For over 20 years, the advantages of using a national patient identifier (NPI) system have been debated. An NPI system would give each United States citizen a unique number to be used across the healthcare system.
The primary reason an NPI system has not been implemented is the privacy concern; however, in June 2019, Congress voted to end the ban that bars HHS from funding NPIs. This allows funding to happen for this project designed to improve patient matching duplicative patient electronic health records, reduce costs for hospitals, doctors, and other health care providers and allow for health care information to be exchanged more efficiently and accurately. In this article, we will provide an analysis of unique patient identifier options as well as the pros and cons of using them.
Pros of using NPIs
Health care providers and payors believe there are many benefits of unique patient identifiers, including helping reduce medical errors and save lives. These kinds of errors can occur when incomplete or duplicate health records cause patient safety issues. By implementing a standard national patient identifier duplicate, incomplete and inaccurate health records can more easily be fixed, allowing doctors, hospitals, and other health care providers and organizations to match the correct data with the right patient giving them a complete, accurate picture of the patients’ health and allowing them to provide the best possible health care.
NPIs can also reduce the chance of mismatched or duplicative electronic health records for patients, which can help reduce unnecessary costs. This can be achieved by avoiding redundant testing for a patient or reducing the challenge of finding a patient with a common name’s health information. Ordering multiple tests for one issue is a significant cost driver, and the implementation and use of NPIs could help reduce those unnecessary costs.
When the concept of NPUI’s was brought up, patient privacy was a significant driver of concern. However, there are already other cases where similar identifying numbers are used. For example, Social Security Numbers or even Medicare numbers for those beneficiaries. Health care providers already use standard identifiers for themselves. NPIs could be more secure and ensure patient privacy by allowing physicians to access medical records using the unique NPI number instead of a patient’s name, date of birth, or address.
Cons of using NPIs
A significant reason there is opposition to implementing NPIs is centered around the implementation and cost related to implementing an NPI system. While there has been no comprehensive cost estimated developed, many believe that the cost of building new IT systems and modifying existing ones could be cost-prohibitive. Systems would have to be built, and modified rules and legislation surrounding issuing, using, and regulating NPIs would need to be developed and be made operational, all requiring significant money, time, and effort.
While ensuring that duplicate numbers are never issued may seem like a simple task, there are many points in the process where mistakes could be made. The implications of a duplicate or erroneous number being assigned to a patient could result in serious medical issues or mistakes occurring when treating a patient using the wrong medical history. If someone were to enter the incorrect number or add a medical record to the wrong number, it could result in the wrong medications or testing being given to a patient, which could be a fatal mistake.
Some other countries have implemented some version of an NPI with mixed success. One of the main drivers of success is the level of centralization and efficiency of the process, often driven by the internet access or lack thereof and system connectivity between the government and health care providers. When those variables are not an issue, the processes of verifying and managing existing NPIs and creating new ones can be done efficiently and accurately. However, when internet access and connectivity are an issue, verifying identities and assigning new NPIs can be time-consuming, cumbersome, and prone to errors.
While we can debate the benefits of unique patient identifiers, further analysis of unique patient identifier options can be pursued now that the restrictions put in place previously by Congress have been lifted. No matter which side of the debate you are on, there is a universal agreement that ensuring health care providers have access to accurate and complete data for their patients is a top priority, so avoidable errors in treatment can be reduced as much as possible.
Implementing a national NPI system would take a significant investment by private payors and the government and would likely take years to develop and implement. Similar parallels can be drawn to implementing the Medicare Beneficiary Identifier (MBI), which replaced the Social Security-based Health Insurance Claim Number (HICN) for Medicare beneficiaries. This project took years to implement and with huge financial investments across the entire continuum of health care.