As the promise of electronic medical record sharing begins to become reality, the industry’s dirty little secret will grow in appearance to the unsuspecting public: unmatched or missing patient’s electronic medical records. As early as 1996, the original HIPAA legislation recognized this ‘elephant in the room’ and began the journey to create a national patient identifier. Again, with the 21st Century Cures Act in 2016 and the CHIME Challenge in early 2017 industry experts surfaced and encouraged us all to identify how to begin solving this existing issue.
To put a little context together to explain the nature of this problem – unlike many other numbering systems created to eliminate/reduce the possibility of mixing up important records, such as the Federal Reserve System or the Social Security Administration, healthcare lacks a formal national patient identifier for patients when new records are created, deleted or even exchanged.
Why a National Patient Identifier
Every hospital, clinic, urgent care center, etc. creates a new number that you are assigned that becomes YOUR medical record number while visiting them and only them. In the dark ages, many health centers used the patient’s social security number. This was listed down the side of every manila file folder. Although this would remedy the problem, most agree that due to modern day privacy concerns, this isn’t the answer.
To this end, while many surrogate approaches exist to make sure we have the right record for the right patient, there are not any specific and mandated standards that the industry adheres to. Best case: duplicate rates are considered to be around 3 percent. This means that even in a healthcare organization that is highly diligent in identifying, avoiding and managing down the creation of duplicate records for patients, the outcomes may still be lacking. Each duplicate identity represents the opportunity for, at worst, a medical mistake due to information error or, at best, a dissatisfied customer not understanding why we must ask their identification again and again and again.
In recent years as hospital mergers have increased, managing larger master patient indexes have spawned new challenges. At the same time, technology to assist us in addressing these issues have come a long way, leveraging national reference databases (e.g., the IRS) and Artificial Intelligence (AI).
Put Aside Perfection to Move Forward
It is clear the security of our most sensitive data and the privacy of our citizens will (and should) rule the day. This can be compromised through the perceived simplicity of a national patient identifier. All other measures must be shown lacking before the administrative burden of creating another national numbering system will occur in the United States.
Even so, the current state is NOT acceptable and the digitization of healthcare IS upon us and isn’t going to wait. We need to accept that there is no silver bullet and support known best practice safeguards, perhaps similar to HIPAA, which includes appropriate expectations around the technical (tools) and administrative (policy) safeguards to commit us all to doing better.
Let’s not let “perfect” stand in the way of “much much better” and resolve to creatively address this industry issue ourselves with the appropriate investment in tools to reduce the creation of duplicates. And also through more intelligent use of publicly available data AND the power of the unique biometric information the human body brings to the conversation.
No, today we don’t have in hand the power of a national patient identifier but we do have the creativity and partnership of new and creative uses of technology to do a much better job. Let us be reminded of our own commitment in caring for our patients to first ‘Do No Harm.’