Congress: Don't fear dialog of a patient identifier

Marla Hirsch

The healthcare industry continues to be plagued by patient identification and matching errors, some of which cause injury and death.

The latest warning comes from the nonprofit ECRI Institute, which conducted a “deep dive” into the problem, reviewing more than 7,600 wrong patient errors at more than 181 facilities (which ECRI determined is likely just a small portion of patient identification errors overall). Its research found, among other things, that anyone can make an error, that incorrect patient identification occurs in any setting and at any time during treatment and that electronic health records contribute to the problem by, for example, not recognizing minor variations in name spellings. 

ECRI also found that most of these patient identification errors were preventable.

The report offers a lot of good advice to improve patient matching and reduce identification errors, such as engaging patients in the identification process, improving the usability of EHRs and confirming two patient identifiers--such as last name, first name, gender and date of birth.

But one specific recommendation that the report fails to address is policy: creating unique patient identifier numbers.

That’s not to say it wasn’t on the authors' minds.  We don’t really know.

But here’s a clue.

Buried in a graphic on the use of technology in “tomorrow’s hospital,” a fanciful look at how hospitals might improve patient identification and matching in the future, the authors write: “The physical therapist [at a rehabilitation hospital] uses the number for the patient’s unique identifier to access the patient’s discharge summary [from the acute care hospital]” in order to commence therapy.

A unique patient identifier number! Used in conjunction, according to this graphic, with biometrics of a patient’s palm to identify unique vein patterns, retrieving color photos of the patient embedded in an image on a patient’s wristband, and radio frequency ID tracking in the recovery room. Not possible today, but maybe in “tomorrow’s hospital.”

Last week’s National Academy of Sciences report was more direct, specifically recommending that Congress revisit the national patient identifier number--which it prohibited more than 15 years ago--as a way to “reset” and improve health IT going forward.

I’m sure that Congress previously had what it considered good reasons to not allow the finalization of unique patient identifier numbers, which were created as part of HIPAA in 1996.

But that was a long time ago. What is so horrible about the unique patient identifier number now?

We have Social Security numbers, national provider identifier numbers, employer identifier numbers, passport numbers and credit card numbers. A patient identifier number wouldn’t be any more vulnerable than those numbers. Even if it was, the benefits of avoiding preventable safety errors may well outweigh potential privacy and security risk. An EHR can’t recognize a minor variation in a name spelling, but it can match numbers.   

The Office of the National Coordinator for Health IT itself has admitted that patient matching is a challenge; others have warned that it’s one of the biggest barriers to safe data exchange. The American Health Information Management Association reported earlier this year that patient matching problems were “routine.” But the Department of Health and Human Services isn’t even allowed to use federal funds to explore the possibility of whether patient identifiers would be better than our current system.

This is not the first time I’ve questioned why we’re not taking a longer look at the unique patient identifier number. But the problem seems even more acute now. Patient identification and matching likely will get worse as data exchange among non-affiliated providers becomes ubiquitous.

Perhaps upon further evaluation, it will be determined that yet another number isn’t the best way to identify patients and match them to their records. But if even that is not a possibility, then we won’t know for sure. At least put it on the table. - Marla (@MarlaHirsch and @FierceHealthIT)