Electronic Health Reporter

By Andy Aroditis, CEO, NextGate.

For years, health IT stakeholders and industry associations have stressed the importance of high-quality patient matching and data standardization in achieving the goals of the Triple Aim. While efforts for a national strategy have stalled, in part because of the government’s ban on universal identifiers, endeavors to improve patient identification at scale are mounting.

Last November, Senator Maggie Hassan petitioned the Office of the National Coordinator for Health Information Technology (ONC) to develop policies for standardized address data given the importance of accurate patient demographics in this ongoing pandemic.

Since then, action has been forthcoming, not only by the ONC but also by the federal government and other private sector organizations who have come together to address the clear need for a unified standard around patient address data. In December, ONC announced their intention to develop a unified specification for a critical component in patient matching—address data.

This new initiative, known as Project US@, will formally launch later this month and help health officials and experts establish consistency around formatting patient addresses. Here are three things you should know about Project US@:

1. Will lead to higher patient matching rates 

Project US@ comes to us at a time where fragmented patient data or inaccurate address data can put patients at significant risk. Delays in medical care and insurance claim errors can be tied back to how patient address data is recorded in electronic health records (EHRs). Despite intense efforts and significant investments to implement EHRs, they lack the competencies to unify information from disparate and external systems. They are also vulnerable to duplication and discrepancies due to incompatible and inconsistent formatting. For instance, some systems will include hyphens, apostrophes and suffixes (i.e. Avenue vs. Ave.); others don’t. The resulting number of incomplete, duplicate and disjointed records lead to patient safety errors, delayed care, skewed analytics, administrative burdens, and lost revenue.

Through Project US@, the ONC, HL7, X12, and the National Council for Prescription Drug Programs will collaborate to create a single standard for the collection and formatting of addresses across health systems. A welcome alliance given that research led by Regenstrief Institute, Indiana University and The Pew Charitable Trusts, indicates that using address formatting guidelines from the U.S. Postal Service (USPS) would boost match rates by 3 percent—enough to potentially link tens of thousands of additional records every day.

With patient records required to be input and stored according to a single criterion, health providers can improve contact tracing efforts for COVID-19, billing and direct mail communications, shipment of essential medications and ensure that every patient receives the appropriate care outlined in their medical profile.

2. Will be a great companion to the Hassan-Cassidy bill

Project US@ is not the first attempt by health officials to improve patient matching policies and promote health data interoperability through address validation and standardization. You may recall that in August 2020, Sen. Maggie Hassan and Bill Cassidy introduced the Patient Matching Improvement Act. This bill aimed to improve patient matching across health care systems by directing the USPS to make their address-formatting tools available for use by hospitals and COVID-19.

More commonly used by online retailers to ensure delivery accuracy, USPS’ free web tool can transform an input address into its format and improve deliverability by matching it against their address database. But prior to this act, health care organizations were prohibited from using the converter.

Sen. Hassan’s belief is that providing health professionals with these tools will “help save lives by making it easier to conduct COVID-19 contact tracing.” It could also improve needed data sharing between hospitals and optimize the future vaccine distribution process.

3. USPS standardization has its limitations

Patient matching is still an area of improvement as there are very few vendors who can give a 100% accurate address matching rate – including USPS. Although the USPS’ extensive database makes it a great jumping point for this kind of mass standardization, health officials recognize some of the nuances that make this data less than dependable.

In Senator Hassan’s letter to the ONC, she references an earlier response from ONC identifying the “limitations in the USPS standards’ application to healthcare and notes that “it would not eliminate all variation and would therefore not eliminate the need for manual reconciliation.”

USPS address-formatting tools use the Postal Service’s database to search, verify, and format addresses. However, this database has generally been plagued by address errors due to inconsistent updates and misconducted street reviews. While the ONC should be praised for taking proactive steps to incite change, more will need to be done to develop address standardization.

Therefore, when considering address verification software (AVS), healthcare experts should be looking for a supplier with legitimate relationships with reputable data sources, a tool that offers international data coverage if operating globally, and a database that gets frequently updated and refreshed.

Data standards for patient matching

While the industry continues to make strides in addressing patient identification issues, the Project US@ initiative is only one step in a long journey toward eliminating patient mismatches completely. To further improve patient matching, ONC should also consider capturing additional elements such as email addresses, phone numbers, insurance identification numbers – more accurate validation and matching.

The truth is, EHRs can only go so far, and reliance on these systems to master patient identity perpetuates the issue. Ultimately the core identity of an individual and their associated demographics should not be in the control of any single system. Rather this information should be externalized from such insulated applications to maintain accuracy and consistency across all connected systems within the delivery network.

While EHRs and other IT applications are essential to the modern healthcare enterprise, they cannot deliver full benefits using proprietary protocols or incompatible standards. Adherence to IHE Profiles and other established standards is critical to health data interoperability.

Linking patient records takes considerable effort. It is easier and more effective when computer programs do the work automatically. In turn, the software’s success rates are boosted further when the data being matched is standardized.