so much to recommend it, why hasn’t a unique identifier system been implemented here? A major reason is political will, which is lacking in the face of general public distrust of a central identifier database related to healthcare. However, the potential for such a system to be developed in the U.S. is growing stronger with movement in at least one side of Congress. The House vote reflects a growing understanding that efforts to improve the safety, efficiency and cost of the healthcare system are essentially stalled until a more centralized way of tracking patients and coordinating care can be developed.
If the Senate vote reflects that of the House, the central challenge facing the development of this system—aside from political will—relates to methods of implementation. There are many open questions about the most effective and secure way to create and manage this system.
- Should the identifiers be provided and managed by a federal body or agency? By the states? By a third-party in the private sector?
- What standards should be set for when the identifiers can be used and why?
- How much control should patients have over the use of these identifiers?
- What logistical qualifications should patients need to associate themselves with their identifier?
Regarding the last two questions, which are fundamental, it’s essential to set realistic standards that reflect the needs of both providers and patients of all kinds. One country that has done this well is the U.K., where a patient is able to have a provider call up his record by stating his name and one of the addresses at which he has lived in the last 10 years. On the provider side, records are accessed, and access logged, only by trusted individuals who have themselves been identified by a secure identity. Privileges to write data into the record require a higher bar of two-factor authentication. The simple provision of personal information by the patient enables them to be accurately identified and coordinated care to begin quickly, safe in the knowledge their personal health data is being securely managed.
By contrast, an overly restrictive system exists in Austria, where a provider is not even able to access a patient’s record without having the physical card that states the patient identifier, which the patient is expected to supply. This high bar for identification presents a problem for providers who want to access patient information before the patient is physically present in the office. An orthopedic surgeon, for example, would not be able to pull prior lab results until the patient came to the office to present his card, an incredible inefficiency that prevents triaging or preparing for provision of care.
It’s this concern for how the system is designed that should be preoccupying those with hesitancy about bringing unique patient identifiers to the U.S. The question of whether people should have an identifier at all is currently of greater public interest, but it presents far less of a legitimate point of apprehension.
I am not suggesting that medical records should be put in a central database online for anyone to access; the need is only for some way of identifying a patient in a unique way, much like states do with driver’s licenses. In fact, the amount of information a healthcare identifier system would store about any given person would be no more than the DMV usually keeps.
So the question at hand shouldn’t be whether a unique identifier should exist, but how the system can be sensitive regarding how the identifiers are used. If the government requires a physical card that is linked to a physical address and a bank account, then the bar is high for access to healthcare in the context of a society that contains a significant number of vulnerable people. But if the U.S. were to follow the U.K.’s model, where anyone with a unique patient identifier in the system can present themselves for care by reciting a minor amount of personal information, care would be not only more efficient, coordinated, affordable and safe, it would also be more accessible to more people.
Healthcare industry leaders are awaiting the Senate’s vote with bated breath. In fact, notable industry groups, including AHIMA and CHIME, recently hosted a congressional briefing urging the Senate to follow the House’s vote. This policy decision holds so much potential to transform patient safety and the delivery of care in the U.S., and I hope that policymakers can follow the lead of other markets like the U.K. that have achieved success with a universal patient identifier system.