National Patient Identifiers: More Harm Than Good

In 1996, HIPAA legislation called for the development of a national patient identifier system that would give each person in the U.S. a permanently assigned, unique number to be used across the entire spectrum of the national healthcare system.

Citing privacy concerns, Congress prevented the Department of Health and Human Services from implementing national patient identifiers by refusing to provide funding. Contrary to my colleague’s opinion, I believe this was the right decision.

Due to the scale of implementing a national patient identifier system, expanding standardized ID numbers to all aspects of care would come with astronomical costs, increased possibilities of fraud and privacy breaches, and create room for potentially fatal medical mistakes.

Complexity and Cost 

With providers scrambling to adopt new technologies and work processes because of the Affordable Care Act, do practices really need the administrative headache or cost issues of aligning their patient records with a national NPI system? 

There is currently no national standard for identifying patients, and implementing such a system would be no simple task. Researchers estimate the cost lies somewhere between $1.5 billion and $11.1 billion.

There are also huge practical concerns related to creating an NPI system. A large number of changes would need to take place, including the issuance of new numbers, the creation of a policy to define where and how numbers are created, the ongoing process of identifying and duplicating ID numbers to the same patient, and changes to including this new data in every single component of health IT software.

Privacy Concerns and Fraud 

NPIs also bring about clear privacy concerns, which is why Congress shot down the initiative in the first place. For instance, simply stealing a patient’s NPI number already means full access to a person’s entire health record.

Unless HHS places proper safeguards into place to prevent this from occurring, misplaced NPIs could have an extremely damaging effects on a patient’s personal and professional lives.

Poor management of patient identifiers could also encourage fraud. In this case, the system would become a magnet for illegal activity, such as drug seekers and medical identity theft.

In theory, a drug abuser could use another patient’s NPI to gain access to prescription medications they were previously banned from. This not only furthers the effects of the current prescription drug epidemic, but could potentially ruin the reputation of a perfectly credible patient.

Fatal Mistakes 

Possibly the worst consequence of implementing an NPI system would be the increased risk for medical errors. Consider what would happen if the wrong patient record were to be associated with an individual? Results could be devastating.

If two patient records were to be merged on accident and one patient receives treatment for another’s disease, the mistake may prove to be grave, if not fatal. This kind of misstep can not only cause significant personal harm to the patient but also incur a huge cost to the provider in correcting and mitigating the error.

A more practical solution to NPIs would be a clean-up of our current system through more efficient electronic health records usage. Creating a network of interoperable EHR systems would facilitate the transfer of patient health information across providers without sacrificing security.

With the Meaningful Use program already pushing for this kind of interoperability, the cost of implementation would be a lot less than employing a completely new identification system across all aspects of the current, highly complex U.S. healthcare system.

You’ve heard our take on the issue. Now, how do you feel about national patient identifiers? Let us know in the comment section below. While you’re at it, don’t forget to sign up for the PYP newsletter too!

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