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The Case for a National Patient Identifier: 20 Years Later

national patient identifier
CEO, LexisNexis Risk Solutions Health Care and President, Clinical Solutions, Elsevier Health

The intention of a national patient identifier started out as a benevolent one: under the guise of HIPAA legislation in 1996, give each patient a unique, permanently assigned number to be used across the entire national healthcare system. Obviously, it’s an important topic if we are revisiting it more than 20 years later—there is still a need.

Until now, Congress was not willing to provide the Department of Health and Human Services the needed funding, citing privacy concerns.

Keep in mind that this was before the era of meaningful use and EHR mandates and before the word interoperability was an industry buzz word.

The good news is that we are revisiting the conversation, a national conversation around effective patient identification. As the industry strives for interoperability standards, the bigger question remains –what’s the priority?  Getting systems to talk OR addressing the misidentification of patient records?

Mismatched patient records has effects much more far reaching than interoperability standards—like risk to patient safety and increased operational costs.

Let’s consider some facts from the American Health Information Management Association1:

  • According to AHIMA, 1 in 5 patients may not be linked with the correct record, resulting in match rates as low as 80% within the same facility.
  • Inaccurate patient identification accounts for $1950 in duplicative medical care costs per inpatient and $1.5 million in denied claims each year.
  • A survey of physicians and nurses stated 86% had witnesses or were aware of a medical error caused by patient misidentification

So, is it a win that the House rules to repeal the ban on funding? Sure. The biggest question remains, how do we solve this critical need? Two words: referential matching.

Everywhere along the Patient Journey

Incorrect identification can occur anywhere along a patient’s healthcare journey and in any setting, from hospitals and nursing homes to physician offices and pharmacies. Every scan, lab test, doctor appointment and hospital stay becomes an additional point where mistakes can be introduced into the medical records. Clerical errors like misspellings or incorrect demographic data increases the odds of mix-ups.

A lack of data standardization, such as whether to include a middle name versus middle initial and how to handle hyphenated names, can also produce errors. If healthcare staff can’t locate a patient’s record already in their system, they create a new record. A duplicate record spreads a patient’s health data over multiple charts, so the record pulled up at any one time may be missing important details such as a patient’s blood type, allergies and medications.

Per research done in late 2018 by the Pew Trust, patient linking can:

  • Enhance interoperability
  • Reduce cost
  • Support innovation
  • Improve patient care and satisfaction
  • Detect fraud

The Industry Can Act Now

In November, The National Council for Prescription Drug Programs (NCPDP) members voted to support the LexisNexis® Risk Solutions LexID® as a universal patient identifier (UPI). This is an important step for the healthcare industry to address preventable errors by helping to ensure accurate identification of patients using a UPI. It assists in uniquely identifying each patient throughout disparate healthcare systems.  

By approving the UPI as a recognized patient identifier, industry partners will be able to use the LexID as a UPI in their pharmacy billing and e-prescribing transactions.

A main, referential database would serve as a safe, accurate and continually updated repository that improved matching technology of patient records. The aggregated data would give patients, hospitals, insurers, physician practices and pharmacies the confidence of seeing the whole picture of the whole patient: the correct patient.

The argument isn’t whether a national patient identifier is good for healthcare delivery, but until one is reached, how we achieve these goals? The answer seems to be solutions that can solve the problem one healthcare organization at a time. The end goal being to give patients, hospitals, payers, physicians and pharmacies the confidence to link records regardless of systems to get a clear picture of the whole patient and make sure it’s the correct patient to start.

Learn more about how to effectively link patient records.


The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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