I want to highlight this passage: "It’s a classic parallel to what we experienced back in the early days of…
Readers Write: It’s Time for a National Patient Identifier
It’s Time for a National Patient Identifier
By Gregg Church
Gregg Church is president of 4medica of Marina del Rey, CA.
Congress has the power to make healthcare safer and less expensive for patients, payers, and providers. It can do this by removing the ban that prohibits using federal funds for the development of a unique national patient identifier.
The patient identifier system would give each patient a single ID that would follow them through their healthcare journey, regardless of provider or payer, while still protecting their private information. It would reduce medical and billing errors and denied claims, while eliminating countless hours insurers and hospital systems spend resolving patient matching errors. It would also aid medical research and make it easier for our healthcare system to respond effectively during national emergencies, like the COVID-19 pandemic.
The federal ban on a national patient identifier was born from good intentions. Former US Rep. Ron Paul in 1998 added the provision to the Labor-HHS appropriations bill. The physician and libertarian cited concerns about patient privacy and the dangers of the federal government collecting and centralizing medical records. His son, Sen. Ron Paul, also a physician and libertarian, now leads the opposition with the help of the ACLU and other groups.
Congress has come close to ending the ban. For the past four fiscal years, the House has removed it from its version of the appropriations bill; the Senate did likewise the past two years. Each year, however, it has been reinstated in the final budget.
In 2021, Patient ID Now, a coalition of more than 40 healthcare organizations, including the American College of Surgeons, American Heart Association, American College of Cardiology, The Joint Commission, and American Health Information Management Association, was formed to push for a nationwide strategy to address patient identification.
The group noted that the ban was put in place 25 years ago at a time when patient records were still largely kept in manila folders. It’s now a hindrance to the necessary digitization of healthcare. While concerns over patient privacy are real, a national patient identifier could be implemented in such a way that it protects patients.
I like to believe that much of the opposition to a universal patient identifier is due to a lack of awareness of the volume of incomplete, duplicate, missing, and overlaid medical records and the problems they cause.
Imagine if your personal finance records had a roughly one in five chance of being duplicated or mixed up with someone else’s accounts by financial institutions. Think of the chaos and damage and the ensuing demands to fix the problem.
Duplication of patient records is one of the most serious problems with healthcare data quality, and it’s more common than many think. Duplication rates are as high as 30% in some healthcare organizations, and a 10% rate is common. Up to half of patient records are not matched in transfers between healthcare systems.
Patients are endangered by low-quality records, particularly duplicate and overlaid records, in which the data for two patients is mixed.
Approximately 70% of care decisions are based on lab tests, which are performed by techs working in relative isolation from the care team. Labs frequently create duplicate records while entering patient information into computers. That bad data can then be multiplied and disseminated throughout a hospital system and between systems.
Clinicians working from bad data can misdiagnose, prescribe the wrong course of treatment, and order duplicate tests, which delay necessary treatment.
Black Book in 2018 surveyed health technology managers about problems with patient identification processes. It found that the cost of medical care due to duplicate records averaged $1,950 per patient per inpatient stay and more than $800 per ED visit.
Those surveyed also estimated that 33% of denied claims were due to inaccurate patient identification or information. That cost the average hospital $1.5 million in 2017 and the US healthcare system more than $6 billion annually.
That unnecessary expense could be eliminated with a standard patient identification system.
True interoperability among patients, providers, and payers is a goal of the healthcare industry, one that could be made more achievable through a patient identifier system that allows for the disruption-free exchange of patient records.
While recent improvements in patient identification processes, such as hospitals adopting Enterprise Master Patient Indexes and the use of machine learning, have improved record matching, it’s barely keeping pace with the explosion in medical records and the sharing of data among different healthcare organizations.
Adopting a national patient identifier would be a significant step toward building a safer, and more effective and affordable healthcare system. It’s time for Congress to listen to the experts and remove the ban. We’ll all be better off for it.
I entered the world of health after caregiving for a parent and seeing the disjointed approach to care. To learn, 10 years ago I attended a multi-week course at a top university — a program that included 51 CIOs, CTOs, and other senior execs from health organizations, and 4 of us from outside of healthcare. The naive
The term national “patient health safety identifier” more clearly articulates the primary benefit of unique identifiers.
The purported “privacy advocates” have (and have had) their heads stuck in the sand (or more likely some other anatomic place), and their refusal to understand the science, clear and abundant in support of the concept, underscores how out of touch with reality they are.
Unique, non-identifying numbers are much easier to create, including additional UHSIs that can link specifically to preserve privacy for items the patient may wish segmented away from general inclusion in their records (e.g., with mental health, reproductive health, drug testing).
Such unique numbers are also easier to parse out of records if there ever is a need, versus the immensely difficulty inaccurately joined data based on patient matching algorithms entails.
It is far past time for fringe minority politics to be rejected, to be recognized as out of touch with reality, and for the USA to join the rest of the modern world in reducing medical errors from inaccurate patient data matching.
I entered the world of healthtech after caregiving for a parent and seeing the disjointed approach to care. More than ten years ago, I attended a multi-week program at a top university to learn about the challenges that health systems face. The program included 51 CIOs, CTOs, and other senior execs from health organizations, and 4 of us from outside of healthcare. The “naive” question I asked was why we couldn’t move to a single patient identifier to address many of the issues I had encountered.
The response from many of the insiders was surprising as they defended the status quo to protect the patient. Have they ever been involved in caregiving for a loved one and experienced those challenges? If so, how could the status quo be supported?
Having now built and sold a health-tech company and building a new one — the same question remains. Why not? It would address so many issues with minimal incremental data security risk vastly offset by improvements in care management. I, for one, would gladly make that tradeoff! And if others choose not to do so, make the identifier an opt-in choice.
So, let me get this straight… we’re going to add yet another identifier which would NOT be used to personally identify us for anything other than our healthcare records? Not a, “tinfoil hat, move to the woods Libertarian” but using the Social Security Number as an example… Yeah. That didn’t work.
Wait… is there a reason we aren’t just using the SSN?
“Those who would carry on the great public schemes must be proof against the most fatiguing delays, the most mortifying disappointments, the most shocking insults, and worst of all, the presumptuous judgment of the ignorant upon their designs.”
Edmund Burke
I penned a similar piece well over a decade ago. Right here in HISTalk. If you really want to know why not? Ask the right wing conservatives that fear government intrusion, and also the left wing ACLU proponents that have the same fear but expressed differently.
The opt-in /opt-out idea has been proposed a hundred times and but never gets a hearing. I believe we will see widespread atomic energy deployed again before we see a UPI.
Meanwhile we can keep complaining about the lack of interoperability while vendors jury-rig their system to link a patient’s data cross care levels. You can file those complaints under “the price of freedom”.
A question for those who advocate a national patient identifier….For many years health systems asked for your SSN. This was one attribute in a set of several used to match and link your identity across the enterprise. One’s SSN is a national ID, it is unique (minus a few instances where that has proven not to be case), it stays with you for the duration of your life (once again, minus a few instances where that is not the case)…but we never relied solely on the SSN to be the definitive authoritative attribute that linked Patient A to Patient B. Always included in the set were the patient’s name, DoB, Sex, and other demographic details. The SSN was certainly highly weighted but it wasn’t the end all – be all solving patient matching.
Years later, most health systems phased out the collection and use of the patient’s SSN. Some deprecated this field entirely from their systems while others chose to use the last 4 digits as a data point useful for patient matching.
If the SSN didn’t solve the challenge of patient matching, why do we think that a national patient identifier will be any different?
I’m not particularly invested in this topic, but I do want to point out that SSN is not directly comparable because it controls so much else in your life. Patients have always been very wary to give that information out because when the inevitable data breach happens, the SSN can be used for identity theft that is very difficult to fix and might ruin someone’s life. The idea with the unique identifier is that patients would be more comfortable using a number that does not tie to their financials. For the orgs I’ve worked with, that has been the driving factor to downplay SSN collection in various areas. Not much of a point if everyone is going to use all 0s or all 9s anyway.
There are additional circumstances that make the SSN a bad identifier. One of them is that up to a certain time, you could determine where a SSN was issued (at least down to the state, if not a large metro area), which for naturally born citizens would correspond to their birthplace, making its use for identity theft that more potent.
I’ve heard numbers from people who should know that HALF the SSNs out there have been used by non-owners. I’ve personally run into several examples in insurance.
SSN is not a good patient identifier. When working for an intercity health organization during data analysis checks, it was discovered that we had multiple patients (30+) with the same SSN. So hard pass on using SSN as a patient identifier.
From the world of Finance: G/L numbers, which are strictly controlled.
From the world of IT: Ticket numbers, to track work
From the world of Vehicles: License plate numbers and Driver’s license numbers and VINs
From the world of Insurance: Policy numbers
From the world of Business: Incorporated names
From the world of Land Management: Plot numbers
From the world of Employment: Employee numbers
What we are doing in healthcare, makes no sense. I bought the citizen privacy story for a long time, but no longer. We’re paying a high price and we still have identity theft, hacking, intrusions, and loss of protected information. I massively doubt that creating a unique healthcare number makes our security & privacy systems any worse, at all.
Meanwhile, identity management, healthcare delivery, and protection of the client from clinical mistakes, would all get better.