Wednesday, December 31, 2014

[UPDATED] Unique Patient Identifiers and Congressional Appropriations

Unfortunately, I have discovered that the prohibition is still in effect. 


The language is slightly different than I am used to searching for but is included in the legislation HERE and copied below:
Sec. 510. None of the funds made available in this Act may be used to promulgate or adopt any final standard under section 1173(b) of the Social Security Act providing for, or providing for the assignment of, a unique health identifier for an individual (except in an individual's capacity as an employer or a health care provider), until legislation is enacted specifically approving the standard.
In March 2013 I submitted a petition to the White House suggesting that the President should ask Congress to no longer prohibit HHS from establishing standards for a unique patient identifier. Sadly, it did not get the required number of signatories (and could have been just ignored in any event) and is now removed from the WhiteHouse site, but the issue now suddenly seems to have been resolved, at least for the time being. 


In 1993 under President Clinton's health plan, the government would have issued "health security cards" to all Americans certifying their right to medical care, and the plans for a unique patient identifier were put in place. While the health reform did not make it into law at that time in 1996 Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) [Public Law 104-191].  HIPAA included administrative simplification provisions that required HHS to “adopt national standards for electronic health care transactions” and “a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the health care system” [PL 104-191]. HHS has since adopted unique identifiers for employers, health care providers, and is now in the process of adopting a unique health plan identifier, but has not adopted a standard unique identifier for individuals. 

On October 21, 1998, the 105th Congress passed Public Law 105-277 (an omnibus appropriations act for fiscal year 1999) that prohibited HHS from spending any funds to “promulgate or adopt any final standard…providing for, or providing for the assignment of, a unique health identifier for an individual…until legislation is enacted specifically approving the standard [Title V, Section 516 of PL 105-277].” 

For the past 15 years, despite calls from experts at RAND Corporation and the Healthcare Information and Management Systems Society (HIMSS), identifying the potential administrative cost savings and safety benefits associated with a unique patient identifier, Congress has maintained this prohibition. It appears there is no such prohibition in the Continuing Resolution Omnibus Appropriations Bill recently signed into law. (hat tip to Carl Bergman at EHRSelector)

While a unique patient identifier is no silver bullet it seems prudent for Congress to permit HHS to pursue its implementation, especially if such an identifier could increase administrative efficiencies and prevent medical errors due to incorrectly linked medical records.