Clinical, Financial and Administrative Insights For Physicians

EHR Interoperability & National Patient Identifier - Are they Related? If so, how?

Posted by Suzanne Prasad

With a population of more than 321,000,000 people, it’s not surprising that patient identity mix-ups continue to plague the U.S. healthcare industry. The push for electronic health record (EHR) interoperability has only EHR_Interoperability-128392-edited.pngmagnified the problem. Without a unique national patient identifier (NPI), the likelihood for errors and patient safety implications grows significantly as providers continue to engage in larger-scale health information exchange (HIE).

This article addresses four important questions about the NPI and what it could mean for EHR interoperability.

1. The transition to EHRs is already well underway. So why hasn’t the healthcare industry moved to an NPI yet?

Although HIPAA required the creation of a unified patient identification system, Congress subsequently introduced a ban to prohibit the U.S. Department of Health and Human Services from using federal funds to create such a system. This ban continues to remain in effect today.

Most recently, the American Health Information Management Association (AHIMA) advocated for a petition that would require Congress to reconsider the ban.

The petition states: “Accurate patient identification is critical in providing safe care, but the sharing of electronic health information is being compromised because of patient identification issues.”

Unfortunately, the association collected only 8,980 of the 100,000 signatures required to move forward.

2. How could an NPI help address patient identity errors in the EHR?

When exchanging health information today, providers must rely on less-than-accurate methods of matching multiple demographic elements in the hopes of getting an overall match. Not only is demographic information prone to typographical errors, but it’s also potentially shared by more than one individual (e.g., two individuals could have the same name and/or date of birth).
 

The NPI changes all of this. As with a Social Security Number (SSN), an NPI is unique to each individual patient. This number would follow a patient wherever he or she goes to receive care, and it would be linked to all of his or her records. Therefore, an NPI—or other type of similar national solution—would help reduce the 50%-60% patient matching accuracy rate that the Office of the National Coordinator for Health Information Technology says occurs when providers share data across unaffiliated organizations.

3. What are the other potential benefits of an NPI in an electronic environment?

An NPI would essentially make patient matching error-free, thus enhancing patient safety and data integrity. Some argue that it could also reduce incidences of medical identity theft because it would eliminate the need to include SSNs in patient files. In addition, an NPI could improve patient satisfaction because patients wouldn’t accidentally be scheduled for the wrong exam or procedure.

4. Is an NPI absolutely necessary to achieve interoperability?

“An NPI won’t solve interoperability, but until we have a national solution for patient matching, we’ll never be able to have interoperable healthcare systems,” Keith Fraidenburg, executive vice president and chief strategy officer of The College of Health Information Management Executives (CHIME), told CIO.com.
 

CHIME announced last March that it would offer a $1 million prize to the winner of a National Patient ID Challenge—a global competition aimed at incentivizing innovators to accelerate the creation and adoption of a solution to ensure 100% accuracy in identifying patients in the United States. CHIME will announce the winner in February 2017.

Looking Ahead

Experts seem to agree that a patient matching strategy and interoperability go hand-in-hand. A more effective patient matching strategy makes for more effective HIE and care coordination as well.

“The eco system of healthcare IT is going to get increasingly more open, with smaller solutions being delivered into our environment to allow things like population health, patient self-management, patient coordination of care and family coordination of care. And the only way that is going to be successful is if we can have a good, positive patient ID so that these applications can share the appropriate data with the appropriate people,” Marc Probst, vice president and CIO at Intermountain Healthcare, told Healthcare Informatics.

Others agree. “Implementing a National Patient Identifier program with a solid validation solution and other tight protections is one critical step among many that will be needed to take interoperability from today’s embryonic state into a full grown reality,” Thomas Grove, of Consulting and Compliance Services at Phoenix Health Systems, told HIT Consultant.

To learn more about how your EHR vendor can assist with interoperability, click here


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RevenueXL Inc. provides best value comprehensive solutions to medical practices. Our solutions include affordable Electronic Medical Records Software (a.k.a. EMR or EHR Software), Patient Portal, and Practice Management or Medical Billing software and revenue cycle services including medical billing, medical coding, coding audits and account receivables management services. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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