ONC looks to improve patient-record matching technology

Every day when a patient goes to the drug store, within the course of a few questions and a few key strokes, a clerk or pharmacist can match that patient to the right electronic prescription and insurance records in their computer system.

It's accomplished with probabilistic matching, relying on five key data elements—the patient's first and last names, date of birth, address and sex. The same basic technique is used throughout the country to match patient-care summaries and full electronic health records in queries by providers to health information exchanges.

The systems used today can, when properly implemented, “achieve extraordinarily high” rates of accurate matching, said Lee Stevens, policy director for the state health information exchange program within HHS' Office of the National Coordinator for Health Information Technology.

And yet, the ONC has just launched a multi-organizational initiative to take what works best with patient/record matching today and make it even better, and then promulgate it nationwide.

“The role of federal government is to look out there across the country and find the absolute best way to standardize those fields,” Stevens said. “Some people put it in different arrangements. It would be last name in the first field. Some do it first name, middle and last.” So, is it St. or is it Street? Is it avenue or Ave.? Is it Apt. No. or Apt. #?” Consensus answers to those questions are what the group wants to reach.

“We've really got to find out which one of those ways produces the highest matches in current systems and standardize that and say, this is the way we do it in professional care,” Stevens said. “We've got to get that straight.”

Other industries are way ahead of healthcare in this.

“If you buy something on Amazon.com, when you put your address in, it will come back and say, 'We've corrected your address, please confirm,” Stevens said. “The way they do that is they ping the U.S. Postal Service. That's an open API. It's not hard to do that. It automatically adds the four digits to the ZIP code. There are just some blazingly obviously things we need to do.”

This week, Apple announced the launch of its newest iPhone with a fingerprint scanner for security, and Stevens said he can “guarantee” Google's competing Android operating system will have its own soon.

Even if healthcare moves to ubiquitous use of biometric patient identification and matching, and it's used to identify the proverbial unconscious patent wheeled into the emergency room without any ID, “it would (still) need those five data fields in standardized way,” Stevens said. “The fundamental underpinnings of the name, address, birth date, and cell phone numbers have to be standardized the same ways to create interoperability.”

The goal is to scour the country and have a list of recommendations to present to ONC's Health Information Technology Policy Committee by the end of the year.

And, oh, by the way, resurrecting a single, uniform patient identifier is not on the group's agenda.

“We're not touching a national patient identifier, but even if we had one, you'd need to know those five things,” Stevens said.

Follow Joseph Conn on Twitter: @MHJConn