CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
August 2021—The iconic Timex slogan “It takes a licking and keeps on ticking” was designed to sell watches in the 1950s and ’60s, but it could just as easily be applied to efforts to repeal the decades-long appropriations ban on a unique national patient identifier—year, after year, after year.
Lack of a national strategy to address patient identification and matching has impeded adoption of digital health information technologies and poses consumer safety hazards, according to Patient ID Now, a coalition of industry stakeholders committed to advancing a national patient identifier program. Yet despite concerted advocacy efforts and proposed legislation seeking repeal of the ban—most recently advanced in July 2020 by congressional representatives concerned with collecting accurate patient information during the global pandemic—the U.S. Senate has upheld the ban in every federal budget since 1999.
The demand for transferring records among health care entities will continue to grow as health care networks merge and patients become increasingly mobile, exacerbating the potential for patient misidentification, says S. Joseph Sirintrapun, MD, director of pathology informatics at Memorial Sloan Kettering Cancer Center, New York City. “And I would hate to think that five years from today we’re still discussing the NPI and nothing has been done.”
CAP TODAY contributing editor Charna Albert asked five pathologists who support a unique national patient identifier why such a system is necessary, how it could be implemented, and what health care entities can do today to reduce the risk of patient misidentification. Here’s what they had to say.
Has COVID changed the need for a national patient identifier or how such a program should be structured?
J. Mark Tuthill, MD, division head of pathology informatics at Henry Ford Health System, Detroit: COVID highlighted the fact that lack of a coherent and integrated patient identifier fragments the entire health care system. We saw this in Michigan, where we were initially sending a lot of SARS-CoV-2 testing out of our health system. Reintegrating that information so that we had appropriate records was a challenge, and that’s a symptom of the fact that patient identification is left to each health care system to manage.
Dr. Sirintrapun
Dr. Sirintrapun (MSKCC): One issue that arose with COVID is we don’t have a good way to track and properly identify patients. If a patient gets a test and then travels to another state and receives another test, it’s probably counted as separate tests and separate people. How do we know all the tests that are run accurately reflect the number of cases? We have to do a lot of guesstimation. It potentially affects forecast modeling and the ability to develop public policy.
Brian R. Jackson, MD, medical director of support services, IT, and business development, ARUP Laboratories, Salt Lake City: COVID should be a wake-up call. One interesting thing about COVID has been all of the testing done in a nontraditional way, with specimen collection taking place outside health care facilities. From that perspective, patient identification has been a challenge. When I think about where we need to go in this country with medical diagnostics, something we need to improve upon is putting diagnostic testing closer to patients, with specimen collection in more convenient settings.
Cost, privacy threats, and fraud have been cited as reasons for not creating a national patient identifier program. Do any of these present potentially insurmountable obstacles?
Dr. Sirintrapun (MSKCC): The privacy and cost arguments are valid, but there are ways they can be overcome. First, you want to make the juice not worth the squeeze for hackers. The problem with Social Security numbers, and even electronic medical record numbers, is they are tied into systems that have value. Don’t have the NPI tied into electronic medical record systems because those systems contain valuable information, such as whether patients have had cancer or have comorbidities that affect disability insurance. If you have an NPI that isn’t tied, IT-wise, to these other things, the value diminishes. We have to provide modern infrastructure so that patients can be identified without having their NPI or other sensitive information exposed.
Estimates in some health care blogs have shown that the costs of implementing an NPI system could fall between $1 billion and $50 billion. Over time that can be mitigated. And the architecture doesn’t need to be a complete overhaul of all our systems. But we know hospitals spend a lot of time and resources on identification, and if a mistake happens, costs are higher.
Dr. Tuthill
Dr. Tuthill (Henry Ford Health System): I think the obstacles are political. And certainly there have been significant privacy concerns at the grassroots level. But lack of an NPI is not preventing the government or insurance companies from accessing patient records. The challenge of integrating a patient’s record across multiple episodes of care in different care environments affects patients and providers, and it is patients and providers who are most hurt by the lack of a patient identifier. In fact, a fragmented patient identifier probably enables fraud because it requires a lot of work to tell what medical care has been administered to a given patient over time and across medical institutions.
The cost of amalgamating patient records and reintegrating records across episodes of care has got to exceed the costs of implementing a national patient identifier. It took millions of dollars to deploy the national provider identifier program, but it saved billions of dollars in fraud and accounting and in the ease of monitoring physician and billing practices. I assume the same would be true at the patient level.
Dr. Jackson