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

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

vi

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Public Health Informatics
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Information Technology
Keyword	IIS UPIs Patient Matching Universal Patient Identifiers Immunization Information Systems Unique Patient Identifiers
Committee Chair / Thesis Advisor	Grant, Frederick PhD, Emory University
Committee Members	Fath, Janet PhD,

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