The pandemic has exposed a lot of weak links in healthcare, and identity is a big one. Healthcare providers float on oceans of sensitive patient data that is not only a glaring fraud risk, but also injects massive inefficiency into an overburdened system.
Issues of duplicate medical records, differing records for the same person stored in disconnected systems — to say nothing of potential fraud, waste and abuse — are motivating big players to get serious about the problems related to patient matching.
“Universal identity is a huge topic,” said Victoria Dames, vice president of product management at Experian Health. “It crosses over everything from providers, health plans, health information exchanges, etc. It exists everywhere today.”
Historically, medical practices have relied largely on Social Security numbers as a stand-in for a unique medical record number.
“It’s both inefficient, because there can be duplicates, as well as a huge security and fraud risk,” Dames said, and so, Social Security numbers are no longer the default.
In 2018, the Centers for Medicare and Medicaid Services began moving recipients to a Medicare Beneficiary Identifier (MBI) system to keep Social Security numbers off the card and out of harm’s way.
In 2022, many providers are moving to online secure portals, which are being used to consolidate medical records from disparate sources and minimize the cybersecurity risks involved with health records.
“We had done a survey, and interestingly enough … 73% of patients said they want to use a portal for communicating, setting up their appointments and reviewing care records,” Dames said. “As you think over the past few years, we get out our device, we use it, and we expect things to happen very quickly now. Why not healthcare?”
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The Problem With Duplicates
Universal identity, authentication and patient matching are more pressing matters in 2022 as millions have moved to digital modes of healthcare delivery.
“We want to make sure that we have a good history and take that from a single view,” Dames said. “All of these things impact both patient and provider success in navigating the patient journey, whether it’s the access to care, receiving or delivering that patient’s care,” and safeguarding their private information along the way.
Experian Health is tackling this with solutions like its patient identity matching service, which uses a “probabilistic matching algorithm” to avoid duplicate records and medical bills.
The need is urgent, Dames added. As the pandemic drove digital adoption, everything — from COVID-19 tests from pharmacies to temporary medical encampments in major cities — is creating a new mountain of health data that’s potentially exposed or entered incorrectly.
Read more: Healthcare Providers Use ‘Deep Data’ to Deliver Better Patient Outcomes
Data Holds the Cure, Too
Data is at all points along the continuum of identity, authentication and patient matching, and it is data that’s being used to fix the problem.
Dames said, “When we talk about patient matching and being able to provide identity resolution, Experian has wonderful reference data that we’re able to utilize to help create that, to understand previous names, addresses and the longitudinal record of an individual.”
That “longitudinal record of an individual” enables health systems to “reconcile that data as it moves through,” Dames said.
“Some of us move or see different providers at different points in our lives, or specialists, etc.,” she added. “You might have a different address. You need to be able to know that that’s still the same person.”
Authenticating patient identity is now a critical function for hospitals, health systems and individual providers as remote telehealth becomes a primary mode of care delivery. Some will adopt more slowly than others, but the longer the wait, the greater the difficulty.
“Intuitively, providers, payers, everybody knew that this was the direction we were going,” Dames said. “The demand increased because of our situation as a nation. It has [been] a great catalyst for everybody. I don’t think there’s any issues with wanting to embrace it.
“Everybody’s pretty much on the same page that the time is now, and the time is now that we get it right.”
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