Experts convened by HHS' Office of the National Coordinator for Health Information Technology clashed over the role a national patient identifier could play in improving patient-matching among healthcare organizations.
A national patient identifier—which would give patients permanent, unique identification numbers—has been banned by Congress for decades on account of privacy and security concerns, but the discussion has been reopened in recent years, in part due to pressure from health IT groups.
"We believe there are a few things that absolutely need to be done as soon as possible," said Russell Branzell, CEO and president of the College of Healthcare Information Executives, at a working session on patient identity and patient matching that ONC hosted on Monday. "One is to continue to fight and get the ban removed from Congressional appropriations language. We need to get that done as soon as possible."
ONC officials said they will use feedback from the more than two dozen speakers who presented on patient identity and patient matching during the session to inform a report to Congress this year. Congress last year directed ONC to submit a report evaluating current patient identification practices and recommendations for future approaches.
"This is a bit of an 'inside baseball' kind of topic," ONC chief Dr. Donald Rucker said. But "it's a thorny problem for a number of deeply fundamental reasons—the challenge of balancing privacy, security, innovation and the role of government."
Much of the conversation at the working session centered on the potential for a national patient identifier to ease patient-matching challenges.
Mismatched records can cost hospitals money spent on duplicative medical care costs and denied claims, not to mention time that health information management employees spend resolving duplicate or erroneously merged records. There's also a clinical concern, since a physician presented with incorrect information about a patient won't be providing the best care.
Matching patients to the right record could prove particularly important during the COVID-19 pandemic, as public health entities need longitudinal data to inform national response.
"What are the clinical trajectories of individual patients? What is the range? How do we look at immunity, serology?" Rucker said. To answer those questions, researchers and healthcare organizations will need to be able to track individuals over time and across providers, and be able to exchange their health information accurately.
Rep. Bill Foster (D-Ill.), a representative who introduced an amendment to reverse Congress' ban on a national patient identifier last year, said patient-matching and interoperability issues that have arisen in the wake of COVID-19 underscore reasons to overturn the ban—calling the prohibition "archaic."
Ed Hammond, director of the Duke Center for Health Informatics, argued that unique patient identifiers would have a much lower error rate than the patient-matching algorithms that are popular today, which tend to have error rates between 2-18%, he said.
But others stressed that while a national patient identifier would link patients with a unique number to identify them, that's not necessarily enough to authenticate a patient.
A unique patient identifier wouldn't be a secret, like a Social Security number. It would be shared with multiple organizations, and shouldn't be used as the only method to authenticate or prove that a person is who they say they are, said Alan Viars, president of Videntity, a software company that develops tools for identity management.
"Identifiers by themselves should not be used as a form of identity-proofing," he said. "Just because you know your Social Security number does not mean you are you."
Ben Moscovitch, project director for health IT at the Pew Charitable Trusts, pushed back on the idea that a national patient identifier would solve patient-matching issues.
Even if the ban is repealed, it would take years to implement—so it's important to continue to consider short-term solutions for patient matching.
"Unique identifiers would certainly improve match rates, but they wouldn't be a panacea," Moscovitch said, noting patient-matching rates aren't 100% even in countries that have issued national ID numbers. A national patient identifier would likely be used in addition to other demographic data already in use today for matching.
Patient matching is a complex issue, which will likely require a mix of improvements related to data standards, new types of data, innovative technologies and other best practices.
Still, experts noted that by prohibiting development of a national patient identifier, Congress' ban has also stifled the ability to evaluate its potential. Even if a national patient identifier isn't the ultimate solution to patient-matching issues, it's still a possibility to consider.
Removing a federal funding ban on unique patient identifiers is just one step to "open up a national dialogue" on patient matching, said Marc Probst, vice president and chief information officer at Intermountain Healthcare.