Patient identifier systems need to move beyond the name game
When I became engaged to my wonderful husband, I spent a fair amount of time debating what to do with my last name: Keep my maiden name, take his name, hyphenate or create a new last name.
These were all philosophical discussions around feminism, identity and what it means to be married, with some tertiary thoughts about how much easier people can spell and pronounce “Newman” rather than “Leis.” In a million years, however, it didn't occur to me the logistics around changing one's name creates a bureaucratic nightmare.
That's why I laughed when a Centers for Medicare & Medicaid Services official, discussing medical record patient identifier systems with me at the LTPAC HIT conference this week, said something to me along the lines of, “You'd think the name fields would be straightforward,” and I replied, “Clearly, you have never tried to hyphenate your last name.”
When I decided I would be Elizabeth Leis-Newman, post-hyphen, I would receive medical bills for hundreds of dollars. Medical records system didn't recognize the hyphen, ergo couldn't match it to my health insurance. Flying became a nightmare because every airline had a different system for processing my last name, first name and middle name. Pharmacists or those I called to place orders through the first part of my last name — Leis — was my first name. By the time I had been married for three years, I was ready to jettison my hyphenated last name, as the patriarchy was killing me through a thousand papercuts of paperwork.
That's why I was sympathetic to the challenges explored in a Patient Identification Forum at LTPAC. There is evidence medical errors — the third-leading cause of death in the U.S. — are often related to patient identification problems, noted Barbara Sivik, vice president of business services at CHIME (College of Healthcare Information Management Executives).
AHIMA senior director of federal relations Lauren Ellis Riplinger, JD, explained that the prohibition on Health and Human Services creating a unique patient identifier system was pushed through Congress in the late '90s. At the time, there was a larger discussion about the future of managed care, and there were cost concerns, not to mention concerns about privacy.
However, legislators also would have barely known the Internet existed, much less have been able to foresee the way technology, specifically electronic medical records, would be de rigour 20 years later.
Riplinger and others' goal is for something that strikes me as reasonably simple, which is for Congress to kill the restriction so that HHS is allowed to engage with private stakeholders. It may not be possible for the government to find a solution due to huge concerns about potential costs and privacy, but I can't see the harm in letting HHS work on the issue with vendors or providers.
For one, as Riplinger noted, in today's environment there are better ways to provide privacy and security in a networked environment. As data increases, patients want more connectivity, which “heightens the need for a unique identifier,” she said. Systems are being forced into exchanging data and becoming interoperable, but often can't get out the door due to challenges related to patient identification.
A natural response from some may be, “Why not Social Security numbers?” which are, of course, government-issued and unique. But these are fallible within patient records because SSNs are used for financial information, such as when you buy a house. That means a data breach at a nursing home could mean more than a medical privacy violation; it could expose sensitive financial information of a resident.
Even in places where everyone knows everyone, the name system can be fallible, noted Mark Pavlovich, senior director of analytics and education at Ethica Health, who noted how the system's nursing homes in Georgia are often in rural locations.
“It's not uncommon to have a mother or father and his or her child in a nursing home at the same time, and to have the same name,” he said. “There's a level of complexity in very small homes.”
For providers that have to figure out a patient identifier system sooner rather than later, Brian Yeaman, MD, chief administrative officer for Coordinated Care Oklahoma explained how his organization matches nine different variables, with cell phone rates driving up the matches.
Date of birth and email (also a word that recently lost its hyphen due to AP Style) are other ways to match, except for issues related to common names in the latter. I have a Gmail account with my first and middle names and have over the years received confirmations to a spa, for a flight, receipt of a car and a long email about a child's health issues. None of these were dire, but Pavlovich told a story where he received several emails for two different men with his name and slight variations in emails related to using dashes and periods, including for a physician appointment. (For example, ask how often an email meant for Joe.Smith@gmail goes to JoeSmith@gmail or Joe-Smith@gmail or JoSmith@gmail, and so on.)
These challenges are behind why CHIME launched a National Patient ID Challenge in January for innovators to figure out a way to solve the problem. It's already received more than 100 submissions. A solution exists, but is likely years away.
“The federal government can't solve this problem. If it was easy to solve it would have already been solved,” Sivik said.
In the meantime, my best advice to providers is to have different variables to match. It may seem cumbersome, but so is a lawsuit related to medical errors caused by inaccurate patient identification.
Follow Elizabeth Newman @TigerELN.