How a Universal Patient Identifier can help solve pharmacy’s patient matching problem

September 10, 2019 by Matt McGrath

Last week, I attended the ONC Symposium on Patient Matching for Prescription Drug Monitoring Programs (PDMPs) and conversations with pharmacy stakeholders confirmed that momentum is growing for an industry-wide solution to the patient matching challenge.

Recent legislative movements could see a removal of the ban on federal funding for a universal patient identifier (UPI), while within the industry, we now have a range of exciting collaborations and innovative solutions on the table to help improve patient identity management.

As someone who works closely with pharmacy leaders, PDMP administrators, health IT experts and standards organizations, I’m optimistic about what patient matching technology could mean for the pharmacy world. Here’s why.

When life doesn’t match health events

In today’s healthcare system, patients move through several facilities and services, seeing multiple doctors, pharmacists, nurses and other clinicians. In between those interactions, life happens. A patient might move to a new house. Get married. Have kids. Relocate to a different state. Maybe they visited Pharmacy A for their medications while living in San Francisco, but delivered their first child in Hospital B, after moving to Los Angeles with a new surname and different address. How does the health service know this is the same person? Who is keeping track?

Patients with similar names can have their records combined, while data entry errors lead to the same patient having multiple unmatched records. The ONC itself has found that 10-20% of patients may not be correctly matched to their entire medical record within an organization, rising to 50-60% when data is shared between organizations.

For pharmacists, the fact that nearly 80% of prescriptions are delivered electronically means the opportunities for data entry errors to creep in is worryingly high. How can they be sure that the prescription they’re holding is for the patient across the counter? A prescription in the wrong hands could be fatal.

PDMP facilitators face the same problem when trying to improve patient match rates for the proper tracking of opioids. Since the data comes from various sources, often formatted differently and not always including required fields, PDMPS are forced to do the best they can with what they have.

To further complicate the issue, states across the U.S. do not have a common, underlying method of uniquely identifying patients to be able to exchange information across state PDMPs. While PDMPs establish central repositories of prescribing and dispensing records of medications classified as controlled substances that can be accessed online by authorized individuals and agencies—individual state PDMPs vary in required prescribing information and in data submission time, usually with a week or more of delay. An additional challenge exists since not all programs share their data with other state PDMPs, preventing information exchange and reducing the effectiveness of the programs.

The answer is to have a single, complete picture of each patient that can be accessed by all relevant organizations in the healthcare ecosystem – but how close are we to achieving true interoperability?

Why EMPIs aren’t the answer

The common solution historically has been  to use an enterprise master patient index (EMPI) to link all versions of a patient’s record within a health eco-system (such as in a pharmacy, a physician’s office, or a PDMP). The problem is these usually rely on limited historical and demographic information, which may have gaps or errors that end up being replicated in any service using the EMPI.

A universal patient identifier that integrates patient information from reliable health, credit and consumer data sources can give pharmacies and other providers a much more comprehensive view of their patients than traditional matching approaches.

Referential matching technology, as recommended by Pew researchers, uses unique identifiers and third-party data to provide continuous updates to the master patient index, so you know you’re giving the right prescription to the right person.

Collaborating for better patient matching solutions

One example of how this is already being used to link patient prescription data at scale is in Experian Health’s collaboration with the National Council for Prescription Drug Programs (NCPDP), which sets the standards for the digital exchange of pharmacy-related healthcare information.

Lee Ann Stember, President of the NCPDP, says: “We needed a single, unified and accurate view of the patient that could address the patient safety and business issues that plague our healthcare system.”

To this end, we’ve teamed up to create a patient matching solution that provides a framework for establishing a unique patient identifier across the entire US healthcare network. This is a vendor-neutral, cost-effective solution that lets providers exchange information efficiently and accurately. There’s less chance of a prescription being given to the wrong patient and causing unwanted and even fatal interactions.

In August 2018, NCPDP working groups approved the UPI as a standard field. This means the UPI may be used by other partners to improve the accuracy of patient data exchange.

The PDMP Reporting Standard was among those identified as suitable for communicating the UPI. With this standard, pharmacies will be able to submit the UPI directly to PDMPs so that patients can be matched using the UPI instead of probabilistic or manual processes.

A UPI can help states who share data improve their matching because it is a real-time solution that will feed into the management of controlled substance prescriptions across state lines, creating better visibility into interstate prescriptions and more importantly improving patient safety. The current lack of transparency into controlled substances—who is filling, when they are filling, how often they are filling, etc.—is feeding the national opioid epidemic which is taking a significant human and capital toll.

Working towards an industry-wide solution

Our strategic alliance with NCPDP was inspired by a shared desire to leverage data for the common good. We want to give more providers the opportunity to benefit from this UPI solution, to help address some of the patient safety challenges facing the healthcare industry.

That’s why Experian Health is offering access to our Universal Identity Manager (UIM) Batch product for no charge. This tool strips out duplicates in your patient data and gives you a UPI that can be used across different health entities, enabling secure information exchange. It can even provide updated demographic information using the United States Postal Service CASS address standardization.

Given the advances already made in trialling innovative solutions for the secure and accurate exchange of prescription data, the pharmacy industry is well-placed to lead the way in adopting more comprehensive and reliable patient matching frameworks.

As we know, better data means better care. More accurate patient matching not only improves patient safety, but allows for better care coordination, financial savings and greater operational efficiency.

Find out more about how the Universal Identity Manager and other identity management solutions can help pharmacies improve patient matching.

Matt McGrath is Vice President of Pharmacy Strategy and Solutions at Experian Health. 



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