Letters to the Editor

Needed: Unique Patient Identifiers

Thank you for drawing attention to the political roadblocks that stand in the way of the next level of progress in swapping personal health information electronically, and in particular, the obstacle of reliable identification (“On Carts and Horses,” March 2008).

Focusing on a RHIO (regional health information organization) before electronic record systems mature among would-be partners in a RHIO is a problem just the same as it was in the mid- ’90s with CHINs (community health information networks). The movement to a connected system of health information calls for a lot of advance work that plays out in frustrating ways. It seems that every step of progress, every bashing of a barrier, brings the next under-anticipated obstacle into view.

Two decades ago, converting paper charts into a usable computerized form was considered a challenge, and the advent of the electronic medical record truly was a big step forward. But the medical-group or hospital-organization focus of an EMR eventually exposed the lack of patient focus in electronic recordkeeping. It was for the benefit of health professionals at a time when those in healthcare saw the wisdom of making the electronic record a force for managing health and promoting wellness by tracking all available data and encounters on a patient. Once the need to aggregate data from many sources into one electronic health record was recognized, the next barrier ahead was how to do that. In mid-2004, I covered the advent of that problem as a reporter in the aftermath of the Office of National Coordinator’s four-pronged “framework for strategic action.” The typical reaction I got to the urgency of interoperability was, “Huh?” But in a few short years the challenge of interoperability is high on the priority list because of that push for a patient-focused EHR.

The ONC and many public-private partnerships are hard at work bringing down the interoperability barrier, as if it’s the final obstacle to achieving e-records and connecting networks. But when all the pieces of a patient-focused record become available to be aggregated for the benefit of a care professional, how does that happen when a patient is identified in many proprietary ways in source records systems and identity can’t be precisely determined? This is the next barrier that will come into view as interoperability becomes ably addressed. The typical reaction, like interoperability four years ago, may be, “Huh?” But without a unique identifier, the margin of error in aggregating records may not be acceptable.

Since the HIPAA controversy of a decade ago, the issue of a unique health identifier for individuals has remained a political problem and is still hot to the touch. But that doesn’t make it any less a problem. Left unresolved, the marathon effort for data exchange—in RHIOs or by any other method—will not cross the finish line.

John Morrissey
Director of Knowledge
The National Alliance for Health Information Technology
Chicago, IL