Identity Crisis? Approaches to Patient Identification in a National Health Information Network

I mprovements in healthcare information technology (HIT), properly implemented and widely adopted, should save money and signifi cantly improve the quality of health care in the United States. A 2005 RAND study estimated that annual savings from effi ciency alone could be upwards of $77 billion (http:// www.rand.org/pubs/research_briefs/RB9136/). A key component of these improvements is a National Health Information Network (NHIN) that would link disparate health care information systems across the United States to allow sharing of critical health information swiftly and easily. Th e Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated the development of a unique patient identifi er (UPI) to enable physicians, hospitals, and other authorized users to share clinical and administrative records more effi ciently. A UPI could serve as a building block for the new NHIN. Since 2004, the Department of Health and Human Services (DHHS) has moved forward with steps to develop the NHIN. However, development of a UPI, a key to linking records across the emerging network, has been completely sidetracked by privacy concerns. Th ese concerns eventually led Congress to ban DHHS from expending funds to develop the UPI. Th e congressional ban has led to reliance on the alternative approach to creating a patient identifi er: the use of statistical matching techniques to identify and access patient information. Th is method involves the identifi cation of patients by matching patient data, such as name, address, zip code, or other information, with medical records. Debate in policy circles continues about the relative merits of the UPI versus statistical matching approaches. To provide a more factual basis for this debate, a RAND study team led by Richard Hillestad analyzed and compared these two approaches across a number of dimensions, including error rates, operational effi ciency, costs, and privacy and security issues. Th e team conducted reviews of the research literature and relevant Key fi ndings: