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The power of a universal identifier

Karly Rowe, Director of Product Innovation, Fraud and Identity Management Experian Health

In the never-ending battle to reduce costs and drive greater efficiency, healthcare organizations face the cumbersome, oftentimes manual challenge of properly matching and managing consumer identities within and across healthcare systems. The sheer complexity of managing identities is compounded by the increasing number of information systems with varying quality that are exchanging data.

In 2009 as part of the HITECH Act, the federal government set aside $30 billion for an incentive program to encourage the setup of electronic health records, which would facilitate the exchange of data and drive lower costs. Since then, the importance of accurately matching consumer identities has intensified with the government’s mandated adoption of electronic health records. Shortly after, the Office of the National Coordinator for Health Information Technology began sponsoring The Patient Identification and Matching Initiative, which focuses on identifying common denominators to establish best practices, ensuring the accuracy of every patient’s identity and making information available whenever and wherever care is needed. Other industry organizations have joined in support, including the College of Healthcare Information Management Executives, which recently launched a $1 million Patient ID Challenge to find a universal solution. However, the lack of a universal identifier continues to contribute to the highly fragmented U.S. healthcare system.

As consolidation within healthcare continues through mergers and acquisitions, creating havoc with a plethora of different data systems, the challenge of managing records becomes even greater. While organizations work to implement electronic health records and increase information sharing through Health Information Exchanges (HIEs) and Integrated Delivery Networks, the accuracy of consumer identities is poised to spiral out of control as duplicate, overlapping and incomplete records become commonplace.

Without a consistent universal identifier, duplicate, overlapping and incomplete records are impacting continuity of care, creating delays in treatment, increasing the risk of medical errors, causing billing delays and opening the door to fraud, which costs healthcare organizations millions of dollars each year. It is estimated that the average hospital has around 800,000 records, of which 8 percent to 12 percent are duplicates. With duplicates costing up to $50 per record pair to reconcile, the result is billions of dollars in wasted expenses for the industry.

The negative implications of incorrect matching on care

Beyond the high costs of correcting duplicate and overlapping records, the implications to patient and member care are no less significant. Overlapping records lead to incorrect identification of consumers, which may result in improper treatments or incorrect medications being administered. In addition, exposing personal health information to the incorrect individual constitutes a HIPAA violation and is considered a data breach, which may even preclude the correct individual from being allowed to access his or her own medical information. Obviously, the consequences of such mistakes can be life-threatening. In emergency situations, when care decisions need to be made quickly, the accuracy of a consumer’s medical history can have significant impacts on the quality and level of care delivered. These factors, along with redundant procedures and tests and the increased incidence of billing errors, can significantly diminish the consumer experience while opening up healthcare organizations to potential liability.

The Holy Grail of record management: The universal identifier

There are solutions available on the market to address the duplicate record dilemma, but most fail to deal with the entire scope of the problem. For instance, consider traditional Enterprise Master Patient Index solutions, which match identities only within a healthcare system but cannot match across disparate organizations. What the industry needs is a vendor-neutral solution that can centralize and analyze information from HIEs, ACOs and other healthcare systems and return a unique, consistent identifier that allows organizations to share a single view of the same patient. The holy grail of managing records effectively and efficiently is the universal identifier.

Matching accuracy is a critical factor when selecting between a deterministic or a probabilistic matching algorithm. Deterministic matching algorithms are more direct and use algorithms and business rules to match records if they meet a specified agreement threshold, which can vary depending on the data elements available and the data quality. Probabilistic matching algorithms take a statistical approach to matching by comparing each data element and assigning weights to determine the probability that two records refer to the same individual. Record pairs are matched if the probabilities are over a specified match threshold. While both matching algorithm methods are accepted and used, a probabilistic matching algorithm is recognized to be more sophisticated and have a higher degree of accuracy than deterministic algorithms. Given the commonality of certain names and the propensity for human error in a fast-paced environment, it is easy to mistakenly link records of different individuals. Leveraging a robust matching algorithm is critical to ensuring high match quality and performance.

How a universal identifier realizes significant cost savings

A universal identifier is a transformational technology that offers several efficiency and cost benefits. First and most obvious are the cost savings associated with reconciliation of duplicate, overlapping and incomplete records. With increased record accuracy and data quality, healthcare organizations also realize cost savings by preventing unnecessary treatments or medications that stem from incorrect identification and also can result in malpractice lawsuits.

A universal identifier enables more accurate record management, which also impedes costs related to fraud and abuse. This prevents the misuse or unauthorized use to receive services or care for which payment is never received. Additional administrative costs also can be avoided by preventing billing errors, which lead to unpaid bills or wasted resources to remove the incorrect claim. In some cases, healthcare organizations dedicate several staff members to manually link and manage records, which is costly and time-consuming. A universal identifier not only saves resource costs by automating the process, but it also allows resources to be reallocated toward more mission-critical tasks.

Record accuracy improves the consumer experience

Today’s savvy healthcare consumers want to play an increasingly active role in their own care, demanding greater transparency and access to their medical records. Healthcare organizations can use a universal identifier to deliver higher-quality care and improve coordination of care by consolidating records into a single view and providing a deeper perspective on a consumer’s medical history. Providing transparency and demonstrating expertise in properly managing information will result in higher consumer satisfaction and loyalty, which encourages full transparency in the patient-provider relationship and adds significant financial value for a healthcare organization over the life of a consumer. Armed with a deeper knowledge of a consumer’s medical history, organizations can positively impact treatment plans and outcomes and deliver a better healthcare experience.

Vendor-neutral solution for delivering a universal identifier

Successfully managing and maintaining a universal identifier in healthcare requires a vendor-neutral solution provider with a deep understanding of the healthcare industry and proven performance and experience in matching. Experian not only meets these requirements, but is an expert in the fields of identity management and healthcare as well.

Experian has more than 40 years of experience in matching identities across various industries, including financial services, healthcare, marketing and fraud. Within its applications, Experian has proven expertise for scaling its matching capabilities to process more than 220 million consumers daily. Its vast expertise in preventing fraud and protecting and managing consumer identities and digital footprints has enabled healthcare organizations to secure consumer information in online portals.