It's time to reopen the dialogue on the unique patient identifier

The Office of the National Coordinator for Health IT covered a lot of ground during this week's meeting on the agency's patient data matching initiative announced in September. Speakers from ONC provided updates on patient identification and matching, ways to improve patient match rates, emerging ideas and an opportunity for discussion among stakeholders. The government presented no less than eight initial findings, including the need for standardized patient identifier content in exchange transactions, the possibility of using nontraditional data, such as place of birth, to improve patient matching and the development of policies to encourage patients to keep their information current.

What I found most interesting, however, was the elephant in the room not allowed to be discussed: the unique patient identifier. It was beyond the scope of the meeting and not on the agenda.

Joy Pritts, ONC's chief privacy officer, made it clear right off the bat that the unique patient identifier was off the table at the meeting.

"The unique patient identifier is on a lot of peoples' wish list but statute prohibits us from discussing it," she said. "It was in HIPAA but became a contentious issue and we can't fund it. ... The federal government can't do it, can't fund it at this time."

What's going on here?

Let's recap just a bit. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 had required unique identifiers for patients, employers, plans and providers to improve quality of care and reduce administrative costs. The national provider identifier (NPI) and employer identifier (EIN) have been implemented; covered entities will need to use the national health plan identifier in standard transactions by November 2016.

And the poor patient identifier? Congress put a "temporary moratorium" on funding it.

In 2000.

That's almost 14 years ago. Bill Clinton was still in office.

I understand that there were privacy and security concerns surrounding the patient identifier. There probably also were issues surrounding the government as "big brother." These are very important issues to address.

But I'm not sure that the patient identifier is any more vulnerable than all of the other identification numbers we have floating around the digital world. We have Social Security numbers, insurance numbers, passport numbers, and driver's license numbers. I also have an employer identification number. And that's just a small sample of the numbers that identify us.

At the same time, the electronic world has evolved since 2000. Our numbers--and our data--may not be more secure than they were back then (arguments can be made for both sides), but as we move inevitably toward interoperability and health information exchange, it becomes imperative that patients be accurately matched to their data. Inconsistent data--the dropping of a middle initial, for instance--can cause the loss of all sorts of information.

The identifier has been frozen in time while the industry has marched right past it.

Pritts hinted at her frustration and offered an opportunity for this dialogue to be reopened: by letting private enterprise take the lead, since the government's hands currently are tied.

"The private sector can do it," she suggested.

I don't know if the private sector will take the bait, but perhaps it's the opportunity to at least reopen the discussion.

I respect that there may be legitimate concerns about a unique patient identifier. But that's no reason to ignore it. It may well be the best solution to patient matching--and we won't know until it's at least part of the discussion. - Marla (@MarlaHirsch @FierceHealthIT)

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