The latest in a series of efforts, ID advocates ask congressional appropriations committees to end the ban on government support for a national ID standard.
May 16 22
Dozens of healthcare organizations are yet again urging Congress to not impede efforts to create a national unique patient identifier.
In a letter sent to the House and Senate appropriations committees, some 119 organizations ask legislators to not include language in any legislative proposal that would prohibit the Department of Health and Human Services from spending federal money “to promulgate or adopt a national unique patient health identifier standard.”
HIPAA, enacted in 1996, called for creation of a national patient identifier. Since 1999, however, Congress has prevented federal agencies from pursuing an identifier, citing concern about patient privacy risks. But a growing phalanx of healthcare organizations says an ID would lead to far better healthcare coordination, which was lacking in dealing with the COVID-19 pandemic.
Dr. John Lee, CMIO, Allegheny Health Network
“If you have dozens of different ways of identifying patients, you don’t have a system.”
The lack of a uniform patient ID also results in expensive and unnecessary records duplication that puts patient safety at risk, according to the Patient ID Now Coalition, which includes the College of Healthcare Information Management Executives, and others that signed the letter.
Earlier efforts fall short
Last fall, the latest in a long series of efforts to eliminate roadblocks to federal involvement in the creation of a national patient ID approach fell short. A draft funding bill by the Senate Appropriations Committee sought to remove the ban, but final language was amended to contain the ban. The House Appropriations Committee has removed the ban from its bill the last three fiscal years.
The healthcare organizations’ letter, addressed to heads of both the House and Senate appropriations panels, calls the ban “archaic” and urges that it be removed from FY 2023 budgets for the departments of Health and Human Services, Labor, Education and related agencies.
“We urge the (committees) to continue the bipartisan support of repeal in Congress and ensure that Section 510, the archaic funding ban on a national unique health identifier, is NOT included in the FY2023 Labor, Health and Human Services, Education, and Related Agencies Appropriations bill,” the letter states.
Removing the language in Section 510 will enable HHS to evaluate patient identification solutions and collaborate with the private sector to identify a national strategy for patient identification that both protects privacy and is cost-effective and secure, the organizations contend.
The letter – as well as a May 11 presentation hosted by CHIME and the Patient ID Now Coalition – describe the challenges caused by the lack of a unified system for identifying patients and matching them to all their electronic records from various sources.
The letter contends: “Without the ability of clinicians to correctly connect a patient with their medical record, lives have been lost and medical errors have needlessly occurred. These are situations that could have been avoided had patients been able to be accurately identified and matched with their records.”
The ECRI Institute has listed patient misidentification among its top 10 threats to patient safety, the letter notes.
In addition to the safety concerns, the current hodge-podge approach to patient identification places an unnecessary burden and significant costs on all players in the healthcare industry, the letter states.
“The expense of repeated medical care due to duplicate records costs an average of $1,950 per patient inpatient stay, and over $1,700 per emergency department visit,” the letter-writers contend. “Some 35 percent of all denied claims result from inaccurate patient identification, costing the average hospital $2.5 million and the U.S. healthcare system over $6.7 billion annually.”
Healthcare organizations shoulder the burden of trying to match patients to records and unravel confusion from duplicate records, says Rachel Podczervinski, vice president for professional services at Just Associates, a consultancy. The increase in the number of mergers and acquisitions among providers, as well as increased use of portals, telehealth and patient self-scheduling, has exacerbated patient matching challenges.
Mistakes in merging records “are a major risk to patient safety,” she adds. “If you pull up someone else’s record who has similar (demographic) information and attach them to someone’s records, that person will be treated based on information in that other record. You have the potential to kill a patient because, for example, you have the wrong blood type and you may give them the wrong blood product.”
Patient self-registration has resulted in more record duplication she adds, noting that one system with which she works recorded one patient with 24 different identities linked to separate registrations. Such instances have increased because of the pandemic and the increase in virtual care.
Clinicians and reform face problems
Clinicians are already facing more data from electronic records systems, and confusion about matching patients to all those records is complicating their efforts to effectively use the information that systems contain, says John Lee, MD, chief medical information officer of Allegheny Health Network.
“There are a lot of changes that are occurring in the healthcare system,” Lee explains. “The biggest thing is the volume of data that we’re being exposed to. It’s a fallacy to think that if you just know the patient in front of you, then you can take care of that patient.
“What we’re limited by now is that we have too much information. The only way to parse and organize that information is by having a better patient ID system. That’s where it starts.”
Organizations use algorithms to match patients to all the right records, but that’s not always an effective approach.
The transition to value-based care also will be impeded by the lack of a national patient ID because identity verification is a necessary component for achieving population health efforts, Lee says. “If we want to get off of fee-for-service, we need to develop a much more accurate patient identification system. Right now, (identification is) wholly inadequate,” he says. Precision medicine requires precise patient identification, he contends.
Some patients are more affected by the lack of a patient identifier than others. For example, pediatric patients, especially those with complex care needs who are seeing a variety of specialists, are particularly at risk of misidentification, Karen Wilding, vice president and chief value officer at Nemours Children’s Health, points out.
Organizations use algorithms to match patients to all the right records, but that’s not always an effective approach. For example, migrant workers often don’t have Social Security numbers or permanent addresses, and certain populations from other countries often don’t know their birthdates and are assigned Jan. 1 as the date, with an estimate for which year they were born, Podczervinski says.
Government needs to be at the table
The healthcare organizations prodding Congress say the government doesn’t necessarily have to be the developer of a unified patient ID system. But because the government is a major healthcare payer and provider, it needs to be at the table and provide the broad strokes that will unify divergent and conflicting patient ID approaches.
“The government has a role in maybe not being the arbiter, but setting a foundation and structure upon which other things can reside,” Lee contends. “This way, it’s not a free-for-all for everyone trying to identify someone – we need standard ‘rules of the road.’ Based on the current interpretation of Section 510, the government cannot even come up with the rules of the road, because that involves money. We need it to say that this is the framework; these are the guardrails.
“If you have dozens of different ways (of identifying patients), you don’t have a system then. The opportunity to fix this is sitting in front of our face.”