The Elephant in the Middle of the Room: The Need for a National Patient Identifier

By Barry Hieb, MD
09:38 AM

The healthcare delivery system is complex in many ways that cannot be simplified.  Human beings present a limitless number of variations to busy clinicians who work under financial constraints to deliver high quality care with technologies and therapies that are constantly changing.  One aspect of healthcare delivery that can be simplified, however, is patient identification. 

Today, a single patient is likely to have multiple healthcare identifiers – one for each insurer, and a different patient number for each physician or hospital where he or she receives care, and possibly multiple identifiers if that care is delivered in a large healthcare organization that uses a variety of health IT applications.  These multiple identifiers lead to fragmented medical records, duplicate tests, increased costs, delayed treatment and poor outcomes.  A simple solution to this problem is the use of a single unique healthcare identifier for each person, but we’ve been debating this idea in the US for 20 years or more – at least until 1998 when Congress, out of concern regarding privacy implications, specifically directed the Department of Health and Human Services not to spend federal money on further investigation of solutions. 

That debate has never been about whether there are benefits associated with giving every American a single healthcare identifier.  These benefits are widely agreed to include:

  • If patient identification is more accurate and clinicians have access to electronic medical records across provider organizations, then contraindicated medications or procedures and redundant, unnecessary testing can be avoided.
  • Eliminating the need for a patient to provide the same demographic information to every provider, perhaps at every encounter, not only improves patient satisfaction and staff productivity, but also minimizes the opportunity for medical identity theft.
  • Establishing a consistent method for patient identification enables the creation, over time, of a comprehensive patient record as well as the accurate exchange of clinical data because up-front identification errors are avoided.

No, the debate relates to patient privacy and the high costs projected for the federal government to develop and deploy such a system.  These are very real concerns that must be considered.  An underlying assumption that has fueled these concerns is that the government would implement a patient identifier system that relies on a central data base of information on every US citizen.  Given this scenario, one must agree that the projected costs and potential security risks are unacceptable.

There’s a different approach, however, that eliminates these issues.  Based on the work of ASTM International and their patient identifier standards E2553 and E1714, the Voluntary Universal Healthcare Identifier (VUHID) system relies on secure server and communications technology that interacts with local enterprise master person index (EMPI) systems to issue and manage identifiers.  No identifying or clinical information is ever sent to the VUHID server, thus avoiding any incremental risk of privacy breaches.  In fact, the VUHID identifier model provides enhanced privacy protections that allow each individual to designate components of his or her medical record to be kept private or shared on a limited basis. 

VUHID employs “lite” technology to solve a complex problem.  The costs of developing the system have been remarkably low.  Initial deployment, expected in mid-2009, will test our assumptions about operational costs but these too are expected to be very low.  And because VUHID is sponsored by Global Patient Identifiers, Inc. (GPII), a healthcare non-profit organization focused solely on the success of the VUHID project, operational costs will remain modest.   

VUHID is not a government-led initiative but a grassroots effort to work with health information exchanges (HIEs) and regional health information organizations (RHIOs) to provide an essential patient identity management tool to make registration across heterogeneous distributed systems more efficient and accurate, to enhance patient control of the privacy of their clinical information and to facilitate error-free sharing of patient information.  Like the transformation of the healthcare system itself, the vision of a nationwide health information network (NHIN) will not be achieved by mandate nor quickly.  It will be built gradually over time, working with HIE and RHIO projects.  Without a solution like VUHID, these organizations will be challenged to share patient information accurately and securely with other HIEs and RHIOs.  In fact, these initiatives are struggling today to find a patient identity management strategy that supports accurate, secure sharing of patient information within their networks.

Using state of the art EMPI demographic matching, HIEs are experiencing patient identification error rates of ~8% (see the RAND Corporation publication, “Identity Crisis:  An Examination of the Costs and Benefits of a Unique Patient Identifier for the U.S. Health Care System”, Richard Hillestad, et. al., Oct. 2008), along with the downstream errors associated with duplicate records or misidentification of patients.  What if we could virtually eliminate these errors caused by missing or inaccurate patient identification?  Not only would we improve the efficiency of care delivery, we would also improve quality and convenience for both patients and clinicians.

The recently enacted American Reinvestment and Recovery Act of 2009 will provide unprecedented funding to support the effective implementation of health IT, including additional investment in the NHIN demonstration projects that began in 2005 under the auspices of the Office of the National Coordinator of HIT (ONC).  Without a unified patient identification strategy, we must take the “N” out of “NHIN” and hope only to achieve local health information exchange – with registration and patient identification errors, and related medical errors, as well as growing privacy concerns and risks for medical identity theft.  The time has come, finally, for our industry to step up to this challenge with a practical patient identification and privacy solution.  Go to for more details.

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