The pandemic has exposed many weak links in health care, and identity is an important one. Healthcare providers are floating on oceans of sensitive patient data, which not only poses a glaring risk of fraud, but also injects massive inefficiency into an overburdened system.
Duplicate medical records issues, different records for the same person stored in disconnected systems – not to mention potential fraud, waste and abuse – motivate big players to take patient matching issues seriously .
“Universal identity is a huge topic,” said Victoria Dames, vice president of product management at Experian Health. “It runs through everything from providers, health plans, health information exchanges, etc. It exists everywhere today.”
Historically, medical practices have largely relied on Social Security numbers as a replacement 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 beneficiaries to a Medicare Beneficiary Identification (MBI) system to keep Social Security numbers off the card and out of harm’s way.
In 2022, many providers are moving to secure online portals, which are used to consolidate medical records from disparate sources and minimize cybersecurity risks related to health records.
“We had done a survey, and oddly enough…73% of patients said they wanted to use a portal to communicate, schedule appointments, and view care records,” Dames said. “As you can imagine, for the past few years we’ve been pulling out our device, using it, and expecting things to happen very quickly now. Why not health?
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The problem of duplicates
Universal identity, authentication, and patient matching are more pressing issues in 2022, as millions shift to digital modes of healthcare delivery.
“We want to make sure we have a good story and take it from one perspective,” Dames said. “All of these things impact patient and provider success in navigating the patient journey, whether it’s accessing care, receiving care, or delivering care to that patient,” and protecting their private information along the way.
Experian Health is tackling this problem with solutions like its Patient ID Matching service, which uses a “probabilistic matching algorithm” to avoid duplicate records and medical bills.
The need is urgent, Dames added. As the pandemic has driven digital adoption, everything from drugstore COVID-19 testing to temporary medical encampments in major cities is creating a new mountain of potentially exposed or incorrectly captured health data.
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The data also contains the remedy
Data is at every point in the continuum of patient identity, authentication and matching, and it is data that is used to solve the problem.
Dames said: “When we talk about patient matching and being able to provide identity resolution, Experian has wonderful benchmark data that we can use to help create that, to understand previous names, addresses and longitudinal recording of an individual.
This “longitudinal recording of an individual” allows health systems to “reconcile this data as it progresses,” Dames said.
“Some of us move or see different providers at different times in our lives, or specialists, etc.,” she added. “You might have a different address. You must be able to know that it is always the same person.
Patient identity authentication 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, everyone knew that was the direction we were going,” Dames said. “The demand has increased due to our situation as a nation. He has [been] a great catalyst for everyone. I don’t think there are any problems with wanting to adopt it.
“Everyone is pretty much on the same page that the time is right, and now is the time to get it right.”
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