The NPI has been the electric third rail of health IT since it was first included among several numeric identifiers required by the Health Insurance Portability and Accountability Act of 1996. Providers and health plans have since adopted their own respective HIPAA-mandated numerators, but privacy advocates attacked the patient identifier, then-Vice President Al Gore did, too. In 1998, he banned work on its development until health IT privacy and security issues could be resolved. Congress quickly followed suit, blocking any federal spending on development of a patient identifier until adequate privacy protections have been put in place.
There have been many attempts since then to resurrect the NPI. All have failed.
Sudomir said he'd like to see someone quantify the resultant “ball of the waste that occurs (due) to mismatching” of patient records.
Spooner said Sharp employs the equivalent of 10 full-time workers clearing up patient record matching issues.
Fellow panelist Stacie Durkin, founder of Durkin & Associates, a Kansas City, Mo., health IT consultant, had some numbers from a Healthcare Financial Management Association study indicating the snarl caused by mismatches discovered on the records of discharged patients cost between $600 to $800 to undo. Another study, across all businesses, suggests the lost revenue to the healthcare industry due to mismatches of customer records could run into the billions of dollars, according to Durkin.
CHIME President and CEO Russell Branzell, who was moderating the record-matching panel, and who recently questioned Dr. Farzad Mostashari about the possibility of revisiting the national patient identifier during an earlier CHIME session, confirmed that the former head of the Office of National Coordinator for Health Information Technology offered no hope that federal opposition to an NPI would change anytime soon. CHIME has a workgroup focused on patient/record matching alternatives.
Spooner said change will come eventually as younger, more computer-comfortable generations create a majority in the overall population.
“The argument that comes back to me, well, that wouldn't be perfect, but I'd be a lot better if I had a better identifier,” Spooner said. “The real opponents are the privacy advocates,” but “nobody under 30 years of age cares about privacy. Out once we get past that, those barriers will fall,” he predicts.
Meanwhile, biometric ID devices, such as fingerprint and palm scanners, are making some inroads as patient identifiers. Texas Health Partners is looking into biometrics, Sudomir said. Sharp already uses a palm scanner, Spooner said.
But, “that's a partial solution,” Spooner said. “That only works when the patient is there. When they're not there and you need to send the record over to another provider, you can't send them the patient's hand.”
Spooner said he'd like to see local communities doing more experimenting, with providers collaborating around the adoption of a common local patient identifier, since most healthcare interactions occur with patients living in the same region as the provider. Patient identification and authentication could be a service provided by local health information exchanges, many of which are struggling to find revenues.
“I think there could be some really good pilots in communities like my own and really identify some best practices,” Spooner said. “HIEs could definitely be the clearinghouse. Let's explore and see what works. We could do that without Congress passing a law.”
Follow Joseph Conn on Twitter: @MHJConn
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