Despite some giant leaps forward in the medical world, achieving accurate and complete patient records remains a major challenge for the U.S. healthcare industry.
It’s estimated that around 30% of patient data held in electronic health records is incomplete or inaccurate, and up to half of all patient records may not be linked correctly. Unreliable patient data presents some huge problems for health systems, from flawed diagnoses and treatment errors to unreliable analytics and billing mistakes.
In an attempt to address the patient matching dilemma, the 1996 Health Insurance Portability and Accountability Act (HIPAA) paved the way for all U.S. citizens to be given a Universal Patient Identifier (UPI), which would follow them throughout their lives. But just a few years later, concerns around patient privacy led to a ban on federal agencies to investigate or create a universal patient identifier (UPI), and a nationwide solution was never realized.
This could be about to change. In June this year, the U.S. House of Representatives voted in favor of lifting the decades-old ban on federal funding. The Foster-Kelly amendment to HR 2740, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2020, now moves to the Senate for consideration.
If approved, what could the implementation of a UPI mean for healthcare organizations and consumers?
A UPI system could improve patient care
No one expects a quick fix for the industry’s challenges, but a UPI is the first critical step in improving patient identity management, with innumerable benefits for patient safety and care coordination.
If you’re not 100 percent confident about the identity and medical history of each patient who walks through your doors, how can your clinical teams be sure they’re offering the right treatment to the right patient? Without reliable records, patient safety becomes a gamble.
As we continue to hear about incorrect treatments and adverse medication interactions that have had life-altering or fatal consequences stemming from patient misidentification, we realize we have a growing patient safety issue. Between 2013-15, the ECRI Institute’s Patient Safety Organization reviewed 7,613 ‘wrong patient’ events across 181 healthcare organizations, where patients were wrongly identified for a treatment or surgery.
You could put in place robust local protocols to prevent these types of errors, but when patients relocate or require a specialization not offered within their current healthcare group, it becomes harder to keep track.
Healthcare organizations are suffering the liability of all patient errors that have life-altering or fatal consequences. However, with UPIs you can reduce the occurrence of “never events” and improve clinical decision-making, as well as eliminate the risks associated with mistaken identities.
The National Council for Prescription Drug Programs (NCPDP), which creates and promotes standards for the electronic exchange of healthcare information related to pharmacy services, has formed partnerships with identity management companies, like Experian, to facilitate the creation of UPIs to link patient data at scale and improve patient safety. It is a model that can be easily implemented in other healthcare sectors to address patient safety, financial and operational challenges across the U.S. healthcare ecosystem.
A UPI could reduce costs tied to identity errors
Patient misidentification also lands a financial blow for healthcare organizations. Healthcare organizations are suffering the costs of not having an adequate solution to accurately match patient identities and must rely on manual intervention and support, which is costly. For providers, millions of dollars are lost as the industry deals with costly errors, wasted physician time and denied claims, all of which could be reduced or eliminated if the data held for each patient was current and correct. In fact, around a third of claims are denied on the basis of inaccurate patient identification, costing an average of $1.5 million per hospital. Pharmacies also suffer the costs of an inadequate solution, estimating that as many as 50 percent of electronic prescriptions do not match to a patient record and the remediation cost is more than a dollar per record.
And for the industry as a whole, UPIs open up opportunities for improved interoperability and coordination of care. A connected healthcare ecosystem means duplicate or incomplete patient data can be detected and corrected immediately, retaining its fidelity at every stage of the patient’s care.
Safeguarding patient data with integrated systems
Despite the advantages of a UPI, let’s not overlook the original worries that led to the funding ban in the first place. Concerns about the exchange and security of healthcare data are understandable. Safeguarding patient privacy is paramount, and the healthcare technology industry is evolving to provide ever-stronger identity proofing and data security tools.
Still, in the years since the funding ban put the brakes on a universal approach, many disparate software solutions have sprung up which don’t currently talk to each other. Integrating these systems in an industry of this scale will take a concerted effort. However, private-sector entities have already developed the technological foundation for data interoperability through the creation of UPIs that are maintained in a master person index. These solutions are vendor neutral, so data can flow between disparate electronic health systems. With federal funding in place, UPIs could be adopted with government oversight of private sector offerings and the creation of national standards to ensure quality patient matching and identification. Without government standards, fragmentation of the private sector UPIs will increase and continue patient safety issues due to misidentification.
Before UPIs can be assigned, it is imperative to ensure the challenges of duplicate and overlaid medical have been properly matched. When patient roster information is combined with comprehensive reference data held by third-party data companies, a more complete picture of each patient is created. Once patient records are accurately matched from a referential and probabilistic matching process, a UPI can be assigned to each patient record. A UPI, which is tied to the master patient index, can connect disparate patient records to give health systems a more accurate and complete picture of the patients they serve, regardless of department or software.
Using UPIs to catch up with other consumer-facing industries
In no other industry, except healthcare, is it okay to prevent consumers from having visibility or access to their data. Today consumers are sometimes helpless in securing their medical histories, with no way other than to ask for print copies from every healthcare interaction they have across physicians, hospitals, pharmacies, labs, specialists, insurance companies, etc. Consumers expect frictionless healthcare interactions, but what happens at the moment is often inconsistent with their experience in other data-driven industries.
A universal patient identifier creates an opportunity for healthcare to catch up with other consumer-focused markets and give patients better access, options and control over their health information.
Whatever the outcome of the current legislative process, there’s no doubt that by arming clinical teams and back office staff with up-to-the-minute data about their patients, providers will be able to use their resources more effectively and ultimately improve patient outcomes.
Karly Rowe is vice president, identity & care management product, Experian Health