Skip to content Skip to navigation

Thoughts and Recommendations on a National Health Safety Identifier

February 22, 2016
by David S. Muntz, former Principal Deputy National Coordinator, ONC
| Reprints

Why do we need a national health safety identifier?  Don’t we already provide enough information to allow our healthcare providers to easily identify us when we interact with them as consumers, members, and/or patients?  If we create another identifier, won’t that just complicate an already complex situation? 

The current problem is easily understood by looking at one well-known use case, patient registration, at a caring, well-intended and effective health system. Harris County Health District (HCHD) is focused on helping all residents in and around the Houston, TX area.  HCHD traditionally did what so many other facilities do to make sure they are pulling the right records for the right person for the right treatment.  Every patient trusts HCHD to start with the most basic step—properly identifying the person who has come for services. 

Traditionally, the patient identification process started with a registration person (sometimes a provider) entering into the registration computer patient- or family-provided data, such as name and date of birth in combination with other available data elements to ensure the records retrieved were selected for the correct patient.  A dramatic set of statistics published by HCHD on April 5, 2011, however, helps illustrate the challenge of this patient matching process without a unique identifier.  Here are their statistics:

  • Number of patients in HCHD’s database: 3,428,925
  • Number of times when two or more patients share the same last and first names: 249,213
  • Number of times when five or more patients share the same last and first names: 76,354
  • Number of times when two or more patients share the same last and first names, and date of birth: 69,807
  • Number of patients named Maria Garcia: 2,488 
  • Number of Maria Garcia’s sharing the same date of birth: 231 

With these challenges, HCHD solved the problem for all of their multiple facilities by implementing a biometric palm-scanning device. The combination of patient- or family-provided data in combination with biometrics has solved the problem at their facilities, but the biometric identifier isn’t readily shareable at this time throughout Houston at non-HCHD facilities, and certainly not across the nation.  There are many contributing factors, not the least of which is cost.

David Muntz

There are numerous problems identified by other use cases associated with consumers, members, and patients (which we’ll refer to collectively as consumers for the remainder of this document except in special cases), and almost all start with identification.  That initial identification has ripple effects for both the provider and consumer across the healthcare continuum and often impacts dozens of different facilities and care sites.  For all participants in the continuum to be as clinically effective and cost efficient as possible, they must be able to share and, more importantly, use information with complete confidence in a secure and private fashion. 

The goal to create a health system that uses enabling health information technology (HIT) to avoid dangerous medical mistakes, reduce costs, and improve care has received bipartisan endorsement from Presidents Bush and Obama, multiple members of the Executive branch, and Congress.  The government has published regulations and currently spent more than $31 billion in incentive payments to encourage the adoption of certified electronic health records (EHRs) and mandated interoperability (information sharing and use).  The basis for achieving interoperability, like so many other activities in healthcare, requires certainty about the identity of the individual for whom information is being gathered, distributed, and used.

The adoption of certified EHRs has been successful for both primary targets of the Meaningful Use program (eligible professionals and eligible hospitals), yet consumer matching continues to frustrate and create barriers to information sharing among the participants. The promise of interoperability has not been realized, and the associated benefits of such have been delayed or diminished, thereby adversely impacting expected improvements in cost, quality, and satisfaction. It is not an exaggeration to say that this lack of practical and pragmatic interoperability has a negative impact on the safety of the consumers, that the potential of the investments not just in EHRs, but all of HIT has not been fully realized and will not until the primary step in every process, consumer matching, is completely reliable and repeatable. Can we really say we are meaningfully using health information as it was envisioned and proposed by President Bush and funded during President Obama’s administration?

Many organizations are sharing their concerns with what they refer to as “patient matching” to members of Congress, particularly members of the House Committee on Energy and Commerce and the Senate Health, Education, Labor, and Pension (HELP) and Finance Committees. These Committees and their staff have made many inquiries, conducted multiple meetings and hearings, and expressed very clear expectations in regards to this and related matters.  Many of the healthcare providers and the HIT professionals are asking the legislators for money and support to discuss a national patient identifier. Ironically, however, there is language in the Congressional appropriations bills that prohibits the funding of any activity by the Federal government specific to the discussion of a national patient identifier.