Why isn’t a national patient identifier enough?

In a landmark decision, the House recently amended a bill that limited HHS’ ability to assist in funding and researching a national patient identifier.

This amendment introduced by Bill Foster (D-IL) and Mike Kelly (R-PA) aims to improve patient safety and care coordination by empowering HHS to explore patient matching solutions and work with the private sector to find innovative and trustworthy solutions. Learn more about the amendment on Bill Foster’s website.

This is a step in a positive direction, acknowledging the importance of innovation in patient matching. Our current poor state of patient matching is a testament to the need for innovation.  Patient records are inappropriately linked together for a variety of non-malicious reasons: a keystroke error inputs a wrong name that prohibits an old record from matching with a new record, Bill Senior and Bill Junior live in the same home creating a puzzle some technology can’t solve. These innocuous errors cause 30% of patient identity information in databases to be inaccurate, incomplete, or out-of-date. As a result, many patient records are not properly linked putting patient safety at risk and making care coordination very difficult.

Unfortunately, many people believe that the only patient matching innovation possible is the creation of a universal patient identifier, or UPI. A UPI would provide a single unique health ID number for every US resident and citizen, and it would be the unambiguous thread that ties all medical records across all institutions to the correct person.

This is not the first time that there has been a push for a UPI. Congress banned the concept back in the 90’s due to privacy concerns. In 2017, subsequent requests for the development of a UPI were also denied, because of the heightened specter of it being used to “track” people much more effectively. Many people now feel that innovations in demographic matching (i.e., Referential Matching) combined with biometrics can solve the problem and will leave a tangible amount of control in the hands of individuals.

Patient matching challenge and UPIs

We should look at UPIs, not as the solution, but as one more tool to help with patient matching. It is not a magic elixir that will completely cure the challenges posed by duplicate records because:

  • It will likely take a dozen years to assign a UPI to everyone in the country (look at the time it took Medicare to design and distribute its new Medicare number to 60M well-known, high-utilizing, registered individuals.)
  • UPIs will be very expensive to distribute and maintain (look how many people are dedicated to managing driver’s licenses and the length of DMV lines.)
  • It will take at least a generation for the new UPI numbers to permeate the immense installed base of medical records at thousands of healthcare systems and payers across the country, and for older medical records without UPIs to be retired as a generation deceases.

And all of these sober predictions pre-suppose that we do everything right when setting up the UPI program for the first time… fat chance!

The theory behind a UPI is that once a person receives it, it will be inserted into all of her medical records everywhere, and she will present it every time she seeks medical services. This will then allow all of her medical records to be automatically linked within and across health systems with unambiguous precision.

Our experience tells us otherwise. There have already been unique identifiers issued on a national level, e.g. Social Security numbers, Medicare Beneficiary ID numbers, etc., that still do not achieve perfect match rates. These numbers are stolen, not remembered, wrongly transcribed, mishandled in processing, and abused by their owners. Think of how many times your simple loyalty card number has failed to associate all of your purchases to you. Thus, we know that any issued number cannot be relied upon just by itself. Numbers will help, just like phone numbers and email addresses will help, but it will take 20 years for the UPIs to be in enough hands, in enough EHRs, in enough health systems, enough claims systems at enough payers, in enough government systems, and embedded in enough medical records to make all the difference.

Verato’s view is that the current state of patient matching today solves about 70% of the problem, and that many health systems address (not solve) the remaining 30% by wallowing around with manual adjudication. We believe a next generation of patient matching uses referential matching for patient identity resolution and can solve 90% of this problem tomorrow. Solved with no change to existing medical records, no imposition or dependency on consumers, and no imposition of new privacy concerns. For the remaining 10%, we believe that biometrics, smart phones, or UPIs can fill this gap. Once you believe that patient matching is a 90/10 problem, the question about UPIs becomes, is it worthwhile to invest an extraordinary amount of money and manpower, suffer very divisive privacy concerns, and wait 20 years for a UPI strategy to solve the remaining 10%? Or, can we solve that remaining 10% with a simpler incremental addition of biometrics or smartphone identifiers at a fraction of the cost, time, and privacy impact? We believe that rational minds will conclude the latter.

Patient matching needs a solution today

There is overwhelming consensus across the industry and government that patient matching must be solved today. Poor patient matching results in rising health care costs, the inability to deliver patient-centered care, and significant risks to patient safety. In addition to exploring the feasibility of a UPI, healthcare stakeholders must look to the innovations in patient matching that are already proven, but not yet exploited. They also need to represent workable, cost-effective approaches that solve 90% of the problem in short order.

So, as we lift the ban on government support for patient matching solutions, let’s make sure we don’t overly focus on UPIs as the solution. Let’s urge government to explore existing working alternatives. This will ensure we don’t boil the ocean to cook a bunch of fish.