Identity Management

There’s an identity matching challenge that’s existed in healthcare ever since the move to electronic medical records began, and the urgency to remedy it has been increased by the speed and danger posed by COVID-19. How do you identify a patient with limited information? How do you know what medical record or lab test to associate with a patient? Capturing complete or accurate patient demographic information is difficult and can be impacted by many factors far less chaotic than a pandemic. By any measure, under normal circumstances, hospital registration takes place in a fast-paced environment. “Normal” changed abruptly for the United States in March and the Office of Civil Rights (OCR) recognized the need to enable innovations that will help keep pace with the virus’ relentless pace. OCR announced in early April that it would exercise its enforcement discretion and not impose penalties against covered health care providers or their business associates for uses and disclosures of protected health information by business associates for public health and health oversight activities during the Covid-19 nationwide public health emergency. The COVID-19 Identity Challenge Pop-up and parking lot testing sites provide little opportunity for healthcare staff to follow typical patient intake processes or access the technology and tools used in their hospitals and medical offices for registration. Information is gathered with everything from pen and paper to tablet devices; however, these methods are challenged to collect a patient’s information while maintaining social distancing requirements. This often results in incomplete or inaccurate patient information, making patient follow-up near impossible – not knowing who to contact or where to contact them.   The number of positive COVID-19 cases continues to grow and public health officials at the federal, state, county, and local level have an urgent need to understand and describe how the virus is spreading, and effectively support impacted individuals. In accordance with OCR’s announcement, Experian Health will provide individuals who meet the public health authority definition free access to certain features of its Universal Identity Manager (UIM) product to assist with filling in missing patient demographics.  Any access to UIM services (and the PHI therein) is limited only to public health authorities and only until the Secretary of the Department of Health and Human Services declares the public health emergency no longer exists or upon the expiration date of the public health emergency1. For additional information on the UIM, please visit our website. This is a step that Experian Health is proud to take, playing our part in combatting the outbreak of Covid-19 and expediting the country’s path to recovery. 1. DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 160 and 164 Notification of Enforcement Discretion under HIPAA to Allow Uses and Disclosures of Protected Health Information by Business Associates for Public Health and Health Oversight Activities in Response to COVID-19 https://www.hhs.gov/sites/default/files/notification-enforcement-discretion-hipaa.pdf

A hundred years ago, the Spanish flu pandemic led to a revolution in public health. Healthcare systems were overhauled, national health surveys were launched, and cross-border cooperation laid the groundwork for what later became the World Health Organization. Now, with everything from grocery shopping to the global economy upended as a result of COVID-19, thoughts inevitably turn to the legacy of the current pandemic. As healthcare providers struggle to reorganize services, staffing and revenue cycles, change is being forced at a blistering pace. Adjusting is tough, but it’s also accelerating technology trends that healthcare has been slow to leverage until now. Could the coronavirus pandemic bring the future of healthcare to us sooner than expected, just like what happened in the years following 1918? What more can providers do to prepare for  challenges in the new normal? Here to stay: telehealth and virtual care Necessity drives innovation – and one key example now is the telehealth explosion. Only a few months ago, remote healthcare was a business choice, selected for being more cost-effective and more convenient for patients, and for reducing the service-load on busy physicians, compared to traditional face-to-face care. Today, it’s an operational essential in preventing the spread of the coronavirus, giving patients a safe way to speak to their doctor without leaving their homes. Relaxed regulations, clearer payment rules and a hundreds of millions of federal cash injection are giving the roll-out a helping hand. Not only is this promoting better patient care and mitigating some of the revenue loss from reduced patient visits, it’s giving providers an unexpected opportunity to conduct a large-scale experiment in the use of telemedicine that would otherwise have been impossible. And it’s working. Patients, physicians and providers are getting used to the benefits of virtual care. Telehealth and self-service patient engagement will likely become the norm once the pandemic settles. Future-proofing healthcare services for a post-pandemic world Even though COVID-19 is far from over, now is the time to plan ahead for managing the pandemic fallout and to protect against future risks. As leading trends forecaster Mary Meeker suggests in her coronavirus trends report, what we really need to prepare for the aftershocks of COVID-19 is better integration of healthcare and technology. We already have the tools at our fingertips – and telehealth is just the start. Where are the gaps? Improving contact tracing and syndromic surveillance The medical community highlights contact tracing as essential for getting a handle on the spread of the coronavirus and potential future outbreaks. Unfortunately, we don’t yet have a system of universal patient identification, which could aid disease tracking by monitoring patient interactions with different touchpoints across multiple health services and generally aiding more accurate patient records. Still, many providers are turning to universal identity managers to track healthcare interactions and share accurate patient information safely and securely within their own networks. Prioritizing data protection and security With the surge in remote care and mobile health, keeping patient data safe through robust identity protection and matching is even more important. A tool such as Precise ID can give providers reassurance that only patients engage with  their information – whether on their phones or visiting a provider’s health portal – without  creating long wait times or adding complexity to the sign-up process. Strengthening the revenue cycle Estimates suggest health systems could lose an average of $2,800 per COVID-19 case, with many losing up to $10,000, if payers do not raise reimbursement premiums. Ceasing revenue-generating services to accommodate COVID-19 cases only compounds the financial strain on the healthcare system. With revenue cycles at breaking point, there is no room for inaccurate coding or claim denials. To help hospitals and healthcare organizations stay on top of rapidly changing payer policies, Experian Health is offering free access to COVID-19 and telehealth payer policy alerts, so providers can avoid delayed payments and costly claim denials. While the 1918 pandemic led to a complete revolution in our understanding of public health, the legacy of this virus may be more of an evolution – accelerating technological progress already moving forward. The organizations that adapt the quickest to the new normal will be most likely to survive. Find out more about the free resources and support available through Experian Health’s COVID-19 Resource Center to help your organization tackled the most pressing COVID-19 concerns. 

There is no doubt the healthcare industry has taken a financial beating as a result of COVID-19. But there is a glimmer of hope for providers. Several new announcements were recently made attached to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, specifically around reimbursements attached to COVID care for the uninsured. The financial stimulus, intended to stabilize hospital finances as providers face short-term revenue reductions due to the cessation of non-urgent procedures and the increased costs for personal protective equipment, has earmarked  a portion of the $100B established for CARES to reimburse healthcare providers at Medicare rates for the treatment of uninsured COVID patients. The guidance does not indicate specifically how much money will be set aside to reimburse these claims. The big question? How long will the funds last and how quickly will providers act? With both unemployment, translating into more uninsured individuals, and COVID cases on the rise, the dollars could be exhausted quickly. A recent study by Kaiser estimates the total payments to hospitals for treating uninsured patients under the Trump administration policy would range from $13.9B to $41.8B. While Medicare payments are about half of what private insurers pay on average for the same diagnoses, estimates surrounding COVID care can be in excess of $50k for those severe cases where struggling patients spend weeks in the intensive care unit on a ventilator. Bottom line, it’s likely the funds will be distributed quickly, especially when factoring in unemployment skyrocketing. As of April 30, more than 30M Americans have filed jobless claims amid the coronavirus outbreak. The all-new portal opened on April 27 for sign-ups, and providers can begin submitting claims electronically on May 6. Healthcare providers who have conducted COVID-19 testing of uninsured individuals or provided treatment to uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020 can request claims reimbursement through the program electronically and will be reimbursed at Medicare rates, subject to available funding. A complete list of FAQs regarding the CARES Act and reimbursements are accessible on the Health Resources & Services Administration website. But what other tips and considerations should providers contemplate as they attempt to get their fair share? Here are three actions to optimize a provider’s chances of claiming reimbursements for the uninsured. Automate the insurance check. Providers must attest that they have checked for healthcare coverage eligibility and confirm the patient is uninsured. If they fail to check, they may be denied. Providers must verify that the patient does not have coverage such as individual, employer-sponsored, Medicare or Medicaid coverage, or any other payer options that will reimburse for the COVID-19 testing and/or care of that patient. There are ways to automate this step, completing a second eligibility check to attest that the patients have no coverage before providers submit claims to the government. Scan for the social security number (SSN), if possible. While there may be instances where COVID patients entered a facility and were quickly admitted with no formal registration process, the CARES Act states an SSN and state of residence, or state identification/driver's license is needed to verify patient eligibility. If these pieces of information are not captured, providers need to attest that they have attempted to capture this information before submitting a claim. The patient may be long gone, but there are still ways to attempt to retrieve a patient’s SSN after they have exited the healthcare facility. Providers should know that claims submitted without an SSN and state of residence, or state identification/driver's license may take longer to verify for patient eligibility. Again, with the possibility that these funds could quickly be exhausted, it is in the provider’s best interest to submit claims that are as clean and validated as possible. Act fast. Recall the Small Business Administration's Paycheck Protection Program (PPP) — a coronavirus relief fund for small businesses that was also established under CARES? The $350B allocated by the bill was quickly depleted in days. While these funds were going to individuals in entirely different industries, there is no concrete projections on how long healthcare providers can expect the $1B fund to cover reimbursements for the uninsured. So, providers need to act now, and fast, by tapping into automation and auditing solutions that will optimize their chances of securing their fair share.

They used to be little more than clunky messaging platforms, but today, patient portals are the key to a frictionless digital healthcare experience. Consumers can check their medical records and test results with a few clicks. They can schedule appointments, pay bills and renew prescriptions whenever they want. Shifting patient information to portals also increases staff productivity and smooths out several sticking points in the revenue cycle. And with improvements in engagement and efficiency leading to better health outcomes, no wonder 90% of healthcare organizations are putting portals at the heart of the patient experience. But these benefits aren’t without risks. Privacy and security are big concerns for consumers and organizations alike. Patients want to feel reassured their data is safe, while providers want to avoid any reputation-killing headlines about data breaches. Identification and authentication can’t be too complicated though, or the patient experience will suffer. The safest strategy is to use a risk-based multi-layered approach, including identity proofing, fraud management, device recognition and even biometrics. Different levels of security checks can be applied, depending on the likelihood of the person being an imposter. If the information being accessed is particularly sensitive, or when the log-in information doesn’t quite add up, your system should trigger additional checks, such as identity proofing questions. But what are the right questions to ask? The right questions balance risk, trust and proportionality There’s no point seeking security information that could be easily guessed, obtained through a quick Google search or stolen from a patient’s wallet. You need questions only the true consumer would be able to answer – “out of wallet” questions, or knowledge-based authentication. This means the traditional “mother’s surname” question would not be a great choice, as it’s easily discoverable by potential fraudsters. Better questions might relate to the consumer’s city of birth, first car model, first pet’s name or previous address. Of course, these identifiers could still be obtained by nefarious parties, but when used in combination with other identity proofing tactics, it’s a significantly reduced risk. The sweet spot lies in the difference between the consumer’s ability to answer correctly and that of a potential fraudster. Your questions should also be relevant to the consumer and appropriate to the context. For example, a common out-of-wallet question used by financial institutions is to confirm a recent transaction. This ticks the box for security, as only the true consumer would likely know the answer, but in the context of a healthcare portal it could seem odd and out of place. It might make the patient wary and actually do more harm than good in terms of building trust. Progressive questioning lets you use smart logic to select a range of appropriate, varied questions, rotated over time and layered up for additional checks when a certain threshold of risk is perceived. In this way, the patient experience will be flexible, seamless and reassuring, without the burden of excessive admin. How Sutter Health System used better questions to increase enrollment and reduce help desk contacts With around 1.8 million patients actively enrolled, Sutter Health System wanted to offer easy access to their self-service portal, but without accidentally giving anyone access to someone else’s information. They had no true identity proofing process for patients, which led to cumbersome checks, errors and high numbers of calls to the help desk. Introducing the PreciseID® identity-proofing tool meant the team could authenticate users more quickly and reliably, using knowledge-based questions without an arduous process. Now, patients have just four or five simple questions to answer, which are checked against a robust dataset. An online risk assessment verifies the patient’s device and determines whether additional checks are required, balancing security with convenience. Tom Mitchell, Applications Manager at Sutter Health System Office describes working in partnership with Experian Health to find the right set of questions: “It took about a month to really hone in on the types of questions and the frequency of questions needed to achieve a level of accuracy that would equate to properly identified patients. You need to select what is important to you and Experian will work with you to make sure you ask the right questions.” Not only has this increased the number of positive patient matches, it’s also reduced the number of people trying to contact the help desk with password issues. Tom says: “We’re always trying to reduce the number of contacts to the help desk. Before integrating with self-service enrollment, patients would have to fill out a paper form or call our contact center, in which case a live person would have to go through some validation processes of our own. It was a fairly cumbersome, long process without this piece of validation.” Find out more about how PreciseID could help you ask the right questions for better portal protection.

Any kind of identity mix-up is disturbing, but when it occurs within the healthcare system, the fallout can be severe. At best, misidentifying patients leads to lowered consumer confidence, but at worst it can compromise a person’s essential medical treatment. As a healthcare professional, you want to be absolutely certain that comprehensive and correct data is associated with each person who comes in for care, and that you’re utilizing the most advanced measures to make it happen. Universal patient identifiers are an integral part of that goal.  Patient Safety Awareness Week is the perfect time to convey that message clearly and positively. What is Patient Safety Awareness Week Patient Safety Awareness Week, organized by the Institute for Healthcare Improvement, is an annual recognition event dedicated to boosting the public’s knowledge about health care safety. In 2020, it runs from March 8th to the 14th. Patient Safety Awareness Week is your ideal opportunity to proactively inform and reassure patients of your commitment to safety. New systems, such as universal patient identifiers (UPI) developed by Experian Health, were created to ensure that patient demographics are as complete and error-free as possible through patient matching. Impact of patient identity problems Many patients may already have concerns about their records, having heard about problems from the news, friends or relatives, or have personally experienced identity misidentification. According to an ECRI Institute report, approximately 30% of the patient data that’s held in electronic health records is either incomplete or inaccurate. So how bad can the damage of patient misidentification be? The Ponemon Institute reported that roughly 86% of all clinicians witnessed a medical error that was caused by patient misidentification. And most disturbing: a study by the National Institutes of Health discovered more than half of all the deaths attributed to medical errors are a result of identity errors. Identification mistakes don’t just lead to unnecessary patient suffering either. These unforced errors undermine the very foundation of healthcare organization: trust. The organization that makes them suffers a serious blow to their brand. How patient identity mistakes are made Human error has been most often to blame for patient identity mistakes. Every day, healthcare providers handle an astonishing influx of information, as hundreds of thousands of electronic patient records flow in from a vast number of different systems and departments. All the while patients’ names and addresses change, which in turn requires updates. Inputting all that data manually is a major challenge, and inconsistencies typically occur in the data entry process. In fact, the National Center for Biotechnology Information found that the greatest proportion of mismatches are centered around a patient’s middle name and their Social Security numbers. Misspellings and entering first, last, and middle names into the wrong fields are also common. Once identity mistakes are entered, a patient can have duplicate records and disparate facts, matching past diagnoses and prescribed medications. Billing problems, too, can result. A patient’s statements might not be sent to the correct mailing address, resulting in them experiencing unnecessary credit troubles. Solutions to identity problems In order to consistently and correctly match patients with their medical records, innovative technology has been developed. UPIs use Experian’s consumer demographic information and methodologies to identify record matches and duplicates in a patient’s file. Once a unique UPI is created for the patient, the potential for identification mix-ups is vastly reduced. More, UPIs lead to efficiencies that drive costs down for all concerned. It’s expensive and laborious for healthcare provider employees to record and update such a high volume of patient data by hand. Rectifying mistakes is not only time-consuming, it can cause insurance issues to arise. Certainly, obtaining the best treatment is paramount to patients, but keeping healthcare costs to a minimum is also important. 79 million Americans are struggling with overwhelming medical liabilities, found The Commonwealth Fund. However, a survey conducted by Black Book found that patient matching discrepancies can lead to nearly $2,000 in extra inpatient costs per person. No one should pay more than they have to for their healthcare, and UPIs can make sure bills are appropriately assessed.  For this year’s Patient Safety Awareness Week, spread the word to your patients that measures have been put into place to protect their identity. As of the end of 2019, every person in the U.S. has been assigned a UPI, and correct and complete information will be associated with each patient. Everyone should be aware that you are taking steps to ensure the accuracy of their medical records — which keeps them safe and their financial obligations down.

It’s amazing to look back at how far medical science and digital technology have come – and how those two worlds are increasingly intertwined. Ten years ago, the idea of managing your healthcare bills or making appointments through an app on your phone would have been unthinkable. Now we take it for granted! But having all these tools at our fingertips means there’s more data being shared between different services and platforms. As a healthcare provider, you might be accessing and sharing patient data multiple hospitals, primary care services, pharmacies, patient portal providers, payers and more. It’s vital to make sure that data is accurate. Research by RAND Corporation revealed that between 8-16% of patient records are duplicates. Trying to provide care on the basis of unreliable data is inefficient and expensive for providers, who lose staff time and revenue trying to match up records and reconcile the data on file with the patient in front of them. According to RAND, a mid-size health system absorbs as much as $96 for each duplicate. What this means for patients is even more worrying. According to the US National Institutes of Health, “195,000 deaths occur each year because of medical errors, with 10 of 17 being the results of identity errors or wrong patient errors.” In a value-based system where patients are covering more of the costs themselves, the financial impact of having unnecessary repeat tests or longer-in-patient stays due to delayed treatment is an added pain. Currently, standard health IT products have some catching up to do, as only 10% of duplicates are spotted. But looking ahead, the future of patient identities is promising. Unique patient identifiers are key to unlocking value-based care The twin trends of value-based care and healthcare consumerism are bumping up patient expectations. They expect a seamless experience. They expect their records to be updated immediately. They’re confused when one department doesn’t have access to information that was just shared with another. And they definitely don’t want to see different services working off different versions of the same record. The answer for many high-performing health systems is to introduce unique patient identifiers (UPIs). This allows a patient’s record to follow them throughout their healthcare journey, ensuring that at every touchpoint, clinical and admin staff are confident in the accuracy of the information they hold. But transitioning to any new system can involve a bit of culture shock for those involved, and so careful planning is essential. What steps can providers take to make sure they implement a patient identity management strategy that’s built to last? How to future-proof your patient identity platform 1. Make sure everyone’s on board with the plan First, whatever solution you’re using to manage patient records, it’s essential that your patients, staff, payers and any other parties involved all buy in to the new approach. Changing the way you handle data and introducing new digital tools such as UPIs can often call for a mindset shift in the way your team and consumers think about data. Be sure to communicate the benefits of UPIs to patients, payers and staff. For example, UPIs can: improve patient safety, by preventing duplicate and inaccurate recordslower healthcare costs, by eliminating inefficiencies and errorssafeguard patient privacy, by keeping records securecreate a better patient experience, by supporting patient-centered carehelp staff access up to date information about their patient’s healthcare situation 2. Choose a UPI system that works within and outside your network Some providers use hospital- or practice-based patient identifiers, where a master patient index is used to link all versions of a patient’s record held within a single organization. An enterprise master patient index (EMPI) does the same, but across several facilities or services. A cross-enterprise solution makes it much easier to manage patient identities across your entire network, without having to wrangle disparate records that don’t interface well with each other. When this system is based on ‘referential matching’, which uses wider data sources and UPIs to build a more connected and accurate data ecosystem, you’ll get a much more complete view of your patients and far fewer inaccuracies. 3. Use data analytics to improve decision-making UPIs bring another advantage: they enable you to analyze health, credit and consumer data for a single patient, giving you useful insights about your patient population as a whole. A network of interoperable data can help you spot trends in the social and economic factors that affect health and wellbeing, so you can target your resources more effectively. As the world of public health data matures, it’s highly likely that UPIs will become the norm. Data-sharing remains a challenge, but by using digital tech to your advantage, you can improve the way patient records are managed in your health ecosystem. Learn more about how UPIs could help close the patient data gap in your organization.

At the end of 2019, Experian Health announced that every person in the U.S. population, an estimated 328 million Americans, had successfully been assigned a unique Universal Patient Identifier, powered by Experian Health Universal Identity Manager (UIM) and NCPDP Standards™ (the “UPI”). Universal Patient Identifiers (UPIs), created with a comprehensive view of patients from health, credit header, and consumer data sources, are thought to significantly reduce the challenges that stem from the misidentification of patients which span patient safety, financial, and operational inefficiencies. But what does 100% coverage mean? And what does this mean for the future of healthcare? To take a deeper dive, we sat down with Victoria Dames, an Experian Health leader in the identity management space to learn more. 1. It doesn’t get more perfect than 100%, so tell us more. What exactly does 100% coverage mean? Experian Health developed an algorithmic engine known as our Universal Identity Manager about five years ago. Since this time, we’ve worked closely with many providers, pharmacies and payers to help address their duplicate records. We’ve been monitoring our adoption and enumeration by unique patient identifiers against 328M individuals in the US population (2010 Census) and achieved this milestone at the end of 2019. Through our broad network of provider clients, which include hospitals, pharmacies, payers, and healthcare technology companies, patients who have received care from participating entities over the past few years have been enumerated.  As new patients enter the healthcare ecosystem, this number will continue to grow.  2. Why are universal patient identifiers (UPIs) needed and how do they benefit providers and patients? The Universal Patient Identifier (UPI) helps providers link the right records together, preventing duplicate records from being created. For example, think of all the ways duplicate accounts or variances can occur: address differences, name variations (Katherine, Kathryn, Kathy, Kat), maiden names and potential user entry error. With the UPIs, providers can link records together and have one complete record and view of the patient, ultimately leading to a better patient experience. It’s important to note that the UPI is not something the patient knows or sees, but rather part of the technology. It can be embedded within a hospital’s information system, for example. It simply links a patient’s records together, so a provider has a complete view of the patient’s identity. The flow of communication happens when participating healthcare organizations send Experian Health patient demographic information; the system provides the organization in return with the insights and identifiers that they need to better manage patient identities and prevent duplicate records. The UPI can be attached - if the situational requirement is met - to active claims in real-time transactions effectively improving the integrity of patient records. During this process Experian Health does not rely on or use any clinical information about the patient; Experian Health only leverages the minimum data elements needed to successfully match an identity.  3. How did you get numbers assigned to all Americans? When a healthcare organization enlists our help, we process all their historical records through the UIM, returning a Universal Patient Identifier (UPI). The initial run of this data helps resolve existing duplicates which can date back several years. Working with multiple providers and pharmacies, we were able to get numbers assigned to all Americans. The number will continue to evolve of course, as the population changes with births and deaths. 4. Are there privacy risks with this? Experian Health is a HIPAA-compliant Business Associate when it receives PHI from customers.  It takes its privacy obligations very seriously.  As to UIM, privacy risks are minimized by the fact that the UIM does not leverage any medical records, prescription histories, or provider systems. The purpose of the solution is to assist healthcare professionals to better match an individual’s identity through data assets that would normally be unavailable to a healthcare provider.  5. Does a UPI function similar to a credit report, meaning it provides a singular view of a patient’s medical history? It depends on the situation.  If a provider has a patient in their EHR twice under two spellings of the patient’s name in error, then yes, the UPI would link those two profiles, creating a singular view of the patient in that provider’s system. Additionally, the UPI generated by Experian Health is designed to help facilitate interoperability between healthcare providers.  For example, if your pharmacy has you listed under your maiden name of Smith and your doctor has your married name of Wilson, during the ePrescribing process, your ePrescription might not get associated with your prescription profile. If both providers have the UPI on record and submit it during the transaction, the systems will match the patient using the UPI. It’s important to note that the UPI is technology for entities and is not patient facing. 6. What is the direct benefit to consumers; will it help them control their medical data? Consumers will benefit depending on how a provider implements and utilizes the UPI. For instance, if a provider has two medical records, and they merge this into one record, the patient will see one consolidated record. Imagine two patient profiles for the same individual at a pharmacy.  One prescription is filled under each profile and the two separate prescriptions, if taken together, could lead to a severe reaction. If filled under two different profiles, the automated process to screen for drug interactions would not identify this harmful reaction. But the UPI directly solves for this issue. 7. What are the next steps and goals for Experian Health as it pertains to UIM? Our goal is to continue to partner with healthcare organizations to help prevent and resolve their duplicate records. We are continuing to invest in our technology and capabilities within identity, as we care deeply about patient safety and data integrity. Having a single, unified and accurate view of the patient is a challenge that plagues the healthcare system, and now we have a comprehensive solution that reduces the barriers to make healthcare safer.

  When a doctor pulls up a patient’s record, it should be a safe assumption that the information on the screen relates to the patient sitting in front of them. It should contain every detail of the patient’s medical history, along with their current address and accurate personal information. It certainly shouldn’t contain anyone else’s data! Yet all too often, patient records are plagued with inaccuracies. Around 30% of patient data in electronic health records is incomplete or inaccurate, and up to half of records are not linked to the correct patient. The ONC estimates that around a fifth of patients may not be matched to their entire medical record within an organization, while more than a half of records shared between organizations contain errors. Despite all of modern medicine’s ground-breaking achievements and our increasingly digitized world, the ability to share information between different payers and providers in a reliable and secure way remains frustratingly out of reach. Could a universal patient identifier unlock interoperability? Imagine a healthcare ecosystem where administrators and clinicians can safely exchange information without worrying about whether it’s inaccurate, incomplete, or incompatible with each other’s systems. Interoperability could make life easier for healthcare staff and patients alike. While regulations such as the Affordable Care Act introduced many carrots and sticks to drive up adoption of electronic medical records to support interoperability, they also revealed a critical gap in healthcare: the need for a universal patient identifier (UPI). This is an identifier that would help manage patient identification across the whole healthcare ecosystem. A UPI would allow providers and payers to follow patients throughout all their major medical and life events and be sure that the information they hold for their member or patient is 100% accurate, current and complete. Instead, the absence of a UPI, compounded by the sheer volume and fluidity of patient data, has created significant issues downstream. Billing errors, unnecessary treatment and testing, HIPAA breaches, prescriptions filled for the wrong patients and many other issues all play a role in the growing number of preventable medical errors (estimated to be the third leading cause of death in the US). Striving for truly interoperable patient information should be a priority across the entire healthcare industry. Still, while federal funding for a UPI is currently being considered by Congress, we’re seeing more and more industry-led responses to help improve patient identity management. 5 benefits of using a universal patient identifier for interoperability Improve patient safety How can physicians be sure they’re recommending the right treatment for a patient, when there could be a vital piece of information missing from their medical history or allergy list? How can a pharmacist feel confident handing over a prescription, when there’s a chance the patient in front of them isn’t the same patient named on the script? A UPI can help avoid ‘wrong patient’ events and allow providers to share information to spot trends in recurring errors so that action can be taken to prevent them in future. Lower healthcare costs The West Health Institute found that that medical device interoperability could save the U.S. healthcare system more than $30 billion per year. For individual providers, UPIs could improve productivity by reducing the amount of time clinicians and hospital staff spend trying to sort out inaccurate records. And with nearly a third of claims denied as a result of patient misidentification, this could mean savings in the region of $17.4 million for the average hospital. A better patient experience Patients are right to be frustrated when their physician doesn’t have up-to-date records about them, or their provider sends appointment reminders to an old address. Expecting patients to fill out multiple forms (often multiple times) is inefficient and hardly contributes to a positive patient experience. A tool such as Universal Identity Manager can help providers exchange timely data, eliminate duplicate records and coordinate care, so the patient is supported throughout their healthcare journey. Stronger privacy Electronic records linked with a UPI allow healthcare organizations to phase out manual processes—which is not only more efficient, but also helps minimize the risk of patient data falling into the wrong hands. It’s much easier to keep the data secure when it’s contained in a single record, compared to multiple versions of a record filled with scribbled notes and random updates that could easily end up attached to the wrong record. Experian Health’s Precise ID gives healthcare organizations a HIPAA-compliant way to authenticate patients and reduce the risk of a data breach during enrollment. Better data to tackle the social determinants of health As consumer data opens up new opportunities to improve population health, a network of shared data will be essential for identifying trends in the social and economic factors that affect medical outcomes. Interoperable data sets and technologies can enhance the way public health data is collected and used, for better patient outcomes and population health. Interoperability currently remains a challenge, but the tools exist to improve the way information is shared and used across the healthcare ecosystem. By integrating clinical data into the patient access workflow, you can increase productivity, reduce costs, and ultimately improve the patient experience. Contact our team to find out how this could help your organization achieve more efficient, accurate and actionable data sharing.  

Last week, I spoke at the technology briefing of a national health plan group to give a presentation on the role of consumer data and patient identity in healthcare and how social determinants of health (SDOH) can help payers improve population health and lower costs. To illustrate the importance of leveraging consumer data for SDOH outcomes, I like to use the example of Vern. Vern is 78 years old, lives alone in a lower income apartment complex and hasn’t attended a wellness check in several years. Last month, he had an unexpected trip to the emergency room (ER) due to heart disease and continues to be readmitted for his condition. But why does he keep getting readmitted? Is it because he can’t afford his prescribed medication? Is he having a difficult time finding transportation? Or could it be that when it comes to healthy eating—buying fresh product on a weekly basis is challenging for him? These are some of the SDOH that could be contributing to Vern’s readmission—not solely his now heart disease. Had his care team known more about Vern, aside from his condition, they could have proactively addressed some of his barriers to care and prevented the ER admissions—saving them from costly care episodes and preventing negative outcomes for Vern. By utilizing SDOH insights, Vern’s care team can help ‘even the playing field’ for him by understanding his non-clinical barriers to health, what key things are driving those barriers, and what makes sense to address them.  All of this, of course, underpinned by an accurate identity (but, let’s talk universal patient identification another day!). With SDOH insights, Vern’s care team could have gotten him to his wellness checks, his condition would have been detected earlier and he would have received the services he needs proactively. This would save countless dollars in repeated readmissions, ER visits and other costs associated with a chronic condition that can’t get better when your members don’t have the luxury of prioritizing health over basic needs. To avoid these missed opportunities, many healthcare organizations are turning to consumer data to understand their patients or members better. Insights on SDOH are transforming the care experience for people like Vern, as well as saving money for patients and the healthcare industry. Here are three ways consumer data is driving improvements in population health and lowering healthcare care costs at the same time: Helping patients lead healthier lives Research shows that clinical care alone is not enough to safeguard a person’s health. Up to 80% of health outcomes are attributable to non-medical factors such as your financial situation, stability of living arrangements, access to transportation and healthful food options, amongst other things. Around 68% of Americans are affected by at least one of these SDOH, which can make prioritizing good health a challenge. When healthcare organizations are more informed of the SDOH impacting their patients or members, they can take steps to help prevent avoidable hospital visits, ED utilization, appointment no-shows and worsened conditions by encouraging and facilitating earlier intervention. For example, 1 in 8 Americans are food insecure.  If care teams are able to recognize when this is an issue for the people they’re caring for—they can look at partnering with community organizations, like a local food bank or meal delivery service, to address gaps in nutrition for better health outcomes. Reducing the financial burden of healthcare expenses In the U.S., healthcare has the world’s largest gross domestic product (GDP) spending (18%).  By helping your members overcome barriers to attending appointments and potentially discovering health issues sooner, the healthcare industry can reduce the costs of healthcare. For example, 3.6 million Americans miss out on medical care due to transportation problems. If care teams knew who they were and what specifically is impacting them ahead of time, they could step in to arrange transportation or offer alternative options, like telemedicine, so problems can be detected earlier. Not only is this better for the patient’s health, it’s better financially too—emergency room visits cost an average of nearly $2,000 while inpatient hospital stays come in at an average of $10,000. When 33% of ER visits are from those experiencing homelessness—the extreme condition of housing instability—it’s imperative that we consider more than a patient’s profile from a claims or clinical data perspective. Offering a better patient experience When healthcare organizations can see each patient as a whole person, they can offer better engagement plans that make prioritizing their health a smaller mountain to climb. Does your patient prefer information by phone, text or email? Do they use their patient portal? Are there other services they might benefit from, that can help improve their health in other ways? Armed with the right data, you can answer these questions and tailor your communications with each patient, ultimately helping them achieve better outcomes. What’s more, when you leverage consumer insights to improve your population health strategies, you’ll also create a better patient experience through improved care coordination, prompt referrals and timely information sharing—making the whole process better for everyone. Translating consumer data into intelligent business decisions With reliable consumer data sourced from Experian—an original-source provider and data steward when it comes to consumer privacy—you can learn more about your patients and make the right care management decisions to address the non-clinical barriers to health impacting the health of your members and your organization. Learn more about how to leverage consumer data to help improve outcomes for your patient population. Mindy Pankoke is a Senior Product Manager for Experian Health