March 1, 2023 | 5 minute read
Senior Principal Product Manager, Oracle Health
Nearly a decade ago, a prolific US advertisement was released in December just in time for the holidays. This ad featured a young person wearing traditional plaid flannel pajamas and glasses, sipping hot chocolate. It prominently featured the hashtag “#GetTalking,” requesting (demanding?) that we discuss getting health insurance with our families over the holidays. The intent was to drive a deep and meaningful conversation about the lack of easily accessible health insurance and set the stage for compliance with the Affordable Care Act (ACA), commonly known as “Obamacare.”
Unfortunately, the ad was widely panned by both sides of the political spectrum because, after all, who doesn’t want to discuss a highly politicized topic with their families during the holidays? Few of us honored the imperative of the ad, and “pajama boy” is remembered more for being meme fodder than for advancing the discussion of insurance availability and healthcare cost. Few would argue that healthcare in the US is affordable, and examples abound where serious injury or long-term illness bankrupt a family that was previously financially solvent. Would universal health insurance solve the problem of unaffordability, or did we miss a real opportunity to identify and discuss one of the true culprits of ever-rising healthcare costs?
Had we followed the imperative and invested the time to delve into the deepest, darkest nooks and crannies of healthcare, we very well may have discovered that while, yes, healthcare is very expensive, one of the primary reasons for its high cost is misidentification of patients during the treatment process.
The true cost of patient misidentification
Patient identity (or lack thereof) is a contributor to skyrocketing healthcare costs. In the US alone, the American Health Information Management Association (AHIMA) estimates that as many as 10% of patient records are duplicates. These misidentifications—which occur when systems or people fail to accurately identify patients or match them to existing records of care—can be linked to as much as 33% of payer-rejected medical claims, costing the US healthcare system as much as $6 billion annually. How does misidentification impact patients? Simply put, just like all increases in the cost of doing business, these can be passed on to the patient in the form of responsibility for payment or as an increase in service prices to offset losses.
Even more concerning than the financial ramifications is patient misidentification’s impact on patient outcomes. AHIMA states, “Risk management professionals have confirmed that duplicate records have caused negative outcomes in the discovery phase of the litigation process because there will be discrepancies with diagnoses, medications, and allergies.”1 This scenario is frighteningly real. For example, the failure to correctly match a patient to a known allergy for something as simple as penicillin could lead to anaphylaxis, or worse.
National patient identifiers in the US and abroad
Beyond the scope of helping to reduce healthcare costs, many countries have national patient identity (NPID) systems in place, which help ensure proper patient identity and facilitate the sharing of clinical data between systems. According to Gartner,2 “more than 30 countries have national health programs, and many issue insurance or entitlement cards with unique identifiers to their citizens.”
The US doesn’t have any form of NPID system, and no such system exists on a global scale to facilitate clinical data exchange across international borders. While the enactment of the Health Insurance Portability and Accountability Act (HIPAA) in 1996 required that the US Department of Health and Human Services (HHS) develop a universal patient identifier (UPI) standard, this mandate was never implemented. As a result, each electronic health record (EHR) typically creates its own system-specific patient identifier and then relies on non-discrete information such as name, date of birth, and residential address to determine identity.
Had we followed the imperative and invested the time to delve into the deepest, darkest nooks and crannies of healthcare, we very well may have discovered that while, yes, healthcare is very expensive, one of the primary reasons for its high cost is misidentification of patients during the treatment process.
A case for UPI in the US
A UPI has the potential to significantly improve healthcare by ensuring accurate patient matching across disparate EHR systems, resulting in more immediate and robust exchange of health information. If integrated with patient identity systems from other countries, the UPI could help ensure the accurate exchange of current and historical healthcare information across international borders.
Consider this as an example: What if you were traveling abroad, involved in a motor vehicle accident, and unable to provide details regarding your medical history due to your injuries? If the emergency medical services in that country you were visiting could “break the glass” and acquire your historical medical information in an emergent treatment scenario, your potential for a positive outcome increases.
Why was the HIPAA requirement for UPI never implemented? In 1999, funding for the UPI requirement was suspended due to privacy concerns. In today’s climate of identity theft, how many of us still willingly provide our Social Security number when asked? Gartner states, “Much of the controversy surrounding NPID involves privacy and security issues and the desire to protect the individual’s personal information from disclosure, fraud, and misuse. NPID opponents believe the harm it causes—in terms of physician-patient trust and the risks to individual privacy rights—outweighs its purported clinical and financial benefits.”3
It’s important to acknowledge potential barriers to success—specifically, public acceptance—when much of the population has a general distrust for centralized repositories that store their personal information. At the same time, most of us carry mobile devices in our pockets that store biometric identification information in the form of fingerprints or facial recognition and never give it a second thought. The cognitive dissonance of the inability to reconcile the importance of positive identification in the healthcare space versus the value of unlocking one’s phone without having to input a passcode is staggering.
The way forward
One component of the Oracle Health vision is a unified health record, and positive patient identity is a cornerstone to achieving this goal. It’s nearly impossible to create an aggregated health record without ensuring information is precisely matched to the correct patient.
Fortunately, Oracle is well-positioned to address these challenges. The combination of our inherent ability to handle big data and make that data available globally via Oracle Cloud Infrastructure (OCI) affords us the opportunity to reimagine what a national (and even global) person index for healthcare might look like. The Oracle Healthcare Master Patient Index (OHMPI) has the potential to be elevated to an OCI service and extended to incorporate features such as referential matching and biometric signatures.
Imagine a world in which you could securely and automatically register with a new medical provider, and your clinical history is seamlessly incorporated into that new provider’s EHR—without having to fill out any paper forms. Envision checking in for a visit simply by walking through the door, facial recognition handling the check-in process. Imagine if your medical history were contained in a blockchain “medical wallet” so you always had custody of that information. The list of possibilities goes on. All we must do to realize these possibilities is invest in the application of technologies already available to the healthcare industry.
Related resources:
1 Shannon Harris, “Double Trouble,” Journal of AHIMA 89, no. 8 (September 2018): 20–23.
2 Gartner, “Prepare Now for the U.S. National Patient Identifier,” G00761070 (February 2022): 2.
3 Ibid.
Article link: https://blogs.oracle.com/healthcare/post/patient-matching-an-identity-crisis-in-healthcare?
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