That prohibition is still in place, but in a bipartisan spending bill in 2017, Congress acknowledged that patient matching is a serious problem, and encouraged the Department of Health and Human Services to work with the private sector to figure out a fix. Some Congress members are expressing support for a unique identifier, and the government is peeking into the idea a bit. Considering the current political climate, however, Halamka isn’t getting his hopes up.
“The idea that you could get the electorate to believe in having a government-assigned number to track you is just not a politically tenable idea in the U.S.,” he says. “We’re just too darned committed to our freedom.”
Read: Are you ready for a medical RFID implant?
Maybe not everybody. Two states, Nevada and Minnesota, have laws allowing the use of patient identifiers within their state borders. And Halamka thinks a voluntary unique-identifier program for individuals who want to make sure their medical records are matched is worth exploring.
The next best idea, in his view, is a nationwide patient-matching strategy that gets hospitals, physicians, information-technology vendors, and everyone else approaching the issue in the same way.
While they are waiting for a nationwide strategy, individual health systems are trying to fix their own patient-match problems.
A little more than a year ago, Northwell had a list of 220,000 possible duplicate records and was creating about 700 possible duplicates a day. “We were taking on water and we were sinking,” says Keely Aarnes, the associate vice president of revenue-cycle management at Northwell. (Yes, Aarnes, the victim of the patient-matching fail at the radiology center, is an expert in patient-matching both personally and professionally.)
In 2016, she led Northwell’s attack on that towering pile of possible duplicates, starting with a manual review of the “no-brainers”—duplicates that were obviously for the same person but needed someone to take a close look before hitting the merge key. To keep the backlog from rebuilding, the health system introduced “probabilistic matching,” checking newly created records against the 6 million patients in Northwell’s master patient index. Is Mary Smith who lives at 231 Crest Wood Ave. the same as Mary Smith who lives at 231 Crestwood?
Next, Northwell introduced “referential matching,” in which patient records are matched against a proprietary database that includes identity information from cable companies, the U.S. Postal Service, and so forth for 350 million people dating back three decades.
Most recently, Northwell started testing an artificial-intelligence technology that takes photos of patients and uses iris recognition to match them to their records. Harris Health System has also introduced biometric technology, in the form of palm-vein scans. Ideally, this will help ensure that all Maria Garcias are properly matched to their medical records—at least until they need to visit a different health system.