- Providers and health IT groups kept up lobbying for removal of the congressional ban on funding creation of a unique patient identifier at an Office of the National Coordinator for Health IT event on patient matching Monday, noting its importance in providing long-term care amid public health events like the COVID-19 pandemic.
- "We want to see that ban removed and hope we can have that conversation on a national level," Mark Probst, VP and CIO of health system Intermountain, said at the virtual conference, a sentiment echoed by the chief technology officer at Indiana's Franciscan Health.
- However, longstanding concerns over establishing a national patient identification system remain, pitting providers, health IT vendors and payers against some lawmakers and privacy hawks concerned that, unless HHS maintains rigorous standards, UPIs could be stolen or misused.
UPIs are numbers, codes or data that differentiate one person from another, like a Social Security number. The push to create one linked to patient medical records has gained steam in recent years to cut waste, duplicates and avoidable medical errors: More than 250,000 people in the U.S. die every year from medical mistakes, some of which are due to to physicians operating on incorrect data, according to Johns Hopkins University.
Congress directed ONC to develop a report with suggestions on how to improve the state of patient matching in the U.S. Monday's virtual conference, for the agency to glean stakeholder input, reiterated the much of the healthcare sector's support for a UPI, especially as the pandemic further disrupts efforts to identify patients and their medical histories across sites of care.
"We are missing opportunities in science and medical care," Frank Opelka, medical director for quality and health policy for the American College of Surgeons, said. "The faster we can move there, the better. I really wish Congress understood this."
The HIPAA privacy law mandates HHS create a UPI for patients. But in 1998, Congress barred the agency from appropriating funds to create or adopt a UPI, citing privacy concerns, and language continuing the ban has been included in every appropriations bill for the past 21 years.
In a bipartisan vote, the House of Representatives elected to repeal the ban last year, but the Senate — despite appropriators receiving a letter from 56 industry stakeholders lobbying for its removal — let the ban remain in its year-end spending legislation for 2020.
Academics, health IT players and providers called that a mistake, especially in light of the pandemic that has infected more than 1.8 million people in the U.S. as of Tuesday. For example, patients' COVID-19 testing results aren't following them quickly across care sites and are often incorrect due to a testing or reporting error, Lorraine Possanza, health IT program director at safety watchdog group ECRI, said.
The inability to track and match patients to their records also hamstrings efforts to research COVID-19's long-term effects and enact a vaccination effort, experts said. If and when a vaccine is approved and a widespread immunization effort is in place, public health agencies will need to identify who has the disease, who's been vaccinated and any health outcomes, such as following a vaccination with a serology test.
"Now more than ever, the current COVID-19 pandemic highlights the need to repeal this archaic ban" as field hospitals and rapidly erected testing centers exacerbate the issue of identifying and tracking patients across sites of care, Rep. Bill Foster, D-Ill., author of the amendment to repeal the moratorium that passed the House last year, said.
However, experts caution a UPI wouldn't be a panacea, and there are privacy concerns around any identifier. Opponents say, like SSNs, UPIs could foment fraud, black market ID sales and damage victims' personal, financial and professional lives. Additionally, creating one would be pricey: One estimate from the RAND Corporation puts the total costs of a UPI between $3.9 billion and $9.2 billion.
Potential solutions to improve patient matching include using biometric data, standardizing how stakeholders input patient data into the EHR, referentially matching records to a central third-party database or implementing smartphones and other digital tools as gatekeepers.
But advocates say a countrywide UPI is an important step to manage frequently changing or missing patient information, cull duplicate records and standardizing patient tracking. The U.S. is the only industrialized nation without a national unique identification system for its patients.
"I think the message to Congress is, it is time to deal with this. The value in advantages of having a UPI vastly overwhelms the disadvantages," Ed Hammond, director of the Duke Center for Health Informatics, said. "This is the only course of action that makes sense."