House votes to lift ban on federal funding for unique patient identifier

Efforts to establish a unique patient identifier in U.S. healthcare—long advocated by many health IT leaders—moved a step closer to reality Wednesday when the U.S. House of Representatives voted in favor of lifting a ban on using federal funding to create patient identifiers.

The House voted 246 to 178 in favor of the Foster-Kelly amendment to H.R. 2740, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2020. 

The effort to overturn the 20-year-old ban now moves to the Senate.

Many health IT leaders see the investigation and creation of unique patient identifiers as critical to solving issues with patient matching and potentially minimizing misidentification and medical errors.

Although HIPAA initially required the creation of a health identifier in 1998, Congress overruled the legislation, barring federal agencies from investigating or creating patient identifiers out of privacy concerns.

The American Health Information Management Association (AHIMA) voiced its support for efforts in Congress to repeal an "archaic ban that has stifled innovation and industry progress for nearly two decades."

RELATED: Health informatics leaders say it’s time for Congress to lift its ban on a unique patient identifier

"Accurately identifying patients and matching them to their data is essential to patient safety and care coordination, and it’s a requirement for health system transformation and the continuation of our progress toward enhancing nationwide interoperability," Wylecia Wiggs Harris, Ph.D., AHIMA CEO, said in a statement. "Removal of this ban will empower HHS (the Department of Health and Human Services) to explore a full range of patient matching solutions and enable it to work with the private sector to identify solutions that protect patient privacy and are cost-effective, scalable, and secure."

AHIMA also sent a letter (PDF) to members of Congress this week signed by 27 healthcare and health IT organizations voicing support for the Foster-Kelly amendment. That letter was signed by America's Health Insurance Plans, the American Medical Informatics Association, the College of Health Information Management Executives and the Federation of American Hospitals.

Dan Cidon, chief technology officer of health IT vendor NextGate, said overturning the ban on federal funding for a national patient identifier is a serious effort to improve interoperability and patient safety.

"While a universal patient identifier is not the silver bullet to solving the patient matching crisis in the U.S., it will help to move the needle forward toward building a safer, more interoperable healthcare system," he said. "Having worked extensively in other countries that currently have a mandated number—England and Scotland—it alone is not enough to achieve total integration across health and social care services. Because the U.S. healthcare system is much larger in scope and far more complex than that of the U.K., a national patient identifier should be perceived as another strong indicator of an individual’s identity, in conjunction with other demographics required for matching."

Nevertheless, he said, the House's decision is a major step forward in enabling a longitudinal health record.

Gus Malezis, CEO and president of health IT vendor Imprivata, agreed that the repeal of the unique patient identifier ban represents a turning point in the effort to resolve the fundamental challenges of connecting the right patient with the right care. 

"True interoperability requires federation and identity management, which we can only achieve with a trusted foundation. That trusted foundation starts with identity proofing and includes record resolution and binding to a biometric authenticator. Simply put: It's time to put an end to the nation’s patient identity crisis," Malezis said.

Health IT and provider groups have long supported the development of a unique patient identifier. In 2017, 25 organizations—including the American Medical Association and HIMSS—called on lawmakers to allow the Office of the National Coordinator for Health IT (ONC) to provide “technical assistance” to efforts led by the private sector. 

In February 2018, health informatics leaders from England, Scotland and the U.S. called on Congress to lift the unique patient identifier ban. In an op-ed published in NEJM Catalyst, the group said Congress responded to a “highly vocal minority” and called on ONC to push lawmakers to lift the decades-old ban and begin piloting possible solutions.