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National Patient Identifier Series, Part One: A Push for Progress

  • November 20, 2015|
  • 2 years ago

by Tom Foley

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Director, Global Health Solution Strategy

This is the first article in a two-part series.

The barriers of interoperability for healthcare systems are only one part of the issue of a shared national health platform. Achieving a single national patient identifier system raises some valid concerns regarding patient privacy and general data security. However, looking at the current state of the industry and the goals in mind for mobile and telehealth enablement, it seems that a national patient identifier is not an option, but a requirement.

The need for a national patient ID system has been drawn into the spotlight largely due to the fact that a lack of agreed upon standards has put patient safety at risk and has cost organizations money – and a lot of it. Commentary surrounding the subject has sparked again, most recently due to the American Health Information Management Association’s annual convention, which Health IT Interoperability reports “advocated for the adoption of a standardized patient matching program, calling such a movement critical to healthcare systems’ ability to exchange patient information quickly, affordably, and safely.”

The lack of standardization raises a plethora of issues relevant to patient safety – i.e. what if two different patients’ records are merged? Or what if one patient’s records are mistakenly scrapped because another patient with a similar name reports them as misinformation? What if one patient is prescribed treatment based on another patient’s list of medications or past medical history? There are many worst-case, inaccurate care scenarios that can easily be the result of unreliable patient identification. Katherine Lusk, chief health information management officer at Children’s Health System of Texas, spoke to the issue at the AHIMA convention:

“A lack of standardization of data can be at the root of inaccurate care with potential harm for patients. Nationally, we are struggling using health information exchange technology tools due to inability to link patient records. The cost of healthcare cannot be managed if we are unable to communicate.”

Frank Irving, editor of Medical Practice Insider, illustrates a specific example of the problem for Health IT Interoperability:

“For example, an estimated 1 percent of the U.S. population has the surname ‘Smith.’ Extrapolating out, if 1 percent of births were categorized simply as Baby Boy or Baby Girl Smith, the potential for health data not properly linked to the correct patient would be about 1 in 40,000.”

As mobile continues to become more and more commonplace in healthcare, interoperability becomes even more complicated – and consequentially, so does security. For providers, adapting is a necessity. Organizations need to be proactive about addressing staff members’ usage of mobile devices, because they aren’t going anywhere – and neither are the security threats that come with them. Dave Cristal, VP and GM, Insight Public Sector, confirms the severity of the issue:

“Whether you are tasked with running an international business or 500-bed hospital, data security is an extremely critical issue, and one that has caused a lot of headaches this past year.”

In response to growing concerns surrounding mobile security in healthcare, Insight Enterprises, Inc. U.S. Operations has comprised a list of the top five considerations healthcare organizations should take into account when choosing mobile security software. What’s at the top of the list?

“Purpose-built for healthcare – Providers should look for software that was built specifically for the healthcare industry and has content classifiers to sort crucial healthcare data, such as medical terms and patient identification numbers.”

The need for a better patient identification system is not new ­– in fact, it legally dates as far back as 1996, when HIPAA “authorized the government to introduce an NPI as a way to make medical records more portable.” Since that time, however, the idea has faced serious roadblocks in the form of privacy advocates and opposing laws from Congress. So while the issue has history, many would argue that the time for action is now – the industry simply cannot wait much longer. However, more public support will be necessary for progress. CIO recently quoted Keith Fraidenburg, executive vice president and chief strategy officer of CHIME, regarding his stance:

“We’ve reached a stage in healthcare where we’re striving for interoperability. We want to share medical information across hospitals, health systems, countries, and even statewide, because we feel it benefits the patients and the caregivers. An NPI won’t solve interoperability, but until we have a national solution for patient matching, we’ll never be able to have interoperable healthcare systems.”

The back and forth of the government – mandating NPI creation in 1996 and then forbidding funding two years later – has certainly put health organizations in a trying position. Regardless, the industry is moving forward. The problem is widely recognized, and support for the issue (at least within the industry) is rallying.

In the same instance as mentioned above, Irving comments on an initiative called the “Virtual Clipboard,” which has been brought to fruition by the Workgroup for Electronic Data Exchange and the National Association for Trusted Exchange:

“Their aim is to create a blueprint for a mobile application that would automate collection of demographic, insurance, and clinical information during the patient intake process. The first phase of the project focuses on efficient dissemination of demographics and benefits coverage to healthcare providers. A second phase will concentrate on patients’ medication and allergy information.”

As it stands right now, the Workgroup for Electronic Data Exchange and the National Association for Trusted Exchange are not the only ones with far-reaching ideas – and that’s a good thing. There are a lot of different players interested and invested in trying to ideate how to best approach a national patient identifier. As different perspectives become public knowledge, it will be important for the industry to find one that takes into account the need for privacy, security, and HIPAA compliance while meeting government scrutiny. In part two of this series, we will explore potential solutions, analyze current thoughts, and try to gain clarity as to where we are, and where we should be headed next.


Reference Articles:
1. “A Call for Patient Matching Among Healthcare Data Standards” Health IT Interoperability. October 5 2015.

2. “Insight Outlines Top Five Traits of Strong Mobile Security in the Healthcare Industry” CNN Money. October 15 2015.

3. “National patient identifier struggles for life” August 18 2015.

4. “FHIR Will Not Save Us: We Need National Patient Identifiers” HIT Consultant. August 10 2015.