We should not waste this opportunity to take steps toward a safer, more efficient, and more secure health care information technology environment. ., pediatrics, homeless, undocumented immigrants, etc.). RFID technologies also offer more advanced forms of data security than barcode technology, including encryption, allowing for patients health data to be kept more secure (
These same issues have been raised in other countries, with various implemented solutions. . . 46 To be fair, developing and implementing a national UPI will not be a small feat, and the costs will be considerable. 43 Available from: Letter to Secretary with Recommendations of the Standards for a Unique Identifier for Individuals for Use in the Health care System, NCVHS, September 9, 1997. The first theme focuses on how patient misidentification can lead to clinical errors or near misses which raises patient safety concerns. Now, faced with the challenges inherent in a once-in-a-generation catastrophe, the benefit of such mechanisms for accurately and efficiently matching patients seen in multiple locations over a short course of time is especially apparent. 27 Perspect Health Inf Manag 2013;10. . . Failure to accurately match patients to their health information can lead to false positives when the medical records of two different patients are mistakenly matched Research should also include an examination of potential privacy risks to patients with the use of such technologies. Accurate and unique identification of patients along the care continuum is essential for patient care and safety, addressing cost and resource concerns, and enhancing data sharing and interoperability. As individuals move among health care systems and among cities, states, and even countries, their medical information needs to follow them to be useful. AMIA Annu Symp Proc 2005;1135. Although many developed countries use such identifiers in health care, the systems face challenges: Duplicate identifiers can be erroneously assigned, patients can misplace their identity cards, and numbers can be used fraudulently, among other problems. ) Those who believe in a unique patient identifier argue that it is a sound public policy that would protect patients and save costs. : A literature review of relevant peer-reviewed and grey literature published from January 2015 to October 2019 was conducted to inform the paper. emergency medicalert nursing facility healthcare aid safety care tag history foundation However, in 1998, then-Representative Ron Paul (R-TX) introduced language that banned the use of federal funds for the development or deployment of a UPI; the ban has remained in every subsequent congressional budget proposal. The debate about a unique patient identifier is worth having and should be informed by international experiences with them. If the United States goes ahead with the development of a system of unique patient identifiers, it should give serious consideration to using biometrics and the technical and privacy issues they introduce.
Available from: Sundhedsministeriet; Danske Regioner of Kommunernes Landsforening D E-health in Denmark. , address, phone, email, and name change) , Estonia Beyond algorithmic methodologies, a growing number of organizations are implementing add-on technologies including referential matching software to increase odds of identifying patients correctly. Referential matching also has limitations related to certain patient populations including children, homeless individuals, and undocumented immigrants because data sources used for referential matching do not contain or have limited information on these populations 20 https:// e.g 
Standardized data elements are also generally needed to optimize matching algorithm accuracy ( 14 Privacy concerns are also often cited as a major concern in implementing UPIs 33 Adelman J, Aschner J, Schechter C, Angert R, Weiss J, Rai Aet al. 15 . 42 USC 1320d-2(b)(1), Omnibus consolidated appropriations; 1998, P.L. However, doing so would be a monumental if not impossible task, for the reasons listed above. This time-saving efficient charting has extended healthcare workers day At the same time, technological and methodological innovations have introduced new approaches such as referential matching, biometrics, and radio frequency identification device (RFID) technologies as ways to further improve techniques for patient identification Further steps can be taken today as regard to existing processes and practices to address patient identification errors. Really? and transmitted securely. ECRI Inst 2016;20. Available from: Rudin R S, Hillestad R, Ridgely M S, Qureshi N S, Davis J S, Fische S H.Defining and Evaluating Patient-Empowered Approaches to Improving Record Matching. and Ireland Concomitant with the decreased number of repeated tests, implementing a UPI would provide financial benefit to the health care system. AMIA Annu Symp Proc 2003;(Figure 2):25963. Lusk K.Healthcare Financial Management Duplicate Records Compromise EHR Investment; 2009;(August). Globally, some countries use unique patient identifiers (UPIs) to assist with patient identification while the United States (US) prohibits the use of a national UPI due to privacy and security concerns . Technologys promises include greater efficiency with onerous tasks, like taxes, more free-time to pursue our creative interests, and unfailingly accurate results that far surpass what we previously did with our brains. at least 2 hours daily. 57 These gains would accrue even without a national identifier and help support accurate matching if one is eventually established. Optimizing algorithmic matching through data standardization and referential matching software should be studied further to identify opportunities to enhance patient identification techniques and approaches. They are essentially blocked by the EHR chart to consider and record alternate diagnoses. 2 . Branding Nordic Healthcare Strongholds A Nordic Story About Smart Digital Health 2018;25. gs1 While matching algorithms can achieve matching rates approaching 90%, they are not perfect and do not represent a 100% accurate patient matching solution Different technological approaches and practices and operational processes that optimize accurate patient identification are necessary to meet the increasing and diverse demands for the use and reuse of data by various stakeholders Stat presents a persuasive article for healthcare Identifiers. Patient identification techniques ranging from UPIs to algorithms to biometric identification have been implemented worldwideeach accompanied by their own set of opportunities and challenges and resulting in no single solution with a 100% match rate. Worldwide, there are several different patient identification approaches, techniques, and solutions including UPIs and algorithms. Some, for example, use Street in addresses, while others use St.. In: Proceedings of the European Conference on eHealth 2006. p. 131-42. 2AHIMA International, Barcelona, Spain; Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.
Smartphones and email addresses can be used as long-lasting identifiers, and we increasingly use biometrics such as facial recognition and fingerprints to unlock our devices or identify ourselves at airports, in banking, for security systems, and even at sporting events. In 1996, the Congress passed legislation calling for the adoption of a UPI 51 Results John D. Halamka, M.D., is professor of international healthcare innovation at Harvard Medical School. Before . Patient identity, patient matching, identification errors, patient identification systems, patient records linkage. There is one relatively simple solution for that issue: Hospitals and EHR vendors could format addresses using the U.S. However, even though UPIs are widely implemented and constitute a preferred method due to reduced reliance on patient attributes for patient matching, the challenges of generating and implementing UPIs often lead to limited implementations within institutions compared to other care settings 55 Inclusion of the report language may continue to help foster private sector-led initiatives focused on patient identification and help identify and implement important policy levers to further advance a nationwide patient identification strategy in the US. Patient identification is the process of correctly matching a patient to appropriately intended interventions and communicating information about the patients identity accurately and reliably throughout the continuum of care . Project HOPE has published Health Affairs since 1981. However, for the second time in as many years, this proposal made it out of the House only to be shot down by the Senate. For example, in the US, recent suggestions have included adoption of US Postal Service certified address standardization rules 17 Additional emerging technologies, like radio frequency identification (RFID) are under exploration by hospitals to enhance patient identification. 41 Patient identification encompasses not only the physical identification of the patient but also technologies able to enhance the accuracy of patient identification 19 . A UPI is a single medical identification number, much like a Social Security number (SSN) or some other identification (such as biometrics or smartphones), that is unique to each person and used to organize their medical information. . 22 2016 International Conference on Orange Technologies (ICOT) 2016, Melbourne, VIC; 2016. p. 207. According to the Pew Charitable Trusts, at least two mission-critical tasks related to the coronavirus response would benefit greatly from enhanced ability to match individuals: contact tracing and the distribution of COVID-19 vaccines. 7 One example is home address: An analysis by the Census Bureau revealed that the average US resident moves 11.7 times in their life; each one of those moves is an opportunity for their identifier set to fall out of date. Available from: Rebello E, Kee S, Kowalski A, Harun N, Guindani M, Goravanchi F.Reduction of incorrect record accessing and charting patient electronic medical records in the perioperative environment. But different electronic health record systems dont always record that information in the same format. Available from: Programme I.Preliminary Study on Mutual Recognition of eSignatures for eGovernment applications Report. e.g or false negatives when the records for the same patient are not matched. 35 . Additionally, RFID technologies offer re-writeable functionality, allowing information to be modified, and require no line of sight, eliminating the need for human intervention . . Health plans There is no longer an adopted standard to identify health plans. In Canada, because healthcare is funded and governed at the province-level and every province has different regulatory frameworks, the deployment of a nationwide UPI proved difficult Available from: 2016 National Patient Misidentification Report. : Errors in patient identification have implications for patient care and safety, payment, as well as data sharing and interoperability. The administrative costs for fixing mismatched and duplicate records can be enormous. The site is secure. As part of new rules designed to aid the exchange of health data, the Office of the National Coordinator for Health Information Technology should require that the postal service format for addresses be used by all electronic health records when sharing patients records. Additional study and research are needed to evaluate the effectiveness of referential matching in improving algorithmic matching rates. In a series of focus groups conducted by the Pew Charitable Trusts, respondents overwhelmingly chose biometrics as the preferred option for a medical identifier over smart cards, unique numbers, or usernames and passwords. Available from: Health information exchange in US hospitals: The current landscape and a path to improved information sharing. As such, there is currently no UPI in use for patients in the United States. . Patient misidentification raises data sharing and interoperability concerns as well. Evaluating the effect of data standardization and validation on patient matching accuracy. Unlike existing barcode technologies, RFID labels can hold more data than barcodes and be read automatically without user intervention Available from: McCoy A B, Wright A, Kahn M G, Shapiro J S, Bernstam E V, Sitting D F. Matching identifiers in electronic health records: implications for duplicate records and patient safety, Why Patient Matching is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The .gov means its official. It isnt every day that the House of Representatives takes bipartisan action to reverse a policy thats been in place for two decades. Similarly, with the existence of multiple records for a single patient, clinicians can miss critical information because it is in the duplicate record Health Inform J 2015 Oct 14. Available from: American Hospital Association. means youve safely connected to the .gov website. This House vote opens the door to establishing a national identifier. . As many participants noted, a smart card or ID number can be lost or forgotten, but a fingerprint or face scan could almost always be used, even when an individual is unconscious. . If the address matches an existing account you will receive an email with instructions to reset your password. Share sensitive information only on official, secure websites. Practices that can enhance patient matching rates include requiring patients photos to be taken at registration and incorporating them into patients medical records so that they are visible to all clinicians across the enterprise, adopting a standard for entering temporary names for newborns in accordance with the Joint Commissions elements of performance to enhance patient identification with infants, and implementing standard processes for how staff should record certain patient demographic data attributes including patients names and addresses Use of Temportary Names for Newborns and Associated Risks, https://www.ecri.org/Resources/Whitepapers_and_reports/PSO%20Deep%20Dives/Deep%20Dive_PT_ID_2016_exec%20summary.pdf, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419943/, https://ieeexplore.ieee.org/abstract/document/7359269, https://www.rand.org/pubs/research_reports/RR2275.html, http://dx.doi.org/10.1177/1460458215608901, http://dx.doi.org/10.1111/j.1537-2995.2008.01923.x, 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https://www.hse.ie/eng/services/publications/healthmatters/health-identifier.pdf, http://www.moh.govt.nz/notebook/nbbooks.nsf/0/745B635139ED8647CC257E97007F46DA/$file/sharing_patient_health_information.pdf, http://international.commonwealthfund.org/countries/israel/, https://www.ncbi.nlm.nih.gov/pubmed/28679924, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835678/, https://www.healthit.gov/sites/default/files/patient_identification_matching_final_report.pdf, https://www.pewtrusts.org/en/research-and-analysis/reports/2018/10/02/enhanced-patient-matching-critical-to-achieving-full-promise-of-digital-health-records, http://www.jointcommission.org/assets/1/18/2004-2015_SE_Stats_Summary.pdf, https://www.journalofhospitalmedicine.com/jhospmed/article/132091/hospital-medicine/health-information-exchange-us-hospitals-current-landscape, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479910/, http://homepages.cs.ncl.ac.uk/brian.randell/Genealogy/NameMatching.pdf, https://www.ncbi.nlm.nih.gov/pubmed/29324953, https://www.ncbi.nlm.nih.gov/pubmed/26666447, https://finance.yahoo.com/news/ncpdp-experian-health-announce-100-130500167.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAMe_pd7marqkYaROpbuleDgglUCDnJGDnPMuyzrpcU-DDqT8Z2AVJLt8sCS0bMSyO90FY7s02MDwKDHAG903cI_FL-AUeKDx71bPb3wwxwRPdhYme_Qsz9G658uJ4_nuUGpUdp4aUglLVc9HYj2P3YvVaRIaHkoioTjcDB-KZOnF, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667827/#ref-5, https://ieeexplore.ieee.org/abstract/document/6117475/citations?tabFilter=papers, https://www.frontiersin.org/articles/10.3389/fpubh.2018.00025/full, https://pdfs.semanticscholar.org/d38c/d4f32daadec8467f7aab4f718117265b65c7.pdf, https://dl.gi.de/bitstream/handle/20.500.12116/23988/GI-Proceedings-91-12.pdf?sequence=1&isAllowed=y, https://ncvhs.hhs.gov/rrp/september-9-1997-letter-to-the-secretary-with-recommendations-on-the-standard-for-a-unique-identifier-for-individuals-for-use-in-the-health-care-system/, https://www.ecri.org/Resources/HIT/Patient%20ID/Patient_Identification_Evidence_Based_Literature_final.pdf, https://qualitysafety.bmj.com/content/22/3/219.citation-tools, https://www.ncbi.nlm.nih.gov/pubmed/27134610, https://www.justassociates.com/application/files/8014/9124/7591/HFM_August_2009_Children_Dallas_cost_of_duplicates.pdf, https://pages.imprivata.com/rs/imprivata/images/Ponemon-Report_121416.pdf, https://sequoiaproject.org/wp-content/uploads/2018/06/The-Sequoia-Project-Framework-for-Patient-Identity-Management-v31.pdf, https://www.aha.org/system/files/2018-03/sharing-health-information.pdf, https://www.ncbi.nlm.nih.gov/books/NBK208618/, https://www.pewtrusts.org/-/media/assets/2019/09/healthit_standardization_v2.pdf, https://www.jointcommission.org/assets/1/18/R3_17_Newborn_identification_6_22_18_FINAL.pdf, https://www.ncbi.nlm.nih.gov/pubmed/26169429. . 36 Other areas for additional study include further study of RFID technologies and the potential use of big data analytics approaches (such as using Fuzzy algorithm (Levenshtein Distance) and MapReduce techniques) EHRs have been a mess. . 1
Thornton S N, Hood K.Reducing duplicate patient creation using a probabilistic matching algorithm in an open-access community data sharing environment. . Referential matching software is a data augmentation where a third-party service provider adds an additional layer of demographic data (typically from outside of healthcare) including datasets from credit reporting and public utilities that are routinely updated and maintained to enhance patient matching
31 13 Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. government site. . ., telephone number, date of birth, address) For instance, one hospital reported 30% of clinicians surveyed reordered tests because of lack of access to previous records And patients seeing a new doctor must complete reams of new patient paperworka step that could be skipped if a UPI were in place. Biometric identification of newborns and infants by non-contact fingerprinting: Lessons learned. 32 Much of this fear is based on concerns stemming from issues around the SSN, but these fears are not transferrable to an identification method used specifically and solely for health data. Biometric technologies are increasingly being used to identify patients in the US , pulling the record of a patient with a name similar to the intended patient, or asking about patients identity while failing to either check a patients identification band or ask for two acceptable forms of identification. The original ban was written in 1998 by then-Rep. Ron Paul (R-Tex. Even without a national system, biometrics are now being used within individual health organizations, though not typically for exchanging data among them. . website belongs to an official government organization in the United States. Evidence suggests that standardizing certain demographic data elements could improve match rates Conversely, a patients record can sometimes be erroneously split, creating duplicate records and making retrieval of patient information difficult. 31 Today, hospitals use multiple data points to match records to the right patient, such as the patients name, birth date, address, and other identifying information. Unfortunately, whats missing is balance. Rather, each health care system maintains its own identifiers for patients. However, without the ability to ensure that the data received from another health care entity applies to the patient in front of them, the safer course for doctors is often to repeat the test or collect demographic and history information again. Additional research and study should be undertaken by non-profit, non-government institutions to identify and evaluate data elements (such as demographic data) that could further optimize the accuracy of matching algorithms. . See Fortune Magazine , March 2019 Death by a Thousand Clicks Where Electronic Health Records went Wrong. Available from: Ethical and Legal Considerations in Biometric Data UsageBulgarian Perspective. Either of these situations can arise from any number of causes, such as a typographical error or a patient using a nickname during registration. Although electronic health records (EHRs) have helped improve care overall, health systems still struggle to link patients to the right record on every visit, and attempting to match records between hospitals can fail up to half the time. Healthcare organizations vary in how they collect and identify patients. In turn, limited health information exchange can lead to clinical decision-making based on incomplete information resulting in increased chances of misdiagnosis, unsafe treatment, and duplicative testing Such approaches are common in Europe including England, Wales and the Isle of Man , register with nickname versus legal name), and failure to update patients information when their demographic information changes (
lock The new PMC design is here! . In the absence of a UPI, institutions have taken to algorithmic, probabilistic means of matching patient records through multiple non-unique identifiers: name, date of birth, ZIP code, phone number, address, and others. 