Misidentifying patients can have tragic consequences.
Numerous catastrophic cases and near misses have been collected by Patient ID Now, a coalition of health care organizations we are affiliated with that is dedicated to advancing a nationwide patient identification and matching strategy.
In one example from the Patient ID Now website, a woman had a routine mammogram, but never received the results. Assuming that no news was good news, she mentioned the mammogram to her doctor months later during her annual physical. That conversation led to the discovery that her results had been misfiled in the chart of a deceased patient who shared her name. The mammogram showed cancer which, during the one-year delay, had become terminal.
This story is not an outlier.
There’s far more than anecdotal evidence that patient misidentification is a serious and widespread problem in U.S. health care. A Government Accountability Office report found that 45% of large hospitals reported difficulty accurately identifying patients through electronic health information. A report from Pew Charitable Trusts notes that accurately matching patients to their medical records can be as low as 80% within a single care setting, and as low as 50% among organizations that shared electronic health information.
This epidemic of misidentification is rooted in the lack of a national patient identification strategy.
Today, a hospital’s or clinic’s ability to accurately identify the patients it serves often hinges on a precarious patchwork of Social Security numbers, phone numbers, driver’s licenses, and home addresses that strains under the weight of an increasingly mobile population with health information scattered across multiple care settings.
Covid-19 has underscored that patient identification is an increasing issue for public health. During the pandemic, there were reports of patients not receiving Covid-19 test results, or receiving the wrong results, because of misidentification. And many received vaccinations outside of their usual doctor’s office at pop-up and pharmacy locations, adding complexities about updating medical records.
Progress toward a national patient identification strategy has been hindered for more than two decades because of a rider inserted into the federal budget that prohibits federal funds from being used to develop a unique health identifier standard.
The history of this annual rider dates back to 1996, when Congress passed, and President Bill Clinton signed, the Health Insurance Portability and Accountability Act. One of HIPAA’s many goals was to aid the transition from paper to electronic records, and it called for developing a unique identifier. Rep. Ron Paul (R-Tex.), Congress’s leading libertarian at the time, saw such an identifier as government intrusion into private health care and inserted language into the federal budget that barred the government from spending any money to develop a unique identifier. That ban has been in place ever since.
Bipartisan support for repealing this ban has been growing in Congress, with the House of Representatives removing the language from its Labor, Health and Human Services, Education, and Related Agencies appropriations bill for three years, and the Senate removing the language for the first time from its draft Labor-HHS bill released for fiscal year 2022.
Final negotiations, however, resulted in the ban being reinserted to the 2022 budget, continuing the provision that stifles progress to improve patient safety and privacy. President Biden signed the budget into law earlier this year. Just last month, the Patient ID Now Coalition continued the push to remove the rider from the 2023 fiscal year appropriations bill in a letter to House appropriators and Senate appropriators that was signed by 119 industry stakeholders.
The health care community has a responsibility to do everything possible to protect the people and communities it serves. To fulfill this mission, it needs to move forward with serious discussions regarding the shape, scale, and cost of a national patient identification strategy, one that ensures the safety of patients and the privacy and security of their personal and medical information.
This national strategy could include a number of solutions that have been proposed, including, but not limited to, a unique patient identifier; biometrics; standardization of demographic elements such as home address or telephone number; or various algorithms, and would require a number of considerations to be taken into account.
As the Patient ID Now coalition proposed in its Framework for a National Strategy on Patient Identity, a national strategy should increase patient match rates, protect patient privacy and security, support interoperability, and improve standardization of health data, data quality, and health equity. To get there, the federal government would need to bring in stakeholders from across health care and public health to address these issues.
This isn’t just a bureaucratic issue. In addition to enhancing safety and reducing health care costs, a national patient identification strategy would empower patients. Recent federal regulations, such as the provisions prohibiting information blocking in the 21st Century Cures Act, give consumers greater ability to store, aggregate, use, and share their health information using apps of their choice. Improving patient identification would make it easier for complete and accurate health records to follow individuals wherever they go and allow them to better control who can access and share their personal health information.
Congress must finally address this outdated ban to make true progress toward solving one of health care’s most enduring problems. Health care has spent the better part of 20 years investing in an interoperable, value-based, patient-centric ecosystem. A national strategy for patient identification is essential for connecting the fragmented health care system, while making it safer and more efficient for patients and health providers.
Wylecia Wiggs Harris is CEO of the American Health Information Management Association (AHIMA), a global nonprofit association of health information professionals. Tom Cox is president of Experian Health, a provider of health care software solutions. AHIMA and Experian Health are members of Patient ID Now.