What is a Unique Patient Identifier?

January 26, 2021 by Experian Health

There is no shortage of data in the healthcare industry. Unfortunately, more data doesn’t always mean better data – especially when it comes to patient information.

A unique patient identifier (UPI) is a method for standardizing patient identification. Individuals are assigned a unique code, and that code, rather than a Social Security Number, name, or address, is what is used by healthcare organizations to identify and manage patient information. A standardized code like this not only protects sensitive health information but supports the exchange of data between healthcare organizations and states as it is a number and format easily read and recognized by all.

While a UPI has yet to be nationally recognized and implemented, a foundation has certainly been made and the industry is perfectly poised to move forward.

How a unique patient identifier is used in healthcare

The UPI helps healthcare organizations link the right records together, preventing duplicate records from being created. There are many ways duplicate accounts or variances can occur: address differences, name variations, maiden names and even user entry error.

With UPIs, providers and payers can link records together and have one complete record and view of the patient or member, ultimately leading to a better experience and increased patient safety. Without reliable records, patient safety takes a hit. Misidentification can contribute to incorrect treatments and adverse medication interactions that have had life-altering or fatal consequences.

The UPI’s ability to achieve accurate record match rates for every patient and member also improves efficient, patient-centered care coordination, as well as population health management strategies, prescription drug monitoring programs (PDMPs), social determinants of health and more.

It is important to note that the UPI is not a patient-facing number and is not known to the patient or provider. It does not collect or share any clinical claims or diagnostic information; its purpose is simply to link records together giving providers and payers a complete view of someone’s identity.

The patient experience within a real network

A healthcare organization’s ability to manage patient data is apparent from the beginning. An inadequate system can force patients to fill out forms they’ve already filled out multiple times or undergo duplicate tests as they travel between facilities. It can also confuse patients who have similar information, such as first and last names, during the identification process.

In an ecosystem built around a strong healthcare network, these discrepancies can be avoided. Patients are given a unique identifier that remains consistent across every healthcare facility they visit, from physicians’ offices to hospitals, pharmacies, specialists, long-term care facilities, and more. All providers that patients visit know exactly who they are.

And it isn’t just greater comfort and convenience that patients gain from a well-connected healthcare network. Managing patients and their data is vital for reducing medical errors. One Johns Hopkins study found that medical errors account for more than 250,000 deaths annually in the United States.

Healthcare efficiency within a real network

The challenge of managing patient data across the entire healthcare ecosystem isn’t new — interoperability has been a hot button issue for years now. While there are several master patient indexes that organizations can use to match patients with appropriate demographic data, these still include gaps, overlaps, and outdated patient information.

These indexes can’t keep up with simple things such as name and address changes or data entry errors. Therefore, providers and payers who rely on them have trouble matching their patients and members accurately. A more effective solution involves combining these data sets to create complete identities and profiles, where every piece of new data is instantly updated and verified.

For example, if a provider has a patient in their EHR twice under two spellings of the patient’s name in error, a UPI would link those two profiles, creating a singular view of the patient in that provider’s system.

Similarly, a UPI can help facilitate interoperability between healthcare providers. For example, if a pharmacy has a patient listed under a maiden name but the doctor has that same patient under a married name, the prescription during the ePrescribing process might not get associated with the right profile. If both organizations have the UPI on record and submit it during the transaction, the systems will match the patient using the UPI.

Every authorized care team member can immediately access the updated data related to a patient or member’s identity, which offers benefits far beyond treatment. For providers, this could mean increased collections. For payers, it could look like improved medication adherence.

For example, ValleyCare Health System in northern California was struggling with hundreds of bills being returned each month because of wrong patient addresses. When the health system implemented an identity verification program, it decreased the amount of returned mail by 90 percent.

The network effect in a nutshell

Sorting through clinical data issues takes up a great deal of time. The administrative costs of healthcare account for nearly 8 percent of U.S. healthcare expenditures. By identifying patients through unique socioeconomic factors, healthcare organizations can more efficiently and accurately manage data and put it to good use.

A healthcare network tied together by streamlined data management provides an environment where duplicate or inaccurate information is detected and corrected almost immediately. Both patients and members are accurately identified, and their data retains its quality at every stage of care.

When combined with other patient engagement solutions, such as patient portalsdata and identity management tools create the infrastructure needed for healthcare to truly become one cohesive, patient- and member-centric network.

Unique patient identifiers in the news

Until recently, the use of federal funds for the adoption of a national patient identifier (NPI) was prohibited. The ban has limited the Department of Health and Human Services (HHS) from interacting with healthcare organizations to develop and implement an NPI strategy. In the years since the funding ban put the brakes on a universal approach, many disparate software solutions have been created which don’t talk or share information with each other. Integrating these systems in an industry of this scale will take a concerted effort.

The ban was lifted in July of 2020, giving HHS the ability to evaluate a full range of patient matching solutions and enable it to work with the private sector to identify a solution that is cost-effective, scalable, secure and one that protects patient privacy.

Karly Rowe, Vice President, Patient Access, Identity, and Care Management Products at Experian Health believes that “private-sector entities have already developed the technological foundation for data interoperability through the creation of UPIs that are maintained in a master person index.” These solutions are vendor neutral, meaning data can flow freely between disparate electronic health systems, regardless of size or location. With federal funding back on the table, “UPIs could be adopted with government oversight of private sector offerings and the creation of national standards to ensure quality patient matching and identification.”

At the end of 2019, Experian Health announced that every person in the United States (about 328 million Americans) had successfully been assigned a unique UPI, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”).

Combining Experian’s expansive data assets and innovative UIM technology along with the unique ability NCPDP brings to share the UPI throughout the healthcare ecosystem using the NCPDP Telecommunication Standard and its SCRIPT Standard, each individual in the U.S. that has received medical care or utilized a pharmacy has been processed through the solution and assigned a UPI. As new patients enter the healthcare ecosystem, this number will continue to grow.

Learn more about unique patient identifiers

Having a single, unified and accurate view of patients and members is a challenge that plagues the healthcare system. Now, there is promise of a comprehensive solution that reduces the barriers to make healthcare safer.

Interested in learning more about unique patient identifiers and how Experian Health can help?

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