Electronic Health Reporter

By Karly Rowe, vice president, new product development, care & identity management, Experian Health.

This year could be the year that paved the way for a major change in the healthcare industry. In June this year, the U.S. House of Representatives voted in favor of lifting the decades-old ban on federal funding for all U.S. citizens to be given a Universal Patient Identifier (UPI), which would follow them throughout their lives.

Why is this so monumental? It’s estimated that around 30% of patient data held in electronic health records is incomplete or inaccurate, and up to half of all patient records may not be linked correctly. Unreliable patient data presents some huge problems for health systems, from flawed diagnoses and treatment errors to unreliable analytics and billing mistakes.

If the lift is approved, what could the implementation of a UPI mean for healthcare organizations and consumers?

The clinical side would see improved care

No one expects a quick fix for the industry’s challenges, but a UPI is the first critical step in improving patient identity management, with innumerable benefits for patient safety and care coordination.

If you’re not 100 percent confident about the identity and medical history of each patient who walks through your doors, how can your clinical teams be sure they’re offering the right treatment to the right patient? Without reliable records, patient safety becomes a gamble.

Identity errors would be reduced which also leads to cost savings

Patient misidentification also lands a financial blow for healthcare organizations. Healthcare organizations are suffering the costs of not having an adequate solution to accurately match patient identities and must rely on manual intervention and support, which is costly. For providers, millions of dollars are lost as the industry deals with costly errors, wasted physician time and denied claims, all of which could be reduced or eliminated if the data held for each patient was current and correct. In fact, around a third of claims are denied on the basis of inaccurate patient identification, costing an average of $1.5 million per hospital. Pharmacies also suffer the costs of an inadequate solution, estimating that as many as 50 percent of electronic prescriptions do not match to a patient record and the remediation cost is more than a dollar per record.

Patient data will be better safeguarded with integrated systems

Despite the advantages of a UPI, let’s not overlook the original worries that led to the funding ban in the first place. Concerns about the exchange and security of healthcare data are understandable. Safeguarding patient privacy is paramount, and the healthcare technology industry is evolving to provide ever-stronger identity proofing and data security tools.

Still, in the years since the funding ban put the brakes on a universal approach, many disparate software solutions have sprung up which don’t currently talk to each other. Integrating these systems in an industry of this scale will take a concerted effort. However, private-sector entities have already developed the technological foundation for data interoperability through the creation of UPIs that are maintained in a master person index. These solutions are vendor neutral, so data can flow between disparate electronic health systems. With federal funding in place, UPIs could be adopted with government oversight of private sector offerings and the creation of national standards to ensure quality patient matching and identification. Without government standards, fragmentation of the private sector UPIs will increase and continue patient safety issues due to misidentification.

Using UPIs to catch up with other consumer-facing industries

In no other industry, except healthcare, is it okay to prevent consumers from having visibility or access to their data. Today consumers are sometimes helpless in securing their medical histories, with no way other than to ask for print copies from every healthcare interaction they have across physicians, hospitals, pharmacies, labs, specialists, insurance companies, etc. Consumers expect frictionless healthcare interactions, but what happens at the moment is often inconsistent with their experience in other data-driven industries.