Errors in patient identification have cost the United States healthcare system over $6 billion annually. These errors have implications related to patient care, safety, payment, data sharing, and interoperability. Is there a way to simplify and optimize the process of patient identification?
In this blog we'll review what a Unique Patient Identifier (UPI) is as well as the potential benefits we could see from a system like this. We'll also discuss what's been keeping UPI from becoming a reality in the United States, and what you can do to help.
What is a Unique Patient Identifier and Why Would We Want One?
Let's take an example: John Smith goes to the hospital for chest pain. His local hospital has 42 medical records for "John Smith" because it is such a common name. How will they know that they're assigning the right chart, records and information, to this John Smith? Currently, we don't have a consistent way for patients to be identified. We rely on their personal information, like names, dates of birth, contact information, or other characteristics which can be mis-entered, change over time, or be consistent across multiple patients with the same name.
If you're thinking "I have a very unique name, so this isn't an issue for me", then consider this scenario:
A patient arrives in the ER who the clinical staff recognize from treatment a month ago. When they access the patient's chart though, no information from their prior visit appears. It turns out their birth date was entered incorrectly at registration. This led to the generation of a whole new medical record number, and prevents the care team from accessing any information from the last visit. The care team then has to spend time searching for the correct records for the patient. Problems like this can and do arise with frequency in our current system.
Unique Patient Identifiers (UPIs) function similarly to Social Security Numbers (SSNs) in the United States: each person gets one and they carry it as their identifier for the rest of their life. Even if they change names, move states, or switch employers, they still have the same number. Unlike SSNs though, National Patient Identifiers are only used for health information, and by healthcare providers, so there are fewer concerns over the security of these numbers, because they couldn't be used to do things like open a fraudulent credit card. Medicare established UPIs for beneficiaries in 2018. The Medicare Beneficiary Identifier allows Medicare to identify beneficiaries by a number other than their SSN.
UPIs allow patients medical records to be accessed across providers and care networks. By allowing this data to be shared seamlessly we could prevent medical errors, and promote efficiency. Now that we have greater interoperability, and can get records from other sites of care, systems like this could reduce burden on providers and protect the safety of patients.
So why isn't this happening for all U.S. patients?
The passage of the Health Information Portability and Accountability Act (HIPAA) in 1996 actually called for the creation of "a standard unique health identifier for each individual". Almost immediately after, Congress passed a ban on using any federal funding for creating UPI systems. In creating this ban, Congress cited concerns over patient privacy.
This ban is not supported by the broad swath of experts. In fact, linking records to the wrong patient has been shown to create patient privacy issues and use of UPIs would protect other sensitive patient information not directly linked to health (like SSN or address).
We've seen attempts at repealing this ban since 2019, with amendments getting passed by the House but not the Senate. However, as the push towards interoperability continues, the goal of creating a UPI is becoming more urgently supported. The COVID-19 pandemic heightened this urgency with vaccine rollouts requiring fast and reliable patient identification.
The development of a UPI system in the United States is broadly supported by Healthcare IT organizations and medical associations alike, with advocacy efforts spanning from letter-writing to the formation of the advocacy coalition-- Patient ID Now.
What Does This Mean for Your Practice?
Right now, the burden of interoperability falls largely on providers and Electronic Health Records (EHR) vendors. Policies around Information Blocking and interoperability are evolving and becoming increasingly complex. Development and implementation of UPI in the United States would simplify much of the complex burden of promoting interoperability while also protecting patient privacy.
We recommend keeping an eye on these advocacy efforts in the near-future, as each year the push towards funding this system comes closer to fruition. For more direct advocacy, you can contact your senator to remind them to support efforts to repeal the ban on funding for unique patient identification systems.
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