A new report from the Pew Charitable Trusts outlined several key themes related to patient matching, while also suggesting recommendations to improve matching and the infrastructure needed for more robust progress in the medium and long term.
Patient matching—the ability to accurately link all of a patient’s health data within and across health systems—is a problem that has plagued the healthcare industry for decades. To compile its report, Pew evaluated solutions to the problem through commissioned research, focus groups with patients, interviews with hospital executives, and conversations with experts. The report explores the impacts of inaccurate patient matching, provides an overview on progress to date, and outlines key next steps and recommendations to improve matching.
The research revealed common themes, according to Pew. First, regardless of the approach taken, a nationwide strategy will require coordination to identify the needed best practices; commitments from healthcare organizations and technology developers to implement agreed-upon standards; and patient involvement. Second, no solution currently exists that could achieve perfect—or even near-perfect—match rates for all patients, but actions can be taken to better link records. Third, although some opportunities exist to make meaningful, incremental progress in the near term, more robust change will require the use of new approaches and technologies.
Near-term activities to help make incremental progress include the following: clarification of restrictions on government funding for unique identifiers; agreement on demographic standards; assessment of privacy ramifications; further research on and adoption of referential matching, where third-party data are used; and verification of phone numbers and other identifying information provided by patients to reduce the likelihood of typographical, data-entry, or clerical errors.
Meanwhile, long-term opportunities to develop the infrastructure include the following, according to Pew: entrusting a single organization to oversee a nationwide patient-matching strategy; launching pilot projects for patients to use their smartphones to help match records; and determining the infrastructure and standards necessary for using biometrics and other technologies for effective and secure matching in a way that protects privacy.
The report’s researchers noted, “Once these recommendations are implemented, clinicians and patients can have more assurance that EHRs contain complete, accurate, and up-to-date medical information—thus improving safety, reducing costs, and better coordinating care for individuals who see multiple medical professionals.”
Indeed, concerns about patient safety have been the driving force in ongoing discussions about the need for a national patient identification standard. In a 2014 report about the issue, the Office of the National Coordinator for Health Information Technology (ONC) found the best error rate among healthcare providers is around 7 percent, though the error rate is typically closer to 10 to 20 percent within healthcare entities, and this rises to 50 to 60 percent when entities exchange information with each other.
In 2016, the College of Healthcare Information Management Executives (CHIME) announced a National Patient ID Challenge, a $1 million crowdsourcing competition to incentivize the private sector to develop a fail-safe patient identifying solution that links patients to their medical records. About a year ago, CHIME suspended that challenge, noting that the competition did not achieve the results that were envisioned.
Further complicating things is a U.S. law prohibits the Department of Health and Human Services (HHS) to use its funds to create a unique patient identifier absent explicit new approval from Congress.
Although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires HHS to develop a unique identifier, subsequent federal appropriations language has prohibited its implementation. In recent years, congressional appropriators have signaled that, although the prohibition stands, the federal government may provide guidance to the private sector in its efforts.
Regardless, the federal appropriations language impedes progress on a national health identifier until Congress lifts the funding prohibition, Pew researchers noted. However, the 21st Century Cures Act— signed into law in 2016—requires the Government Accountability Office (GAO) to examine steps taken by the federal government and the private sector to reduce matching errors.
The report also pointed out other examples of attempted unique identification, in addition to the CHIME challenge. These included authenticators, used by some hospitals, which are something the patient knows, has, or is, which can include a biometric, a text message to the patient’s smartphone that requires a response from the patient, or a personal identification number, among many other option.
Further, Pew researchers recalled that in 2015, Congress required CMS (the Centers for Medicare & Medicaid Services to remove social security numbers (SSNs) from Medicare cards. In implementing this provision, CMS intends by April 2019 to replace SSNs with an 11-character identifier composed of numbers and uppercase letters. In theory, CMS could also allow private insurers to also use this system.
In response to the report, Daniel Cidon, chief technology officer of NextGate, a cloud-based healthcare identity matching company, said in a statement, “We appreciate the extensive and well-structured research conducted by Pew on the long and short-term approaches to improving patient matching accuracy. The key takeaway is simply that there is no ‘silver bullet’ solution and tackling the issue requires multiple strategies, technologies and stakeholders.”