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A Unique Health Identifier alone won't prevent duplicate creation. Make sure your strategy includes a focus on data quality and data governance, too.

Australia has decided to implement a unique health identifier (UHI) to resolve the problem of patient identification. Recently, I wrote about some of Initiate’s experience with interoperability and how a UHI can fit in.  Today, I’ll delve into some of the challenges facing a UHI strategy.

A fundamental issue often ignored because it can be conveniently swept under the carpet is that a unique identifier alone will not prevent duplicates. For example, Nehta is proposing that if the individual cannot be properly identified, then a temporary number will be allocated. Based on our experience and typical healthcare registration practices, this will happen very often.

Every time a temporary number is allocated it will result in record duplication, repeat diagnostic testing and inability to provide a complete and accurate account of a patient’s history or care resulting in possible adverse event.

It will become very apparent quickly that it is not solving the problem of uniquely identifying an individual after all, and trust in the quality and reliability of the national UHI Service will be undermined.

For example, the Nehta strategy is to allow only a deterministic match (that is an exact match) of the search criteria entered at the point of registration. They claim due to patient’s privacy they have been forced down this road to prevent ‘white pages’ searching of an individual against a national database.

That means if I present to hospital the registration clerk must enter my entire name, date of birth, sex and potentially address. If it doesn’t match exactly with the version of truth on the national UHI system, or more than two records exist with those details, then they will create a temporary number.

They will only merge the identifiers if I later find the time or inclination to present to a Medicare office and verify who I am with proof of identity.

How they then notify the system who issued the temporary number, or downstream systems who have since consumed it is not clear. If you do not maintain a client index of which systems have consumed an identifier then you cannot notify of any changes to that identifier.

It’s even worse if someone has been inaccurately given the wrong UHI – how do you work out what systems are associating clinical data to this incorrect UHI if you keep no index or registry of source systems using that UHI?

Unless Australia is prepared to invest significant amounts of time and energy cleansing all of the source systems, updating the technology to accept a new identifier, and ensuring the capability to link the new UHI to the old record identifier, then the UHI alone will be useless for many, many years.

The point I am trying to make here is a UHI is just another identifier. It is another identifying attribute, and as such has all of the data quality problems found in the current healthcare identification processes. For a UHI to be successful, it must be implemented in tandem with proven EMPI capability.

If we started to treat the UHI strategy as more than just an identifier, I believe we will be able to tout real benefits from the massive investment Nehta is making.

Rather, we must see the UHI as an entire identification data service that addresses existing data quality in all of the sources of clinical information in existence today. The new UHI must be transitioned and adopted into the existing source systems and linked to existing client information. Improved search capabilities, data stewardship and data governance are also vital to success.

If we treat the National Identifier as the ‘the  sole solution’, we will be not heeding lessons learned from other countries who have already been down this path, and will be asking the Australian tax payer to fund an eHealth framework that will be inherently and significantly flawed.

Bottom line: what will be the impact on patient safety? And how can we leverage a UHI to improve patient safety rather than further complicating matters?