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How Can a National Patient Identifier Improve Interoperability?

By Sara Heath

- In a healthcare system that is growing more complex through the use of coordinated care, health information exchange (HIE) is becoming increasingly important because various members of a care team need easy access to a patient’s medical records. Although many solutions, such as a national patient identifier (NPI) number, have been brought forward, the process of tackling patient matching isn’t quite as simple as one might think.

national patient identifier will improve health information exchange

Various organizations have recently proposed the use of a universal organization code, such as an NPI number. In fact, as recently as March, the College for Healthcare Information Management Executives (CHIME) offered a $1 million prize to the individual who could produce a 100 percent accurate NPI system.

But what is this system? How can it help improve the process of HIE? And does it have the proper security protocols for it to be an effective solution?

What is a National Patient Identifier?

Much like Social Security numbers are to finance, NPIs, otherwise known as universal patient identifiers (UPIs), are number codes that would be used across all healthcare providers to identify individual patients. This system has been proposed in lieu of more traditional identification methods such as a patient matching system where a doctor simply enters a patient’s name, date of birth, or address to access their medical files.

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An NPI would work much like a license plate number or a Social Security number in that it would be a universal way for any doctor, regardless of practice, to identify a singular patient without error. The unique number set would correlate only to the patient to whom it is assigned, and would grant all physicians – from primary care physicians to specialists – access to certain patient medical records.

How can it help health information exchange?

The primary benefit of an NPI is an added ease of health information exchange (HIE). When using patient matching systems, physicians have a lot of room for error, either by entering a duplicate name (e.g. if there is more than one John Smith), or entering patient information incorrectly (e.g. the names Sara and Sarah are commonly interchanged). This could cause physicians to access the incorrect patient files and make treatment decisions based off of inaccurate information. NPI use would eliminate that problem as each patient would be identified solely by their NPI, removing the chance for error.

According to EHRIntelligence.com, implementing NPI systems would also be more efficient and cost effective. Not only would physicians be able to access patient information more quickly, and therefore be able to deliver care in a more timely fashion, but they would also avoid administering the wrong sort of care which can often be expensive to remedy.

What kinds of security measures do NPIs have in place?

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A fundamental concern for most healthcare policies and systems is the question of health data security. In the case of NPIs, strict HIPAA regulations would safeguard patient information. In fact, those regulations have been in place since HIPAA came to fruition in 1996, according to HealthITAnalytics.com. Congress halted the development of an NPI under HIPAA due to a negative public response.

NPI advocates argue that this system would be more secure because it would eliminate the need for Social Security numbers to be included in patient files, and decrease the vulnerability of other patient information, according to Rand Corporation. Additionally, any security lapses could be alleviated by other technical safeguards.

“If the UPI were to facilitate the development of a more efficient national network, any potential negative effects of such a network could be ameliorated directly through other aspects of systems architecture, such as encryption, access controls, and audit trials,” Rand Corporation reports. “And use of a UPI would actually improve privacy by limiting the transmission of more sensitive identifiers, such as combination of names, address, date of birth, and Social Security numbers.”

What are the downsides of NPI implementation?

Many NPI critics cite health data security lapses as a primary reason not to adopt such a system. The creation of an NPI system would produce a huge commodity for data thieves as all of a patient’s health information would be stored in one central location. However, many healthcare professionals are starting to feel that those security issues are ones that can be handled, and the ease of HIE that NPIs would bring is worth the risk.

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“It’s time to stop using ‘privacy’ as an excuse,” argues Derek Ritz, P.Eng., CPHIMS-CA, principal at ecGroup Inc. “Although privacy and security issues are genuine, they are also readily solvable.”

There is another major logistical problem with NPIs: the costly and arduous task of creating the system. Creating a unique identification number for every individual receiving healthcare is an expansive task, and would require much time and money to do so.

According to Rand Corporation, estimates for cost amount to approximately $3.9 to $9.2 billion. However, as many experts note, there seems to be very little headway in the development process for NPIs, so few estimates have actually been confirmed.

Regardless of the pros and cons to NPIs, there is one thing experts are agreeing on: there is a great need to improve patient matchings systems due to their importance to HIE and care coordination. Through various initiatives like the one referenced at the start of this article that CHIME is offering, or the patient matching system lab HIMSS hosted, the healthcare industry is well underway to creating an improved HIE system.

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