Patient Identification: Toward a New National Strategy

“We hope the future includes a national strategy for patient identification,” McFadyen says. “This is an issue that affects everyone from small clinics, to large hospitals, to the public health system.”

Kate McFadyen, Director of Government Affairs, American Health Information Management Association (AHIMA)

Health data is at the core of modern healthcare, from in-person visits to cutting-edge virtual care. It is collected, stored, and shared in ever greater quantities. But that data is only as powerful as its ability to be matched to the right patient. An incomplete or inaccurate record can be more dangerous than no record at all.

As simple as it sounds, patient identification remains a worryingly large issue: denied claims due to patient misidentification cost the US healthcare system over $6 billion annually. And the consequences go well beyond the financial, with severe implications for patient safety and privacy. To secure the future of healthcare, America needs a national patient identification strategy. But for years, it’s been held back by arcane language buried deep in the federal budget.

Read on to learn more about the importance of patient identification and how healthcare advocates are pushing for a safer and smarter approach to it.

Meet the Expert: Kate McFadyen

Christina Gardiner

Kate McFadyen is the director of government affairs at the American Health Information Management Association (AHIMA), where she focuses on the congressional and policy work for the association. Previously, McFadyen was the director of government affairs for the American College of Preventive Medicine (ACPM), where she worked on public health and preventive medicine issues within the medical specialty.

She was also previously director of government affairs at QGA Public Affairs, where she handled healthcare issues, including Medicare, funding for biomedical research, and access to medicines.

The Importance of Proper Patient Identification

“Patient identification is incredibly important,” McFadyen says. “It’s not only a patient safety issue, it’s a patient privacy issue, and it has a lot of implications for the cost of our healthcare system, too.”

One patient safety issue is record overlays, where two or more patients combine their data into a single record because of similar demographic information. That can result in a patient receiving treatment based on another patient’s symptoms or personal information. Another safety issue is duplicate records for a single patient, which may arise when a patient visits several different healthcare settings and the records at each are never fully combined.

“Physicians basing their treatments on incomplete or inaccurate records is a huge patient safety issue,” McFadyen says.

The privacy aspect is multilayered as well. In the instance of overlaid records, one patient may access another’s, resulting in a HIPAA violation. But privacy is also a systemic issue: patients must repeatedly provide their personal information at every health setting they visit.

Both privacy and safety issues contribute to the issue of cost. Costs associated with patient misidentification are high and largely get passed on to the patient.

“The expense of repeated medical care due to duplicate records costs an average of $1,950 per inpatient stay and over $1,700 per emergency department visit,” McFadyen says. “That comes from patients having to undergo duplicate tests because the provider can’t be sure they’re treating the same patient that potentially got the same test at another clinic.”

Advocating for a National Strategy for Patient Identification

At its core, patient identification is a data issue. But the technologies and tools used to collect, store, and share that data are not the problem. The problem is the lack of a unified national strategy. The result is a fragmented landscape full of duplicate information, missing information, and inconsistent data integrity.

“We don’t currently have a national strategy for patient identification and matching,” McFadyen says. “That’s largely because of Section 510 in the Labor HHS appropriations bill. That language has been in the federal budget for more than 20 years now, and it prohibits federal funds from being used to adopt a unique patient identifier.”

This obscure-sounding legislative issue is holding back significant progress. The language in Section 510 originated from concerns around privacy, with some politicians expressing concern over creating a government-controlled database of patient medical records. But even with the introduction of unique patient identifiers, health data would continue to be stored at the point of collection—the hospital or clinic where a patient receives treatment. It would simply be easier to match that data to the correct patient.

So far, HHS’s interpretation of the language in Section 510 has been narrow, believing that if unique patient identifiers are off the table, then a national strategy for patient identification is, too. But the Patient ID Now Coalition, representing more than 50 leading healthcare organizations, remains solution agnostic: while unique patient identifiers would likely be part of a national strategy, several other potential solutions could be utilized. Freeing up the language in the federal budget would allow HHS to work with the private and public sectors to have more progressive conversations and advocate for an effective national strategy.

“We’ve been making strides in education on the Hill over the last few years,” McFadyen says. “Our champions are Representatives Mike Kelly from Pennsylvania and Bill Foster from Illinois. This is a bipartisan issue. We are seeing increasing numbers of members on the Hill that want to see this language taken out because they understand the ramifications to patients of patient misidentification.”

The broader healthcare sector also supports the effort to remove the ban from the federal budget. A recent letter sent to House and Senate appropriators was signed by more than 150 healthcare organizations.

The Future of Patient Identification

In 2021, the Patient ID Now Coalition released a framework for what considerations a new national strategy on patient identification should include, with detailed outlines on privacy, equity, data quality, data interoperability, and sustainability. The framework posits a need for multiple solutions rather than a one-size-fits-all fix.

“We’re looking at all avenues of how to improve patient identification and matching,” McFadyen says. “We want to improve it however we can.”

New technologies and best practices around patient identification are continuing to come to market. Advanced algorithms and biometrics can help improve patient match rates. In 2022, the Office of the National Coordinator for Health IT (ONC) publicized its work on ensuring addresses are being put into patient records in the same format. But until there’s a national strategy, McFadyen says, improvements can really only take place on the edges. Without a unified effort, patient identification issues will worsen: as more health data gets stored and shared, the possibility of misidentification or incomplete record sharing increases.

“We hope the future includes a national strategy for patient identification,” McFadyen says. “This is an issue that affects everyone from small clinics, to large hospitals, to the public health system. It needs to be addressed, so we can protect patients’ safety and patients’ privacy, and we can reduce the cost of the healthcare system.”

Matt Zbrog
Matt Zbrog Writer

Matt Zbrog is a writer and researcher from Southern California. Since 2018, he’s written extensively about emerging topics in medical technology, particularly the modernization of the medical laboratory and the network effects of both health data management and health IT. In consultation with professors, practitioners, and professional associations, his writing and research are focused on learning from those who know the subject best. For, he’s interviewed leaders and subject matter experts at the American Health Information Management Association (AHIMA), the American Society of Clinical Pathology (ASCP), and the Department of Health and Human Services (HHS).