Download eBook for Free

Full Document

FormatFile SizeNotes
PDF file 0.6 MB

Use Adobe Acrobat Reader version 7.0 or higher for the best experience.

Summary Only

FormatFile SizeNotes
PDF file 0.2 MB

Use Adobe Acrobat Reader version 7.0 or higher for the best experience.

Abstract

A national health information network, or NHIN, that enables disparate health care information systems across the United States to allow authorized users to easily and quickly share critical health information has the potential to enhance safety and dramatically improve the quality and efficiency of the national health care system. A unique patient identifier (UPI) to use as a singular key to accurately link, file, and retrieve individual health records was seen as an important element of the national system and was mandated as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) legislation. However, privacy and security concerns about electronically sharing patient information have completely sidetracked the development of standards for a UPI and threaten to delay the development of the NHIN.

Correctly linking patients to their health data is a vital step in achieving quality health care. The two primary approaches to this linking are the UPI and statistical matching based on multiple personal attributes, such as name, address, and Social Security number (SSN). Lacking a UPI, most of the U.S. health care system uses statistical matching methods. There are important health, efficiency, security, and safety reasons for moving the country away from the inherent uncertainties of statistical approaches and toward a UPI for health care.

This monograph examines the operational advantages and disadvantages, compares the errors, examines the costs, and discusses the privacy issues associated with the UPI and its alternatives. Our analysis indicates that a health care system in which every patient has a unique, nondisclosing (i.e., containing no personal information) patient identifier is clearly desirable for reducing errors, simplifying interoperability, increasing efficiency, improving patient confidence, promoting NHIN architectural flexibility, and protecting patient privacy. A one-time cost of $1.5 to $11.1 billion for a UPI, to remove the systemic errors in health-records retrieval, is small by comparison with the value a potential efficiency savings of $77 billion per year at the 90-percent level of adoption (with additional safety and health values that could double these benefits) that previous studies estimated for connected Electronic Health Record (EHR) systems. Prohibiting development of a UPI actually sidesteps the larger problem: the development of a NHIN without first establishing a legal environment that best protects privacy while also encouraging the advances that interoperability of EMR systems between providers would bring to health care quality and efficiency. Continuing de facto endorsement of statistical matching as the only practicable approach to linking patients to their electronic health records will inhibit the effective development of the national health information network.

This monograph should be of interest to health care IT professionals, other health care executives and researchers, and officials in the government responsible for health policy.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    The Primary Approaches for Identifying Patients and Linking Their Health Records

  • Chapter Three

    Errors in Linking to Medical Records

  • Chapter Four

    Operational Issues

  • Chapter Five

    Privacy and Security of the Alternatives

  • Chapter Six

    Costs

  • Chapter Seven

    The Policy and Political Environment for a National Patient Identifier

  • Chapter Eight

    Conclusions and Implications

  • Appendix A

    Analysis of False-Positive Errors in a Large Demographic Database

  • Appendix B

    Designs and Costs of Systems for Accessing Personal Health Information

Research conducted by

The research described in this report was conducted within RAND Health, a unit of the RAND Corporation, and sponsored by a consortium of health information technology companies: Cerner Corporation, CPSI, Intel, IBM, Microsoft, MISYS, Oracle, and Siemens.

This report is part of the RAND Corporation monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND monographs undergo rigorous peer review to ensure high standards for research quality and objectivity.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.