HIT Happens

Shut down thoughts of a national patient identifier, stage 2 extension

If your crystal ball says the CIO-endorsed ideas of a national patient identifier or meaningful use stage 2 extension will happen, check its firmware.

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After the government shutdown drama, it's clear that snails, molasses and glaciers move faster than our elected officials. If you're a health IT leader with an outlook aligned with the fellows of the College of Healthcare Information Management Executives we interviewed last month, that's not good news.

CHIME members all called for a national patient identifier to solve the most basic of all patient data interoperability conundrums: tracking the same patient through multiple data systems. That means keeping that patient's data together as it moves through the network without commingling it with another, similarly named patient's record.

Right now, legislators can't pass a bill to save their lives. It's beltway business as usual.

Other CHIME leaders we interviewed went to D.C. to lobby Congress for a meaningful use stage 2 delay, too. Neither goal looks to have a promising outcome.

Former national health IT coordinator Farzad Mostashari, M.D., addressed both issues. Ultimately, he didn't, and his successor won't, have the power to make a decision on a national patient ID. In commenting on it, he could only handicap its prospects as a Vegas wiseguy would set odds for the woebegone New York Giants winning the Super Bowl.

Before he stepped down, Mostashari told SearchHealthIT that regardless of Congress in 1998 overturning the HIPAA provision mandating a patient identifier for Americans, healthcare providers need to try harder to solve the problem with data points they already have. If they could somehow prove to the Capitol's gatekeepers that they can't keep patients straight by cross-checking a patient's identity with address, Medicare ID numbers and even cellphone numbers, then, yes, maybe they could persuade legislators to change their minds -- but not until.

ONC isn't leaving healthcare providers on an island, completely, however. In the days leading up to National Health IT Week, the federal agency announced the Patient Matching Initiative, which aspires to reduce problems the lack of national patient identifier is causing. Sadly, like the two commercial efforts Healtheway and the CommonWell Health Alliance (the latter inspired by a Mostashari pep talk challenging EHR vendors to solve the identifier issue at a 2012 Bipartisan Policy Center meeting), the matching initiative is just a substitute for the real thing: a unique number for every patient, preferably with a two-digit checksum at the end, which industry sources tell us would do the trick.

Likewise, the meaningful use stage 2 extension CIOs want sounds like a great idea. What's not to like about taking a little more time to install two major EHR system upgrades, one to add ICD-10 support for 2014 deadlines and the other to meet meaningful use 2014 certification standards? We need to do something besides going "big-bang" with those IT initiatives all at once. Between those upgrades, new HIPAA security rules and data-gathering workflows for CMS's accountable care organizations and similar quality-based incentive programs from commercial payers, a measured approach would likely benefit patient safety in the long run.

Less than a week after he left office, Mostashari showed up in Scottsdale, Ariz., at the CHIME Fall Forum, his civvies looking much the same, down to the bowtie. His words, however, were no longer filtered by obligations to his office. Handicapping a meaningful use extension, he gave it no chance. No matter the merit of the idea, he told the CIOs in attendance, they're asking for a year's grace; such an extension would take up to a year to approve, throwing U.S. health IT into "total chaos" as uncertainty would reign during the rulemaking process to amend the schedule.

Nevertheless, CHIME and other healthcare associations convinced 17 senators to sign a letter to HHS Secretary Kathleen Sebelius asking for an extension. Anyone can write a letter -- or a blog post, for that matter -- asking for anything. Right now, though, legislators can't seem to pass a bill to save their lives, which reduces the extension letter to beltway business as usual.

Considering the D.C. shenanigans this month revolving around the shutdown, it's clear Congress can't agree to fund the government for more than a few months at a time without a Miley Cyrus-sized drama. Helping the healthcare CIO make patient care safer by making data more accurate, and buying them more time to implement such measures? Forget it. It's time to double-down on overtime budgets.

Let us know what you think about the story; email Don Fluckinger, news director or contact @DonFluckinger on Twitter.

This was first published in October 2013

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