The Pew Charitable Trusts is urging Congressional leaders to support improved patient matching in electronic health records (EHRs) to help combat the COVID-19 pandemic.
The letter highlighted how the use of additional demographic data elements such as phone numbers and email addresses, along with standardizing how existing elements such as mailing addresses are recorded, could improve match rates. Those elements, in turn, could assist with both contact tracing from new cases and a future vaccination campaign, wrote Ben Moscovitch, health IT project director at the Pew Charitable Trusts, a research and policy organization.
The letter noted that most plans to re-open the country in the midst of the COVID-19 pandemic emphasize two core elements: the ability to effectively trace back the contacts of infected individuals and broad administration of an eventual vaccine. “Both factors hinge on having correct patient demographic data—such as individuals’ names and phone numbers. Unfortunately, current flaws in the identification and matching of patient records inhibit the nation’s ability to accomplish these efforts successfully,” Moscovitch wrote.
As such, Pew believes that Congress should work with federal agencies—such as the Office of the National Coordinator for Health IT (ONC) and the U.S. Postal Services (USPS)—to ensure that they are using all the available tools they have so that public health entities scan effectively trace contacts and track immunizations.
Experts agree that contact tracing, or the ability to trace and monitor the contacts of infected patients to prevent additional virus spread, is a paramount step to safely reopening the country, but tracing often lacks key information needed to effectively identify and communicate with COVID-19 positive individuals, Pew wrote.
Specifically, the group stated, research has shown that phone numbers are often not sent from laboratories to public health authorities, and when they are included, the numbers often refer to an ordering physician and not a patient. “As a result, contact tracers spend indispensable time searching for a phone number or email address to contact an individual—all while the virus may be spreading by unknowingly infected individuals that have not been reached via contact tracing mechanisms,” the letter read.
Related to the development of a vaccine for COVID-19, Pew noted that public health professionals and clinicians rely on immunization registries to track whether someone has obtained a dose, However, absent these steps, clinicians may not provide the right number of doses to secure immunity or provide too much of the vaccine when supply is low, the group cautioned.
And once again, they wrote, the effectiveness of immunization registries relies on the ability for healthcare professionals to locate the right record. To do so, they use demographic data—such as name, date of birth, and address. But typos and information that changes over time can influence the identification of the right record; in healthcare, research has shown that patient matching rates between hospitals can be as low as 50 percent, they stated.
Like with contact tracing, Congress can take steps to address this perennial challenge that could hinder national vaccination efforts, Pew said, specifically pointing out that better standardization can support both contact tracing and immunization. These steps include:
- Adding more data elements: The federal government should advance the use of other regularly collected demographic data elements for patient matching and identification. While recently released regulations from ONC mandate that EHRs must have the capability of sharing phone numbers, email addresses, previous addresses, and other information critical for identification and matching, they only apply to EHRs and not to the systems that may transmit data directly to public health authorities for contact tracing or to registries—such as lab systems.
- Standardizing data elements: Currently, data elements—such as addresses and phone numbers—may not be standardized across health IT systems, Pew points to research that has shown that use of the USPS format for address can improve the accuracy of matching records by approximately 3 percent, which could result in tens of thousands of additional correct record linkages per day.
Pew noted that many immunization registries, and the information systems they use, have already recognized the value of using the USPS address format for patient matching, and pay to use a shared service to conduct this standardization and validation. But EHRs don’t yet use this standard, and “Without all systems using the same format, data exchanged between them will not reap the full benefits from the standardization for improved data quality and increased match rates,” according to Pew.
