Stakeholders Remind Congress Why Unique Identifiers Would Help

The Patient ID Now Coalition was founded in 2020 and has grown to more than 50 members pushing Congress for repeal of a ban on using federal funds to adopt a unique patient health standard and advancing a national strategy to address patient identification and matching. During a recent webinar, stakeholders explained why this issue remains so crucial to patient safety and interoperability.

John Lee, M.D., chief medical information officer for Allegheny Health Network in Western Pennsylvania, said the impact of patient misidentification on patient care falls into three main categories. There's the risk of patients getting the wrong treatment. He mentioned one example of a patient receiving an inappropriate antibiotic because the allergy information that had been attributed to the patient was actually from a patient with a similar name. Lee said he knew of another patient who couldn't get their COVID vaccine, because according to the records, that patient had already received a vaccine. Their record had been overlaid with another patient's record. “I can tell you that that sort of thing happens at scale, on a repeated basis, throughout our healthcare system,” he said.

Beyond individual healthcare episodes, if we want to get off of fee for service and actually get to true population health, we need to be able to identify our patients across provider organizations, Lee said, “and we can't do that without a much more developed and much more accurate patient identifier filing system, because right now it's wholly inadequate.”

The step beyond that is knowledge generation, Lee said. If we have large amounts of data at scale, then we can identify situations where certain drugs or therapies may be particularly worthwhile and be able to focus in on some of the precision medicine efforts that we want to develop with big data and genomics. “I do not believe that there's any privacy gain in having this ban in place,” Lee added. “In fact, I think it probably contributes to reduced privacy in that patients have to enter and submit multiple pieces of various identifying information in various different provider organizations, and that process actually makes them less secure.”

Karen Wilding, vice president and chief value officer at Nemours Children's Health, said her organization supports a national strategy around patient identification because it recognizes that the current system is not supportive of Nemours' goals around care across the continuum and the ability to share medical or records in order to facilitate that care. “There are adverse effects happening every day,” she said. “It happens all too often across the United States that because we don't have unique identifiers, you often will have medical records that get mixed up where allergies, medications, procedures, and other pertinent, really sensitive clinical data is not aligned to the patient and that can have a long-lasting effect on a child's health if information is not correctly attributed to their medical record.”

Rachelle Boulton, health informatics program manager for the DPH Informatics Program at the Utah Department of Health and Human Services, noted that public health activities rely on quality data that comes from multiple sources — healthcare organizations and laboratories; state, tribal, local, or territorial health departments, as well as the multiple data systems that are managed within the same public health department. Public health agencies oversee immunization information systems, which collect and consolidate immunizations from multiple providers into a single consolidated immunization history for any particular person, she added. Patient identification issues can result in incomplete immunization histories, and that can negatively impact clinical and public health services. “Public health also conducts case-based surveillance that allows us to monitor, control and prevent diseases or conditions of public health significance. Patient identification issues can result in incomplete records, and that can negatively impact analysis and evaluation.”

Rachel Podczervinski, M.S., vice president for professional services at Just Associates, spoke about the challenges with duplicate records — when you have more than one record within a healthcare system and those records have not been connected. When a registrar or scheduler searches for you in the master patient index, if they don't find you or the data is not congruent enough that they feel confident that that is in fact your record, they create a new one, she said.

Another way duplicates come about is through mergers and acquisitions of health systems.

“If you're in a close geographical range, and you merge with a hospital or a clinic that is near you, you're going to have a lot of overlapping patients, and you have to try to reconcile those identities so that the records from both of those facilities come together within your master patient index,” Podczervinski said. “If you have a duplicate within a healthcare system, you are not going to receive the best possible care because when those healthcare professionals are treating you, they're not going to have access to all the information that they could. Maybe they're missing a previous chest X-ray, maybe they're missing blood work, maybe they don't know all your allergies or your blood type, because all that information is stored in the record that is not the one that they have for you right now. So those physicians are going to be treating you on incomplete information.”

Lee mentioned that one of the biggest changes occurring in the health system is the volume of data that providers need to handle. “We are drinking out of an open fire hydrant, and that fire hydrant is getting larger and larger every single day,” he said. “I think it's a fallacy to think that if you just know the patient in front of you, then you can take care of the patient. What we are limited by now is that we have too much information, and the only way to parse and organize all that information and be able to surface the things that any individual patient or provider or healthcare system, or population health system needs to know about a larger group of patients with all the data that's associated with them is by having a better patient identification system,” Lee added. That is really where it starts. Without that, we might as well go back to practicing Marcus Welby medicine with only the patient in front of us. And we all know that doing that right now, given our current circumstances, is completely unsustainable.”