Unique Patient Identifiers (UPI) Needs to be Addressed Again
The National Health IT week this year ended its week long activities and events with the HIMSS 11th Annual Policy Summit. The participants went to Capitol Hill to explain HIMSS’ top three “Congressional Asks” to Congress. This year’s Asks, developed by a task force of HIMSS member volunteers, were:
- In the interest of patient safety, privacy, and security, and in order to achieve the full potential of health information technology, Congress should direct a study of patient data matching issues and best approaches to identify an appropriate nationwide patient data matching strategy.
- In order to improve the quality of healthcare for all Americans while also reducing costs, Congress should continue its strong bipartisan support for Health Information Technology.
- In order to realize interstate Health Information Exchange (HIE), Congress should support the harmonization of federal and state privacy laws.
One of the biggest challenges that can be said about any database structure is how to identify and handle duplicate records or associating data to the correct main header record. This is no different in the quest for health information networks and exchanges. Patients today unlike our parent’s generation see many health care providers and possibly in more that one geographical location that might not even be in the same State. Unlike our parent’s generation patients today will live in several locations before retiring. And not to mention how many times the average person has some type of name change or change of medical insurance payer in their lifetime. So how will a single patient be identified and their records distinguished in the nationwide exchange? Currently it is estimated that 8% to 14% of medical records contain erroneous information which does not actually belong to that identified patient.
A unique patient identifier was an idea that first publicly emerged in 1993 in the Clinton Health Security Act. A “Unique Individual Identifier for healthcare purposes” was mandated in the Health Insurance Portability and Accountability Act (HIPAA) passed in 1996. It became known as a Unique Patient Identifier (UPI). In 1998 the Secretary of HHS was in motion with intent to publish a proposed rule on requirements for this identifier. After a federal hearing held by the National Committee on Vital Health Statistics (NCVHS) on the patient ID, it was apparent there was an overwhelming movement against the proposal. By 1999, language had be added to the 1998 budget by Congressman Ron Paul, MD (R-TX), to prohibit federal funds from being used to create the UPI. The language has remained in subsequent budgets since.
HIPAA enacted in 1996 also required other identification numbers in addition to the UPI. The National Provider Identifier (NPI) is issued to all doctors, clinics, hospitals, and other practitioners. The NPI system was adopted in October of 2002. The mandated Unique Health Plan Identifier (HPID) were brought to light again with the passing of the Affordable Care Act and regulations were included in a final rule in August and will be effective on November 5, 2012. The Employer Identifier became the already in use Employer Identification Number (EIN) in 2004.