Australia’s Unique Health Identifier: Is it the Answer?
Print This Post
Share this Post
Australia should heed lessons from others on the unique health identifier path.
I think it’s reasonable to say that almost all countries moving forward with electronic health records agree that the ability to uniquely identify a patient and provider is a fundamental and primary issue which must be addressed. Many countries, including Australia, have decided to implement a Unique Health Identifier (UHI) to resolve this issue.
Based upon Initiate’s broad experience, here’s how we think Nehta’s UHI Service supported by Medicare Australia can be successful in effectively supporting real interoperability of electronic health information.
A unique national identifier for healthcare clients and providers is only part of the solution of uniquely identifying an individual, certainly not the silver bullet as it is often portrayed by many countries leading the way with this strategy.
You see, we are not fortunate enough to be dealing with a ‘Greenfield’ implementation here in Australia. We have come from a cottage industry where patient identification is handled ‘uniquely’ within local systems. A patient is given a unique identifier by these systems and this identifier is unique only to that system or integrated downstream systems.
Due to inferior search and linkage capability many of these systems are littered with duplicate patient records and poor data quality.
This is the exact problem a UHI is supposed to resolve. In a ‘Greenfield’ situation it may well, however such situations are extremely rare if not completely nonexistent. In the real world we cannot ignore the issue of existing inadequate registration and search processes within the point of care systems, the unresolved duplication and poor data quality.
If this is not addressed we will be exacerbating the issue at the national level and the very things a UHI is meant to prevent (i.e. duplication of patient records, incomplete clinical history, unnecessary duplicate diagnostic testing, etc) will only increase in magnitude and complexity.
To add to this, an approach based solely on UHI could cause significant patient safety issues. Initiate generally see rates of 2 to 5% - and more - of patient duplicates in systems with robust unique identifiers but with no probabilistic matching capabilities that also considers all available demographic information.
From a patient safety perspective this is very significant as it could mean in a population the size of Australia (20+million) that around 1 in 30 patients presenting to a clinical service could lack a complete picture of their relevant clinical history. This represents significant risk to patient safety.
What is missing is the concept of an identification data service for patients and providers of healthcare. That is, a ‘service’ to address the issue of uniquely identifying someone, whether they have a unique identifier or not.
The benefits of a unique identifier as touted in Australia simply cannot be realized for many, many years after it is implemented. They may only be realized if implemented with a complete identification data service. Required for interoperability under an EHR vision, this should consist of:
- Best of breed search capability with the capacity to extend its matching capability
- Data model
- Data stewardship and data governance functions
- Communication to support cross-application
However, there are several other factors to consider. In my next post, I will delve into some of the issues currently being overlooked, including examples of how existing UHI strategy falls short.
Leave a Response
Entries(RSS)