Developing the COVID-19 vaccine was the first monumental milestone on a long and arduous journey to achieving the entire U.S. population’s vaccination.
One of the barriers to achieving this task is the absence of a reliable, scalable way to uniquely identify each individual before or after they receive the vaccine. Furthermore, in the absence of this unique identifier, it is extremely difficult to reliably use existing state or regional data repositories to identify and prioritize vaccination of individuals who share clinical and demographic characteristics that put them at high risk for COVID-19 morbidity or mortality.
As patients traverse the health care system, they frequently “touch” multiple organizations, and as a result, there is a significant overlap in the patient records across these entities. Our inability to accurately match patient records renders these data repositories ineffective in supporting an efficient and accurate vaccination strategy.
The Social Security number (SSN) was created in 1936 for the sole purpose of tracking the earnings histories of U.S. workers, for use in determining Social Security benefit entitlement and computing benefit levels. Almost 454 million unique social security numbers have been created since the program’s inception. As it was the only available, universal and unique identifier, the SSN quickly became broadly used for multiple purposes – many banking, financial and legal transactions rely heavily on the use of SSNs. For a time, health care organizations broadly relied on SSNs to uniquely identify patients. Unfortunately, as the crime of identity theft became more prevalent, use of the SSN for general purposes has been discouraged and the use of the SSN has been limited to interactions with governmental agencies and in major financial transactions. In this context, many health care organizations no longer collect social security numbers and if they do, they are not displayed or utilized in day-to-day clinical activities or interactions.
For over two decades, there has been a call for the creation of a National Patient Identifier (NPI). The House of Representatives and the Department of Health and Human Services (HHS) have extensively debated an NPI system. The initiative was never undertaken due to concerns regarding safety and privacy, as well as concerns about the costs associated with undertaking a project of this magnitude. In June 2019, the House voted to end the ban that bars HHS from funding NPIs, but this bill was never written into law. It would have provided the HHS the ability to evaluate a full range of patient-matching solutions and enable it to work with the private sector to identify a solution that is cost-effective, scalable, secure, and one that protects patient privacy.
In spite of this congressional resolution, the progress on the creation of NPIs has been slow. Even if material progress is made in the upcoming administration, this likely will be too slow to impact the urgent COVID-19 vaccination challenge we are facing. One can only hope that the COVID-19 pandemic and the challenges it has presented may provide the necessary energy of activation that will finally propel forward the long-overdue creation of a National Patient Identifier.
Betty Rabinowitz is chief medical officer, NextGen Healthcare. She can be reached on Twitter @DrBettyR.
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