Why CHIME’s NPID Challenge is Necessary for Healthcare’s Future

Aug. 24, 2016
In an important patient care development last week, CHIME announced a $1 million National Patient ID (NPID) Challenge, which is a significant step in the right direction given the current healthcare landscape

In an important healthcare development last week, the College of Healthcare Information Management Executives (CHIME) announced a National Patient ID (NPID) Challenge, a $1 million crowdsourcing competition to incentivize the private sector to develop a universal patient identifying solution that links patients to their medical records.

Those foreign to healthcare might wonder why there is no solution already in place that would ensure greater accuracy in identifying patients in the U.S. beyond the current approach of using simple demographic data. The problem, though, is bigger than many realize; in an environmental scan in 2014, the Office of the National Coordinator for Health Information Technology (ONC) found that the best error rate for patient identification is around 7 percent.  In other words, seven out of 100 records are mismatched, while the actual error rate is likely closer to 10-20 percent, and it rises to 50 to 60 percent when entities exchange with each other, according to CHIME.

According to ONC’s 2014 report, for example, “Kaiser Permanente (which has 17 instances of Epic across its regions) reported a match rate of greater than 90 percent within each instance; that rate fell to around 50 percent to 60 percent when sharing between regions using a separate instance of Epic or with outside Epic partners.”  For some background, the ONC scan included a formal interview process with a diverse set of organizations representing four sectors of the healthcare industry, with a specific set of questions for large health systems and integrated delivery networks (IDNs); health information organizations (HIOs); electronic health record (EHR) vendors; and master data management (MDM)/master person index (MPI) and HIE vendors.

As ONC reported, healthcare organizations have made strides in improving patient identification and matching, but those solutions have not been universally adopted. For instance, providers vary greatly in how they format names and addresses. Also, the quality of the data entered into systems can be mixed. Additionally, CHIME data shows that hospitals differ in how they identify patients; more than 60 percent of CHIME members use some form of a unique patient identifier to match patient data within their organizations, while others rely on complicated algorithms. But, nearly 20 percent of CHIME members surveyed in 2012 could attribute at least one adverse medical event to incorrect patient matching.

Further complicating matters is that since 1999, the federal government has been prohibited from spending public funds on the development of a national patient identifier (NPI). When the Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996, it originally required that all Americans be issued a unique patient identifier based on the obvious potential benefits they could bring to healthcare. However, after a 1998 federal hearing caused a public outcry due to invasion of privacy claims, Congress prohibited the use of federal dollars to create such a solution. Thus, the onus fell onto the private sector.

Now, CHIME is linking arms with HeroX, a crowdsourcing innovation platform, on the initiative to encourage innovators to help solve the complex problem of patient misidentification without requiring government regulation. In the spring, CHIME and HeroX will announce participants moving forward on to the Concept Blitz Round. Innovators will then develop and refine their ideas for the Final Innovation Round and CHIME will announce the $1 million winner in February 2017, according to HCI Assistant Editor Heather Landi’s report on the CHIME announcement last week.

As part of the CHIME/HeroX launching of the NPID challenge, the organizations explained why the need for an NPI is so crucial for better patient care:

Healthcare organizations spend a lot of time using and perfecting complicated algorithms that use a lot of different pieces of information to ensure that the John A. Smith standing in front of them is the same John A. Smith found in their system. Trying to delete duplicate errors and match records from one healthcare provider to another for every patient takes an inordinate amount of time that could be spent focusing on prevention and treatment, not matching records. Because it is still so difficult to get records from other providers, patients often have x-rays and other tests repeated, which in some cases is harmful to the patient, and at the very least wastes time and money.

To this end, during the CHIME announcement, per Landi’s report, Mark Probst, vice president and CIO at the well-renowned Intermountain Healthcare, a 23-hospital health system in Salt Lake City, Utah, said that his organization spends about $4 million to $5 million annually on technologies and processes to try to ensure proper patient identification. Probst highlighted several ways the lack of a 100-percent accurate patient identification standard impacts patient care, such as a woman who has a mammogram and the results of that mammogram end up in the wrong patient record. Also during the pronouncement, Probst acknowledged the challenges that the federal government has created with developing such a system. “We all know there is politics around this issue and that’s why I’m so proud of CHIME for taking the leadership from a non-governmental perspective and as the private sector to try to get a challenge out there and try to find a positive way to identify patients,” Probst said.

While a national patient identifier might seem like a no-brainer to many, there is another side to the debate, in which privacy advocates argue that their identities wouldn’t be safe if all of their information would suddenly be much more out in the open. A medical record may contain more intimate details about an individual than could be found in any single document, opponents of an NPI say. Skeptics add that that the identifiers that will be in place could be used for purposes beyond what they were originally intended.

Whenever I hear this argument, I ask myself why patient safety and health data exchange have to be pegged against patient privacy, as if you can only choose one side. With healthcare’s obvious push towards greater interoperability, it would seem awfully tough for the various providers along a patient’s care continuum to share information with one another, via electronic systems, if there is no universal solution for patient matching. Indeed, an NPI won’t solve the industry’s interoperability problems, but there’s no question that it should serve as a prerequisite.

I think it’s time to stop hiding behind the excuse of privacy, and I’m happy that CHIME has stepped up the plate with this initiative. We don’t know what the end result will look like, and CHIME warns that this challenge is not directly about exchanging health information, nor will it fix all of the duplicate records in a health center’s system. But I have confidence in the world’s innovators, and believe that this challenge is a heck of a step in the right direction, years after Congress thwarted the idea.

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