How national patient identifiers that improve data quality could ultimately transform healthcare outcomes
Terry has an appointment with an orthopedist. When she meets with the doctor, she says the history of her problem and her recent MRI can be found in her medical records, all of which should have been transferred to him from her various providers. However, the orthopedist hasn’t received them and can’t diagnose her until he does. Scott arrives at the hospital to receive medication that requires a blood test be administered first. He insists the test has already been done, and he is clear to take the medicine. The provider can’t find the lab records associated with that patient and is forced to repeat the test.
Linda arrives by ambulance to an emergency room. She is unconscious and alone. ER personnel find her driver’s license in her purse. When they enter her name and birthdate into their system, they see a match. Unfortunately, the match is incorrect and they begin treating her based on information in a different patient’s records.
The consequences of incorrectly linking patient records can range from minor inconvenience and added costs to treatment that places a patient’s safety in jeopardy, which is why many healthcare professionals are now calling for the creation of national patient identifiers.
A numeric identity for every patient
In 1996, HIPAA legislation called for the development of a national patient identifier system, but the industry is still debating the best solution. It’s important to define what a national patient identifier is as much as what it is not to fully understand its place in healthcare. A national patient identifier would assign a unique number to every individual patient and member engaging in and across our healthcare delivery system.
Think of it as a healthcare version of a Social Security Number with one important difference. While it would have tremendous value in the healthcare ecosystem for linking member and patient records, a national patient identifier would not have any value as a financial identifier, rendering it unattractive for financial related crimes.
Utilized by hospitals, healthcare insurers, physician practices, pharmacies and other medical facilities nationwide, this identifier would allow information to be aggregated and linked to patients with high levels of confidence.
The joining of medical records from disparate providers and care settings, with the patient’s consent, would give clinicians immediate access to a clear, complete picture of the patient’s health. The result would be faster, more-informed decisions based on complete diagnosis and treatment information. It’s a win-win for the provider, the payer, and most importantly, the patient.
Aren’t names and birthdays enough?
In a word, no. As the population grows and more health records are made digital, the number of people with the same name and other similar personal data multiplies. When looking at the health records for Tom Smith, how can clinicians be sure they’ve found the right Tom Smith? How can they be positive that all the information in that file belongs to the Tom Smith they’re treating?
Every scan, lab test, doctor appointment and hospital stay becomes an additional point at which mistakes and mismatched information can be introduced into a patient’s medical records.
Adding to the problem is the common practice of creating a new record for a patient if healthcare staff can’t quickly locate a patient’s record that is already in their system. A duplicate record spreads a patient’s health data over multiple charts, so the record pulled up at any one time may be missing important details such as a patient's allergies, lab results and medications.
Mismatched records put patients at risk
Traditional patient identifiers, such as oral demographic data, Social Security Numbers, and patients’ addresses, can be easily mistyped, which can then lead to mismatched records. When you factor in human error, these basic and common data points have the potential to render themselves more of a risk than an asset.
Medical records are critical to a patient's identity in the healthcare system. Reading the wrong person’s records or viewing incomplete records jeopardizes patient safety. Preventable medical errors are the third leading cause of death in the United States, causing an estimated 440,000 deaths per year.1
Mismatched records also raise costs for providers and payers by potentially leading to:
• Incorrect diagnosis and treatment
• Redundant tests and services
• Unnecessary hospitalizations
• Productivity loss
Most of the time, mismatched records are caught and only cause frustration to the patient and staff. When they go undetected, the consequences can be dire, even life-threatening.
A patient number versus a name
A national patient identifier would help prevent identity mix-ups, which can occur anywhere on a patient’s healthcare journey. Many record linking challenges that exist when using patient names and birthdates would be eliminated with a unique patient number including:
• Duplicate records for the same patient
• Clerical errors such as typos
• Variations in hyphenated names
• Use of middle names vs. middle initials
• Inconsistent use of suffixes like junior and senior
A national patient identifier can be assigned using sophisticated linking technology and a referential database so the patient’s records can be linked. When patient records are matched against a referential database, any duplicates, errors and inconsistencies are more easily detected.
A referential database is a single source of truth that is continually updated. Each additional piece of information tracks changes in the patient’s life and improves the chances of matching patient records correctly now and in the future.
Linked records create a complete picture
Clinicians want a holistic view of their patients. A national patient identifier that gives healthcare providers access to a patient’s full medical history—including diagnoses, procedures, pathology, lab reports, and prescriptions—rather than just a snapshot view acquired in a single visit, would enable doctors to reach an accurate diagnosis more quickly and cost-effectively.
National patient identifiers would also facilitate information-sharing among doctors. They would simplify referrals and continuity of care post-hospital discharge by allowing clinicians to link records to patients when they are transferred.
Establishing guidelines
For a national patient identifier system to work, it must meet the following parameters:
• Every individual must have a single, unique identifier.
• Patients determine who has access to their information. Records cannot be shared without their permission.
• Providers must be authorized and verified before being given access.
• Identifiers, and therefore patients’ medical records, follow patients for life as they age, move, work for different employers, change their name (i.e. marriage), etc.
A win for payers, providers and patients
As healthcare organizations focus on improving the patient experience and reducing their cost of care, the implementation of a national patient identifier system could be a significant step in the right direction.
It would simplify sharing patient data between providers. Patient privacy and security would be enhanced with less sensitive data at risk. Care could be provided more efficiently, which would lower costs for payers and providers.
Most importantly, patients could feel confident that their physicians are viewing the right medical records—not those of someone else with the same name—and getting a comprehensive picture of their medical history before making decisions about their care, resulting in better health outcomes.
1 Source: https://www.imprivata.com/blog/4-statistics-prove-theres-patient-identification-crisis
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About the author:
Erin Benson, Director Market Planning – LexisNexis Risk Solutions
Ms. Benson serves LexisNexis Health Care as Director, Market Planning. Her focus is on the development and execution of strategic planning for Identity Management and Socioeconomic Determinants of Health solutions. Prior to joining LexisNexis, Ms. Benson worked at Deloitte Consulting. She holds a Bachelor’s and Master’s degree in Human and Organizational Development from Vanderbilt University and an MBA in Strategy and Management from Duke University, The Fuqua School of Business.
LexisNexis Risk Solutions Health Care solutions combine proprietary analytics, science and technology with the industry’s leading sources of provider, member, claims and public records information to improve cost savings, health outcomes, data quality, compliance and exposure to fraud, waste and abuse. For more information, please visit www.risk.lexisnexis.com.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.