Off the Beaten Pathway: In the U.S., Care Coordination Should Start With Unique Patient Identifiers

By Robbie Hughes, Founder and CEO, Lumeon

The U.S. Senate has voted not to lift the ban on using federal funds for a national patient identifier program in their draft fiscal 2020 HHS spending plan, in contrast to the House of Representatives vote in favor of the amendment earlier in the year. Debate will continue as the Senate begins the mark-up of the bill, and I expect that eventually, the conversation will shift beyond the fears of giving up personal freedoms to focus on the fundamental need for a common way to agree on who a patient is before treating them.

In the U.S. healthcare system, a single patient is likely to be identified by many different numbers and codes created by the various providers who care for that person. He may be represented by medical number 5874 at his primary care provider, #R34509 at his surgeon’s office, and #70932 at the lab where his bloodwork is done. The patient’s insurer has yet another number to assign to his care.

Say this patient’s PCP, surgeon, and lab need to coordinate planning for an upcoming surgery. It’s a tricky task, considering none of them are speaking the same patient-identifier language. They can achieve a common understanding using other identifiers such as the patient’s name, date of birth and address, but the data that each collects on the patient remains connected to disparate numbers in disparate systems. It’s little wonder a recent study showed less than a third of hospitals are sharing, sending and receiving electronic patient records with outside provider groups, given the inability to definitively link those records.

To date, almost all of the conversation about interoperability in healthcare has been about the logistics of exchanging health records, but the more fundamental problem is that providers can’t even agree on a common way to identify the patient whose records they are exchanging.

And from a process perspective, it’s next to impossible to do effective care pathway management (CPM) without a common identifier that connects a patient to all the pieces of his care. Lumeon took great pains to solve for this problem; the Lumeon platform contains a master patient index that allows users to map multiple patient identifiers against the same patient across multiple endpoints. This allows users to create their own common identifiers for patients that respect the local medical record number at each site with which the software connects.

It took a substantial amount of effort to create the digital infrastructure to solve this multiple-identifiers dilemma, and the fact that this extra, strenuous step is needed creates a very high bar for potential entrants into the CPM market. It is fundamental to our abilities to orchestrate care across care settings, and one of the reasons Frost & Sullivan recognized CPM for its unparalleled capabilities as leader in the care coordination IT market.

CPM holds remarkable promise for improving care delivery, and the patient-identifier problem is another layer of complexity in an already complex system that is unnecessarily holding back those who recognize the importance of easily connecting patient records across organizations.

There’s no good reason not to have a unique patient identifier system, just as the DMV maintains driver identifiers to centrally track all of its customers. The U.S. would benefit immeasurably, and lawmakers are moving in that direction. Just recently the House of Representatives struck down a ban on such a system, and the current administration’s focus on making healthcare more consumer-friendly is perfectly aligned with streamlining patient identification.

Being able to connect the patient identity across different health systems and use it to share data is a phenomenal benefit. The PCP, surgeon, and lab could all quickly and accurately identify the same patient and trade needed information without having to transcribe ID numbers from one system to another. This ease-of-collaboration would improve the efficiency, efficacy, and cost of care, not to mention reducing errors and complications.

A nice analogy is the Amadeus booking system for airlines. This was instituted when all the airlines came together and said, ‘We’ve all got the same problems of ticketing and booking. We need to have a body that allows us all to have shared booking and shared management of the customer.’ The system uses unique customer identifiers, and it works extremely well. You have a seamless experience when you fly, even when using multiple airlines. The system coordinates connections and baggage handling to get millions of people where they’re going every single day.

A unique patient identifier for healthcare could have a similar effect — getting millions of people where they need to go, health-wise, with as little friction as possible. Lumeon is already making that possible with our CPM platform, but the technical solution we have developed to work around the lack of unique patient identifier in the U.S. should not be required simply to make sure all providers can identify the correct patient when coordinating care.

Regulators are, albeit slowly, instituting policies such as the CMS Discharge Planning Rule to improve quality and patient experience by requiring the exchange of patient information between care settings. These types of improvements can obviously only be realized if there is a mechanism in place to assure patients are correctly identified as they transition between care settings.

Easier coordination of care should be the rule instead of the exception, and instituting unique patient identifiers is the best way to make that happen.