While a national patient identifier could help ease patient-matching woes among providers, it's not the ultimate solution, experts shared during the 2020 annual meeting of HHS' Office of the National Coordinator for Health Information Technology.
"We know unique identifiers would be helpful, but not a panacea," said Ben Moscovitch, project director for health IT at the Pew Charitable Trusts, during a panel discussion on unique patient identifiers Monday. "It would be used in addition to the other demographic data already in use today for matching."
For decades, Congress has prohibited HHS from allocating funds for developing a national patient identifier—which would give patients permanent, unique identification numbers—citing issues related to privacy and security. But the discussion has been reopened in recent years, in part due to pressure from health IT groups.
The U.S. House of Representatives last year passed an amendment to reverse the longtime ban as part of its $99.4 billion HHS appropriations bill. The Senate opted not to lift the funding ban in its version of the bill.
During remarks at the ONC's annual meeting, one of the representatives who introduced the amendment, Rep. Bill Foster (D-Ill.), argued that improved patient-matching could help to reduce medication errors and "doctor shopping" for opioids, among other challenges in the healthcare industry.
"Repeatedly, (unique identifiers) would tackle a known problem in our healthcare system" he said. "It's obviously only one step of many, but it's an important one."
Although matching patients with their medical information sounds like a simple concept, it's not. The practice is plagued by such issues as typos, missing data, similar names and new addresses, creating possible patient-safety and reimbursement issues—with inaccurate patient identification accounting for an average $1.5 million in denied claims per hospital each year.
But while a unique patient identifier would be helpful for matching patients, it would still be just one of many identifiers considered —"not the only data point," Mary Beth Kurilo, policy and planning director at the American Immunization Registry Association, a group that encourages development of immunization information systems, said during the panel discussion Monday.
There are arguably already unique identifiers in healthcare, said Blake Hall, founder and CEO of ID.me, a company focused on identity authentication.
"I want to challenge the notion that a unique patient identifier would be a panacea," he said, noting Social Security numbers, driver's licenses and—for companies with advanced technology—physical characteristics, like a scan of someone's face, all could be considered unique identifiers.
The problem, according to Hall, isn't that an identifier doesn't exist—it's authenticating that someone presenting that information really is who that person claims to be. Having multiple identifiers for cross-referencing helps with that authentication, hopefully reducing the risk of concerns like fraud and identity theft.
Another concern, shared by Dr. Sarah Corley, chief medical officer at Mitre Corp.'s center for veterans enterprise transformation, is that it's challenging to create a system that truly includes everyone in the U.S.
Today, not everyone has a Social Security number, driver's license, cell phone number, or other identifier that one might want to apply across the industry. And even with a unique patient identifier, that might not account for non-U.S. citizens seeking care.
While Corley said she liked the concept of a unique patient identifier, she emphasized any system would need to be tested first, to determine where secondary forms of authentication would help to ensure the right match.
Even if Congress lifted the ban on unique patient identifiers, the healthcare industry would still be "years out" from deploying a program nationwide, Moscovitch said. He emphasized there are steps the government and private sector can take today to address patient-matching challenges, such as standardizing how demographic data like addresses and email addresses are collected.
A focus on demographic data—rather than a mandatory patient identifier—also gives patients control over what information is shared with a provider. While a unique patient identifier would be assigned to a patient, using a characteristic like e-mail addresses allows the patient to select which email address they want to use, said Dr. Adrian Gropper, chief technology officer of advocacy group Patient Privacy Rights.
"That helps with privacy … and introduces some level of consent," he said.
