Quiz ID: Q1919009 | EXPIRATION DATE: OCTOBER 1, 2020
HIM Domain Area: Clinical Data Management
Article—“Close Doesn't Count: Patient Matching Challenges
Review Quiz Questions and Take the Quiz Based on
this Article Online at https://my.ahima.org/store
Note: AHIMA CE quizzes have moved to an online-only format.
NEHII helps organizations prioritize performance improvement initiatives based on recurring errors and omissions. It also
helps them merge and manage duplicates as well as educate
The feedback and assistance that HIEs provide is especially
helpful for smaller specialty hospitals where HIM professionals
wear many hats, making it difficult for them to focus on identity
management, says Costello.
HIEs may even be able to establish an HIE-level patient identifier that would ease the matching burden on a state or regional
level, says Bland.
SHIEC recently launched a patient matching workgroup that
includes HIE representatives as well as technology vendors to
discuss quality standards and best practices for developing intake forms, resolving identity conflicts, and more. SHIEC is also
exploring partnerships with various federal agencies to deploy
predictive analytics for population health. “There’s a genuine
interest to make healthcare better one community at a time,”
says Thompson. “It’s not enough to share information. It needs
to be good-quality data.” ¢
1. Grannis, Shaun et al. “Evaluating the effect of data standardization and validation on patient matching accuracy.”
Journal of the American Medical Informatics Association
26, no. 5 (May 2019): pgs. 447–456. https://academic.oup.
2. Office of the National Coordinator for Health IT. Notice
of Proposed Rulemaking to Improve the Interoperability
of Health Information. June 2019. https://www.healthit.
Lisa Eramo ( firstname.lastname@example.org) is a freelance writer and editor in Cranston, RI, who specializes in healthcare regulatory topics, health information
management, and medical coding.
Vetting the National Patient Identifier
EXPERTS HAVE LONG touted a National Patient Identifier
(NPI)—a unique number assigned to each patient that would
travel with them throughout the healthcare ecosystem—as a
panacea for patient matching challenges; however, the jury’s
still out as to whether the NPI will ultimately solve the problem.
“There’s no doubt the NPI would improve matching accura-
cy,” says Grannis. “The question is, by how much and at what
The Regenstrief Institute analyzed data from the Indiana
Network for Patient Care and found that a statewide NPI
would yield relatively nominal improvements in data quality
even though it would cost $250 million to implement.
Even if adopted, the NPI wouldn’t be a perfect solution,
says Grannis. Matching algorithms will continue to play an
important role in emergency scenarios where patients are unable to provide any identifying information.
There could also be duplicates and typographical errors at
the national level when NPIs are initially assigned, necessitating the need for matching algorithms at the provider and HIE
levels, says Chaundy.
“An identifier is certainly one way to incrementally improve
the accuracy of matching,” adds NextGate’s Cidon. “It’s a lot
easier to match one number with another number.”
However, Cidon says even England and Scotland, both of
which have used a unique identifier for more than a decade,
continue to have problems with matching patients, most
notably the resource-intensive process of enriching exist-
ing registrations with the unique identifier and matching that
number to the right patient internally.
There’s also a massive onboarding process in terms of
creating the identifiers at a national level that takes time, he
adds. “Don’t hang your hat on this,” he says. “We’re talking
about a decades-long process before you can rely on this
single identifier, and even then, I’d be hesitant.”
When asked whether using biometrics is a reasonable al-
ternative to the NPI, Cidon says implementing fingerprint or
iris scanners at every place of service also takes time. “There
have always been practical reasons why we continue to
come back to this lowest common denominator approach
of taking in the data streams, looking at demographics, and
making the best match we can safely make,” he adds.
Decentralized identity management (i.e., allowing patients
to manage their own identity and present it to various providers) is a potential solution but one that wouldn’t yield immediate results, says Cidon. “This, to me, is the only solution
that’s substantially different as a model that may succeed,”
he adds. “But it will take a lot of time to get to that point.”
The healthcare industry may have the opportunity to explore the NPI as a potential solution if the Senate joins the US
House of Representatives in repealing a ban on federal funds
to adopt a unique patient identifier. Using federal funds to
create this identifier was originally banned out of privacy concerns; however, repealing the ban would allow collaboration
between the US Department of Health and Human Services
and the private sector to identify solutions for reducing medical errors and protecting patient privacy.
Close Doesn’t Count: Patient
Matching Challenges in HIEs