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CHIMA: Exploring the UPI and Patient Matching

By Karen Proffitt MHIIM, RHIA, CHP and Mackenzie Higgins, RHIA

Inaccurate patient identification is a costly and common problem in healthcare. According to one 2016 report, 86% of healthcare professionals witnessed or know of an error caused by patient misidentification. And a 2017 study by the American Hospital Association found that 35% of all denied claims were the result of inaccurate patient identification or incomplete or erroneous patient data, costing the average healthcare facility $1.2 million per year.

Worse yet, these errors can get in the way of delivering quality or appropriate care. This is especially concerning when dealing with a crisis such as the COVID-19 pandemic, when poor patient matching can increase duplicate record creation rates due to the volume of admissions, drive-through testing sites, quick lab registrations and online registrations, and a sharp uptick in telehealth visits. It can also cause data integrity issues, such as results being imported into the incorrect patient’s record and problems matching records for complex populations like homeless and transient/migrant worker patient populations.

One solution is the implementation of a national unique patient identifier (UPI), which 70% of providers and healthcare information exchange professionals are in favor of, according to a survey conducted by the eHealth Initiative Foundation.

In fact, more than a dozen healthcare organizations recently formed a coalition, Patient ID Now, focused on addressing patient identification and legislation. The coalition supports the removal of a section of a bill to allow the U.S. Department of Health and Human Services to develop a nationwide identification strategy — including the adoption and implementation of a UPI.

During a 2020 virtual meeting hosted by CHIMA, we highlighted the pros and cons of the creation of a UPI and its potential in solving the issues around patient matching.

The presence of a UPI can benefit patient matching because it will strengthen initial patient identification while, over time, adding another strong identifier. Because 60% of error rates occur when organizations exchange patient records — especially when dealing with patients who have severe illnesses and need to be treated by multiple physicians — a UPI will facilitate and improve record linkages.

However, there are challenges. A report from RAND estimated it will cost U.S. taxpayers more than $11 billion, and patients may fear their data has a higher chance of being breached or compromised if centrally managed.

For example, Taiwan implemented a Smart Card Solution in 2002. The card, which was funded by the Bureau of National Health Insurance, allowed physicians easy access by storing all of a patient’s data on the card, which was uploaded online after every six visits for data analysis, audit and authentication. However, this program has led to identity fraud as well as an excess of false insurance premium claims from healthcare institutions.

Costs and security concerns aside, a UPI is not a magic bullet that will cure all the industry’s patient matching woes. For an overall national matching strategy to be effective, it needs to be multifaceted in its approach, including industry-wide standardization, USPS data formatting tools, third-party data, and expert analysis and intervention.