Unique Patient Identifiers and Immunization Information Systems: Benefits to Consider Open Access

Williams Sebastian, Nikki (Fall 2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/4x51hj023?locale=en
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Abstract

INTRODUCTION: Currently, the United States is not developing a unique patient identifier (UPI) to use as a singular key to accurately link, file, and retrieve individual health records. Although the existing Congressional prohibition against using federal funds to develop UPIs remains, in early 2017, a House committee advised it does not prohibit the examination of ways to effectively and accurately identify patients.

AIM: The purpose of this research is to 1) examine existing legal framework surrounding why UPIs are currently banned for use in the U.S. healthcare system 2) perform a literature review of current methodologies of identifying patients 3) review existing UPI proposals and the feasibility of UPI implementation into existing IIS.

METHODS: The research performed in this thesis takes place in three stages: 1) An analysis of federal legislation and private industry publications to examine the Congressional ban on the use of unique patient identifiers in the U.S. healthcare system. 2) A comprehensive review of public health literature to identify patient-matching protocols and investigate how patient identities are determined without the accuracy and stability provided by unique identifiers.  3) A general review of publications that detail IIS data quality challenges resulting from the lack of UPIs.

RESULTS: The results of this thesis are organized into three stages, 1) Legislative analysis results, 2) Systematic literature review results, and 3) IIS data analysis results.

DISCUSSION: Evidence suggests that UPIs would improve efficiency and data quality of IIS by eliminating duplicate records and by allowing for accurate data exchange to facilitate more efficient tracking of immunization histories.  This can only be achieved through federal legislation that addresses confidentiality, privacy, and security concerns of sharing data across nationally distributed electronic health information networks. Public education, engagement, understanding and acceptance of UPIs will also be required in order to realize their full potential. Informed by the literature, a clear case exists that IIS would benefit from the implementation of UPIs

Table of Contents

Chapter I:   INTRODUCTION 1 1.1 Background 1 1.1.1 Immunization Information Systems 1 1.1.2 Challenges with IIS Data Quality 3 1.1.3 Patient Identification in the U.S. Healthcare System 3 1.1.4 Inefficiencies in the Healthcare System 5 1.1.5 Unique Patient Identifiers (UPIs) 6 1.2 Purpose 7 1.2.1 Thesis Organization 7 1.3 Research Questions 9 1.4 Table 1: Definition of Key Terms 10 Chapter II:    REVIEW OF THE LITERATURE 13 2.1 Introduction 13 2.1.1 Literature Review Strategy 13 2.2 Summary 14 2.2.1 Table 1: Literature Review Search Terms 14 2.2.2 Healthcare Privacy Legal Framework 17 2.2.3 Impact of HIPAA on State and Local laws 18 2.2.4 HIPAA’s Impact on the Implementation of UPIs 18 2.2.5 Patient Identification Methodologies 21 2.2.6 IIS 21 Chapter III:   METHODS 24 3.1 Introduction 24 3.2 Procedures 25 3.2.1 Stage 1: Systematic Review of Federal Legislation 25 3.2.1.1 Stage 1: Summary 30 3.2.2 Stage 2:  Systematic Review of Patient Matching Methods 30 3.2.2.1 Master Patient Indexes (MPIs) 31 3.2.2.2 Statistical Matching 32 3.2.2.3 Biometrics 34 3.2.2.4 Social Security Numbers (SSNs) 34 3.2.2.5 Stage 2 Summary 36 3.2.3 Stage 3: General Analysis of IIS Data 37 3.2.3.1 Stage 3: Summary 39 3.3 Procedures Summary 40 Chapter IV:   RESULTS 41 4.1 Introduction 41 4.2 Findings 41 4.2.1 Stage 1: Legislative Analysis Results 41 4.2.2 Stage 2: Systematic Literature Review Results 45 4.2.2. Analysis of UPI Proposals 45 4.2.2.1 Data Encryption Proposals 46 4.2.2.2 National ID Cards 47 4.2.2.3 Private Sector UPI Initiatives 48 4.2.3. Stage 3: IIS Data Analysis Results 49 4.2.3.1 Pharmacies and IIS 52 4.3 Chapter IV Results Summary 54 Chapter V:  DISCUSSION 57 5.1 Discussion of Research Questions 57 5.2 Key Findings 58 5.2 Recommendations 58 5.3 Conclusions 59

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