U.S. healthcare industry is undergoing a dynamic transformation. The demand for high quality care, increased productivity, cost effectiveness and continuous quality enhancement has triggered rapid restructuring of the healthcare delivery system. This trend, as reflected in managed care and in various integrated delivery systems, has resulted in geographically dispersed and functionally diverse entities such as group practices, independent practice associations, management service organizations, physician/hospital organizations, provider-based organizations, etc. Modern innovations and advances in computer and communication technologies support and foster this transformation to continue into the future. Unique Health Identifiers help to uniquely identify individuals, employers, health plans and healthcare providers within the healthcare system. They establish a comprehensive framework to facilitate exchange of information, access to healthcare, continuity of care, evaluation of quality improvement, outcome measurements and population- based healthcare.
Information technology has changed the way medical record information is stored and retrieved. Computer-based Patient Records (CPRs) have the unique potential to improve the care and well-being of both the individual and the population as a whole. They link an individual's clinical records created by different providers, sites of care and episodes. Computer and communication technologies enable the aggregation of information from CPRs across organizational boundaries to facilitate population-based research, planning and improvement. In order to facilitate the linkage of various clinical records from different care settings and times, and across institutional boundaries, healthcare organizations and computer systems, a valid and reliable patient identification method is required. An identifier that uniquely identifies an individual is a Unique Patient Identifier (UPI). It is required to manage the various clinical and administrative functions relating to the delivery of care.
Several options have been suggested to address the identification requirements of an individual. The objective of this study is to analyze the suitability and efficiency of the various Unique Patient Identifier options. In order to evaluate all functional and operational aspects of these options, this analysis utilizes a two step process. In the first step, various issues surrounding the Unique Patient Identifier, including its required characteristics, capabilities, components, functions and uses, are carefully examined and analyzed. In the next step, the available Unique Patient Identifier options are analyzed in detail for their suitability and efficiency. The report is divided into nine (9) parts:
Part I Executive Summary
Part II Patient Identifier
Part III Unique Patient Identifier (UPI) and Components Integral to UPI
Part IV Privacy, Confidentiality and Security issues relating to UPI
Part V Method of Analysis
Part VI Unique Patient Identifier Options and Alternatives
Part VII Analysis of the UPI Options
Part VIII Central Trusted Authority Options
Part IX Findings and Summary of the Analysis
Part X Available Courses of Action
Healthcare is a multi-disciplinary process. Patient Identifier is used to communicate with members of the multi-disciplinary services and coordinate the delivery of care. During the course of active treatment, the identifier is used for ordering tests, procedures, medication, diet, x-ray, etc. and reporting their results and progress. Other services, such as patient registration, transportation, dietary, scheduling, eligibility verification, billing, coordination of benefits and reimbursement also require the use of a patient identifier. The patient identifier is used to support care during the current encounter as well as retrieve and review the treatment procedures, diagnosis and medications that were provided in the past. Secondary users of healthcare information such as private insurers, health maintenance organizations, federal health agencies and employers depend on Patient Identifiers to perform their business and administrative functions. In short, the patient identifier is an integral part of the delivery of care and health maintenance.
Patient Identifier is an integral part of patient care information. It is an essential component in the management of healthcare information and manual record keeping. Key functions such as documentation, manual record keeping, automated collection and storage of information, and access to and communication of information require the use of a patient identifier. Access to historical patient care information (e.g. persistent medical problems, allergy, medication, surgery, etc.) across time is essential for the delivery and continuum of care across multiple providers. Healthcare provider organizations depend on patient identifiers for medical record chart analysis and completion, transcription, chart assembly, coding and abstracting, billing, reimbursement, etc. The Joint Commission on Accreditation of Healthcare Organization's (JCAHO's) Information Management (IM) Standards mandate that the patient identification information be part of a patient's medical records.
Patient Identifier is invaluable to facilitate the current and continuum of care across different providers, care settings and time. Typical uses of Patient Identifier include the following five (5) categories:
1. Coordination of Patient Care Services
Interact with
other service domains such as laboratory, x-ray, dietary, physical therapy, etc.
and communicate orders, results, request for services, supplies, consultation
etc.
2. Record Keeping/Information Management
Collect and
organize information such as orders, results, procedures, notes, etc. into a
manual medical record chart or in an automated electronic medical record for
current and future use.
3. Administrative Functions
Handle administrative
functions including billing and reimbursement.
4. Storage and Retrieval of Historical Information
Retrieve
and review past medical history including problems, diagnosis, procedures,
medication, allergy, etc.
5. Aggregation of information from multiple patient information
Collect,
aggregate and perform analysis on groups of patients for treatment efficacy,
research, statistical reporting and planning.
The current method of patient identification consists of the use of a medical record number, issued and maintained by a practitioner or a provider organization. This medical record number is based on a Master Patient Index (MPI). The numbering system used is generally specific to the individual organization, and the numbers are unique only to that organization. Recently, Hospital Information System (HIS) vendors have begun to develop software to facilitate cross reference to MPIs across an enterprise, often known as Enterprise-wide Master Patient Index (EMPI). In addition to a medical record number, some organizations use a patient account number for billing and reimbursement purposes. Patient account numbers are unique to each patient encounter or visit to the provider. V.A. hospitals, Medicare and the Department of Defense use Social Security Number (SSN) to identify patient
Computer and communication technologies have transformed the way business functions are carried out. Being the most information-intense industry, healthcare is no exception to this transformation. Physicians and other providers of healthcare depend on accurate and timely information. Healthcare is multi-disciplinary; providers generate, process and communicate care-related information continuously. Various activities including performance of critical procedures, administration of medication, management of therapies, etc. require communication of an enormous amount of care-related information. Therefore, access to information and communication are fundamental functions in the healthcare industry. In addition, patients themselves are mobile. They visit multiple providers and service centers distributed nation-wide and even across the globe. To manage their care, access and communication must be available both within the same provider organization and across multiple provider organizations regardless of their geographic location. The communication innovations and the transformation of manual documentation into a computer-based patient record have made the sharing of patient care information among healthcare providers across organizational and geographical boundaries close to reality. An identifier that can uniquely identify a patient across different providers and times is the next step to achieve this reality.
The scope of use or the domain within which an identifier is implemented or used will determine the level of usage. The scope of use may be within a single organization or an entire enterprise across the nation or beyond. For convenience, they can be divided into the four (4) levels listed below (All five categories of uses described earlier are applicable to all four levels):
At the lowest level, the identifier's scope of use is limited to functions within the provider organization. The current use of patient identifier by most of the healthcare organizations is at this level.
At the next level, the identifier's scope of use includes an entire enterprise. The enterprise may include multiple provider organizations providing same or different types of services. The identifier in this case is used to identify an individual and provide enterprise-wide access to his or her medical record/information. The patient has access to care across the enterprise at this level.
At this level, the identifier's scope is expanded for nation-wide use among healthcare organizations. The full potential of a patient identifier can be realized at this level: 1) access to and use of patient care information from different providers for the purpose of delivery of care, 2) electronic integration of information from different providers, 3) lifelong view of a patient's information and 4) aggregation of population-based information for research and development. The national healthcare reform initiatives, such as managed care and integrated delivery networks, have expanded the patient identifier's scope to a nation-wide use.
At this level, the identifier's scope is further expanded to world-wide use. All benefits and uses discussed earlier are transformed to global level.