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Readers Write: National Patient Identifier: Why Patient-Matching Technology May be a Better Solution

National Patient Identifier: Why Patient-Matching Technology May be a Better Solution
By Vicki Wheatley

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Advances in technology, combined with The Patient Protection and Affordable Care Act, have begun to revive calls in the media for a national patient identifier—similar to the national provider identifier (NPI) assigned to physicians. The HIPAA legislation of 1996 included provisions for such an identifier, but they’ve never been enacted out of concerns for privacy and security.

Despite current law prohibiting the use of national patient identifiers, many proponents say creating such an identifier would make it easier to track patients across the continuum of care, leading to more effective treatments and better outcomes for patients. Others believe existing credentials such as Social Security numbers make a national patient identifier unnecessary. Lost in all the debate, however, are patient identification issues that will always exist—whether a national patient ID does or not.

Although adding a national patient identifier would provide one more data element to help confirm a patient’s identity, it still wouldn’t resolve some key record-matching challenges, nor would it fully enable organizations to use data for analytics, population health management or accountable care.

For a national identifier to work, even in theory, every single potential patient in the country would need to be assigned one—and only one—number and use it consistently. This holds true whether we generate a new identification number or use an existing one, such as a Social Security number.

For the sake of argument, let’s say Social Security numbers were to be used as national patient identifiers. Truth be told, many individuals living in or visiting the US don’t have Social Security numbers, like newborns or foreign visitors. Others may be fraudulently using someone else’s number for employment or other purposes. Additionally, using Social Security numbers as patient identifiers likely would raise security and privacy concerns due to the amount of financial and personal information already tied to them.

Just as the NPI has not been the fix-all for helping healthcare organizations exchange provider information, implementing a national patient identifier or using Social Security numbers will not resolve patient identification issues either. The reason: it won’t address concerns regarding existing information discrepancies or duplicate patient records. Additionally, like any identifier, it can be mis-keyed, transposed, or even stolen. Adding yet another identifier does not solve the patient matching conundrum.

Rather than advocating for a panacea that won’t solve the problem, healthcare organizations should instead focus on strengthening their existing enterprise patient-matching strategies, which can be easily implemented within individual organizations.

In order to provide optimal care, clinicians need to have an accurate view of the individuals they treat. Likewise, organizations as a whole must know who their patients are, what coverage they have, and which payer’s rules they must adhere to in order to receive payment. All of this information is particularly valuable when patient data is being used for analytics, accountable care, or population health management.

Thus, resolving patient identification problems is essential not only for enabling quality care, but also for supporting the financial viability of the healthcare organization. The challenges are further compounded by the fact that patient data resides across disparate systems encompassing the patient’s entire continuum of care. As a result, available patient data must be accurately linked together from within and across multiple organizations.

Unfortunately, however, errors occur. Registration staff may inadvertently transpose numbers, record nicknames instead of legal names, or fail to validate and update key data elements. Patients change addresses, phone numbers, insurance coverage, and names all the time. Data provided and collected is not always complete or accurate. Some patients forget information; others even want to hide it. To err is human, but mistakes introduced into patient records lead to discrepancies and duplicate patient records that complicate the patient identification process.

Patient-matching technology within an enterprise master patient index (EMPI) allows hospitals and health systems to bring together disparate information from various IT systems within or across organizations. This is essential for effectively managing the patient population and preparing for payment reforms. For example, an EMPI that compares patient data using probabilistic matching tools and algorithms can generate a unique enterprise identifier for each patient, eliminating the need to change information in source IT systems and enabling exchange of clinical and financial data. With an EMPI, multiple key data elements such as name, birth date, gender, address, other identifiers, and even biometrics can be used to accurately identify patients, ensuring the data in front of providers matches the patients they’re treating.

It’s a fact: as long as people are involved in providing and entering information, some level of human error remains inevitable. Yet by employing a strong strategy to address underlying identification issues, hospitals and health systems can compensate for some of the human elements that will always complicate patient identification—with or without a national patient identifier in place.

Vicki Wheatley is executive vice president of enterprise master person index solutions of QuadraMed of Reston,VA.