What is a National Patient Identifier and Why is It Important?

Patient matching issues have surrounded the healthcare industry for decades. Patient matching, or the ability to connect the correct medical data to the appropriate patient, is a key patient safety issue made complicated by limited interoperability and data governance. One potential fix that has been particularly controversial, yet brought up on occasion, is the National Patient Identifier (NPI).

Patient matching aims to connect patient records across different medical providers or facilities. The same patient visiting two different doctors or two different hospitals should always have the correct medical record brought up. However, this does not always happen, and a mistake can be both lethal to the patient and it can carry a heavy financial burden for the health system.

In a recent survey of roughly 120 healthcare providers and HIE leaders, researchers identified patient NPI barriers, how to improve patient matching rates, and the need for government support as top patient matching issues.

“As the number of players and organizations in the healthcare space continue to expand rapidly, patient matching is even more important,” Jennifer Covich Bordenick, chief executive officer of eHealth Initiative Foundation, said in a statement.

 For over two decades, the House of Representatives and the Department of Health and Human Services (HHS) have debated the NPI system.

In short, the system would assign each American citizen a unique number to be used across the healthcare system. This unique number would eradicate the chances of overlapping a patient health record when an individual shares the same name or birthdate.  

In that survey, 70 percent of the respondents agreed some federal funding should be available to create an NPI system. More specifically, 31 percent somewhat agreed, while 39 percent agreed completely. Forty-seven percent of respondents who worked specifically with HIEs agreed completely that federal funding should be available to create an NPI system.

While some health experts said the number would aid patient privacy due to clinicians no longer needing to have access to a social security number, Congress’ reason for not providing funding stemmed primarily from that same concern. An NPI system could raise serious patient privacy risks.

If the NPI number is compromised, the patient’s entire health record would be easily accessible in one location. As a result, HHS would have to implement strong security measures to ensure the number is safe and secure.

Congress first expressed security concerns in the mid-1990s, and it remains the same today.

Additionally, a new NPI system would have to be created and the cost could be astronomical. Not only would the numbers be assigned to all United States citizens, but the new IT system must be implemented, policies must pass, and duplicates need to be avoided.

The creating and assigning of the unique number could cause problems. If two patients were accidently  given the same number, serious medical issues could occur, and the same would happen if the clinician were to type in the incorrect number.

But in June 2019, Congress voted to end the ban that bars HHS from funding NPIs. Organizations such as HIMSS pressed Congress to lift the ban so that HHS could assist in funding the system to help improve patient matching and reduce the chances of creating duplicative patient EHRs.

Still, the development of a unique NPI is not yet underway and patient matching errors can still occur up to half of the time at medical facilities.  

From data entry errors, to poor technology, to issues such as individuals moving or divorcing, there are many factors that lead to poor patient matching.

However, healthcare and health IT professionals, such as Shaun Grannis, MD, vice president of data and analytics at Regenstrief Institute, believe government support could reduce these issues.

“If we want to standardize data, then we need to get people to agree,” explained Grannis.

“Whatever it's going to be, we need a consistent approach to make sure that we do the best job possible identifying patients. Without a consistent approach, there are going to be gaps in the system, and information is going to be missed. Patients will continue to receive less than optimal care.”