Leaders at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) are pushing ahead in their efforts to accomplish the creation and adoption of a national patient identifier. CHIME’s senior leaders are agreed: it is absolutely time for the United States to adopt a national patient ID. The problem? There’s a core challenge on the policy level, as the U.S. Congress passed legislation several years ago actually forbidding the adoption of legislation to create a national patient ID.
As a result, CHIME’s leaders have been creating a policy workaround. They’ve partnered with the international HeroX Foundation (originally a spinoff of the international XPRIZE Foundation) to create a challenge-based process whereby they can stimulate inventiveness in this area, leading to the awarding of a $1 million prize for the organization or group that develops a solution that can be scaled nationally across the U.S. and, they hope, become a universalized solution in this area.
As announced in a March 17 press release, “The College of Healthcare Information Management Executives (CHIME), the healthcare industry’s leading professional organization for chief information officers and senior IT executives, is calling on innovators throughout the U.S. and around the world to participate in the CHIME National Patient ID Challenge. In an effort to find a universal solution for accurately matching patients with their healthcare information,” the press release said, “CHIME will launch a $1 million challenge early this summer on the HeroX platform, co-founded by XPRIZE CEO Dr. Peter Diamandis.”
The press release went on to say, “The digitization of the U.S. healthcare system maintains that electronic health records must be able to seamlessly share and exchange information. Interoperability, however, is not enough. To realize their full potential, patient data contained in the EHR must be accurate in order to support the requirements of coordinated, accountable, patient-centered care.”
And it quoted CHIME CEO and president Russell P. Branzell saying that “There is a growing consensus among payers and providers that a unique patient ID would radically reduce medical errors and save lives. Incomplete or duplicate health records,” Branzell said in the press release, “present significant issues in terms of patient safety, and there is a pressing need for preventing, detecting and removing inaccurate records so hospitals can positively match the right data with the right patient in order to provide the best possible care.”
The press release also offered statements of support for the initiative from senior leaders of the American Health Information Management Association (AHIMA), the CommonWell Alliance, the Health IT Now (HITN) Coalition, the National Patient Safety Foundation (NPSF), and the Healthcare Financial Management Association,” among other organizations.
The completely virtual HeroX Foundation, founded in 2013, and with a staff of about 20, has awarded four prizes so far: Agricultural Innovation Prize (2014); the Ellucian Student Success Challenge; the Jerusalem Challenge; and the Rockefeller Foundation Storytelling Challenge (all 2015). It has considerable flexibility in how it handles the issue of intellectual property, which will be particularly beneficial in the current collaboration with CHIME.
Keith Fraidenburg, CHIME’s executive vice president and chief strategy officer, spoke recently to HCI Editor-in-Chief Mark Hagland regarding this initiative. Below are excerpts from that interview.
You and your colleagues have been pushing very hard on this initiative around the development of a national patient identifier. What is the landscape around that initiative right now?
National patient ID is really, really hot. We’re happy to see that it’s actually being discussed in DC, on the Hill, in Congress, at the agencies. It wasn’t that long ago when I was going to meetings with agencies and Senate committees, and such, and people would literally say, “We know what you want to talk about, and we’re not going to talk about it, so let’s move on”—and I heard that in a Senate committee! That was two years ago And where we are today, it’s in the media, it’s in the news. And when we meet with ONC, they ask us how they can be supportive and helpful. So there’s a growing recognition that this is a critical issue that has to be resolved.
What, at the highest level, would you like to have happen?
Our ultimate desire, which has driven us to this path of working with HeroX, is to identify a solution. The end-state of this is that we will be able to present to the industry a solution for a national patient identifier. HeroX is an offshoot of the X Prize Foundation; they’re best known for launching rockets. They help produce challenges to spark innovation in many different fields. The challenges that X Prize runs are in the 10, 20, upwards of 50 million-dollar range now. So as they’ve moved up in scale and scope, they’ve created HeroX. HeroX’s challenges are generally for a million dollars or less. Our prize is for one million dollars. As XPrize gets bigger and bigger, now you have HeroX.
So they’re hoping that vendors will create a solution?
Yes, it’s like global crowd-sourcing. They have a database of something like 5,000 companies, ranging from start-up organizations to small non-profits, to for-profits, to universities. So HeroX and XPrize bring access to these potential competitors to the table, in a platform that connects them with people who have the potential to support it. It’s possible that a company from China might come in to solve this; it doesn’t have to be U.S.-based or healthcare IT-based.
When will the challenge launch, live?
It’s still in pre-launch phase; we’ll be able to announce the scheduling of a live date sometime soon. Meanwhile, we’re in the phase of challenge design right now. We’re developing the criteria that competitors have to fulfill. And with an issue as complex as a national patient identifier—we’re getting close to being able to publicly share in draft form the challenge requirements, so that we can crowd-source and provide feedback—we’re within a few weeks of being able to offer those requirements.
Very broadly, what kinds of things are going to be in the criteria?
Let me give you some broad criteria; the actual requirements will be much more detailed. But the solution should be privacy-enhancing; it should be secure and resilient; it needs to be interoperable or support interoperability—that’s key; it has to be cost-effective to become nationally scalable; it needs to be voluntary; and it should be able to support clinical workflows.
What are your expectations around what level of activity will come out of this challenge?
We would love to see hundreds of potential competitors. In the pre-registration stage right now, approximately 50 organizations have indicated preliminary interest in the competition. We’ve really been overwhelmed by that level of preliminary interest already. We’ve been so hard at work working on the design requirements, we haven’t really spent much time promoting the challenge itself, so that is very heartening. Our hope would be to possibly garner 100 or even 200 competitors. That would be a moon shot, but we’d love to see that. And outside HeroX, I don’t know how you could bring in that many bright minds to solve something this complex—which makes it very exciting.
This will be a private, voluntary solution, but you’re hoping it will be doable and therefore will be adopted across the U.S. healthcare system?
We’re talking about intellectual property issues now; our hope is that if and when this solution is developed, will live in some sort of public/private collaborative. In order to be scalable and achieve the aims we’re setting for it, it would be difficult if it were totally private and proprietary. Fully open-source would be ideal; perhaps somewhere in between would be where this might end up; but we’re still working out those details.
Could there be any possibility of an eventual outcome where there might be more than one solution, which would lead to non-universalization?
I don’t think so. We’re really trying to end up with just one solution. I think that that is unlikely that that would happen. Just from attending an XPrize event—they identified a winner and some runners up who had great solutions, but maybe didn’t end up exactly fitting.
Is there any possibility that someone could come up with some competing solution to compete with the solution you came up with?
I don’t know what could happen post-identifying a winner of our particular challenges.
And after you award the prize, you’re going to try to get everyone to participate, right?
Yes; it obviously has to be voluntary. And the best we can do is to shine a spotlight on this and say, this is what our industry has been looking for, for a long time. We’ve come up with a winner based on a very rigorous process, and here you go. You can’t force anyone to adopt something if it’s voluntary, obviously. But if you look at the press release on the launch of the challenge, a number of organizations, including AHIMA, CommonWell, and others, were very supportive. I think as an industry, our hope is that if we can identify the solution—and we’re extremely transparent about the requirements and the rigor—that the industry would be hard-pressed to say no.
Politically, on Capitol Hill it’s not possible to pass legislation mandating this, at this point?
Despite the fact that there’s a lot more discussion on the Hill about a national patient ID, but do I think the prohibition on the Department of Health and Human Services to develop this will be eliminated anytime soon? No, I don’t. I do think that federal officials are hoping something like this will emerge; they just can’t spend a dime on it. And perhaps the interest in this has something to do with the elevated dialogue. And we would hope that by CHIME drawing a line in the sand saying, look, if no one else will do this, we’ll move forward on this and shine a spotlight. I hope that that would be the case. It’s sort of an ancillary benefit, even prior to any solution emerging.
Is there anything you’d like to add to this?
The only other thing that I would add, and it seems as though this comes up whenever I talk to a potential competitor or even any stakeholder on this, is—we feel it’s as much about adoption as about technology. We feel the technology already exists out there. But until we find a solution that meets all those criteria I mentioned above—until we find one technology or a blend of technologies, that blends all of that in with some rigor it’s never going to be adopted, certainly not on a national level.
