4 Managing Patient and Provider Identification

Section4.12 Implement

Section 4 Implement—Managing Patient and Provider Identification - 1

Managing Patient and Provider Identification

Prepare to improve your client and provider identification processes to support health information exchange (HIE).

Time needed: 2 hours
Suggested other tools: NA

How to Use

1.Review the importance of accurate client and provider identification for HIE.

2.Determine whether your client and/or provider identification processes need “cleanup” or other improvements.

3.Review HIE standards in your state to determine whether there are specific requirements or recommendations for identifying clients and providers who can help you collect information to achieve the best possible client and provider matching in HIE.

Importance of Person Matching

A key factor in achieving success with HIE is to ensure you can accurately identify the individual about whom or with whom you want to exchange information.

Client identification is essential. If the information presented at the point of care is matched with the wrong client or sent to the wrong provider, it is unusable, dangerous for the client and a potential HIPAA violation. While each participant in HIE will have its own methodology for identifying clients, it is essential to make sure that the information you collect is accurate.
Ideally your data collection should include the data elements recommended by your local or state health information exchange organization (HIO). Visit your HIO’s website for additional information. For example, in Minnesota, the Minnesota Department of Health certifies HIOs and provides guidance on Standards Recommended to Achieve Interoperability in Minnesota, available at:
Providers, health plans, and medical devices must also be identified accurately. All of these have relatively new identifiers that have been standardized by the federal government (see list of resources below).

In the absence of a unique national identification number or some other unified way of identifying clients, master data management (MDM) and master person indexing (MPI) offer organizations a more consistent understanding of their clients’ identities across disparate systems and diffuse networks. MDM solutions utilize one of two approaches to link peoples’ identities:

Deterministic matching approaches attempt to line up different pieces of demographic information, such as last names, addresses, telephone numbers, and date of birth, etc., to look for exact matches.
Probabilistic matching considers a wider range of potential identifiers and computes weights for each identifier. It uses these weights to calculate the probability that two given records refer to the same person. Possible matches are then presented with the probability of matching accuracy at a specified threshold.

While HIE using Direct does not necessarily require a sophisticated MPI, as HIOs develop to more advanced services, an MPI will be necessary. Query-based exchange relies on an MPI to work in coordination with a record locator service to pull client records from various organizations and return the results to a provider querying the HIO. Without the MPI that can resolve identities across these organizations, the query functionality will not work.

For additional information on MDM within HIE Infrastructures, read this white paper commissioned by the Office of the National Coordinator for Health Information Technology (ONC) in 2012:

Managing Identification Data within Your Facility

To improve your ability to identify your clients, providers, health plans, and medical devices within the context of HIE, consider using the following checklist:

Make sure you have a master person index for your clients.

Identify the data you are collecting to identify your clients, and whether this data set is consistent with requirements for any HIO in which you plan to participate.

Determine the accuracy of the data in your MPI:

For any given person, is the identifying information accurate? Accuracy can be evaluated by having registration staff verify accuracy with each client contact.
Determine the extent to which errors exist in selecting persons from the index. This can be assessed by the number of errors in paper chart pulls, in lists of clients, and other uses of identification information.
Look for duplicates. Very often, a data entry error results in a duplicate record when a user looks for but does not find a person. This can happen if the person wasn’t clear in providing information, has changed their name or address, etc. Duplication of entries and resulting duplication of records is very common.

Develop standards for data collection:

On any form used to collect identifying information, be very explicit about what each data element means. For example:
Specify that the person’s name must be taken from his or her Medicare card or other government issued identification. During subsequent contacts, ask for the person’s name as recorded on that form of identification.
Ensure the order of names listed is accurate, especially when a first or last name contains two words. If there are compound names or foreign characters in names, be sure you capture the right punctuation and use the correct character set.
Specify which telephone number is provided, such as home land line, caregiver’s number, cell phone, etc. (Because telephone numbers can now be kept as people move, the telephone number can be an accurate piece of identifying information.)
As for month of birth, use name of month and for year of birth, use all four numbers. Month and day may vary with the person’s country of origin. As people are increasingly living past the age of 100, accurately recording the year is more important.
Use boxes on any paper or electronic form to ensure that all components of a name or other identifying data element are completely recorded.
Use look-up tables if available (e.g., zip codes should be able to generate the name of the city of residence). Use a type-ahead feature to generate a list of possible person names in your system to select the one that most closely matches the current person, and verify the accuracy. Use caller-ID to assist in selecting the person to the phone number, and verify accuracy.
Consider using photographs to validate with whom you are visiting. Although this is not going to help the MPI in a behavioral health facility, it can serve as a double check that you are visiting the right person. This is becoming increasingly common in EHR systems.
Consider what data are being collected and the likelihood of error. For example, Social Security number is now rarely used as an accurate identifier. Mother’s maiden name is also seldom used because it has become so commonplace that it is no longer a viable identifier to validate a person. If the population of persons your facility serves has several persons with the same or similar last names, it may be necessary to always obtain a middle name . While accuracy is more important than volume, the more accurate data elements you collect, the higher the probability of making a more accurate match.
Evaluate your training program. Everyone should be a steward of accurate data collection. If a record is pulled and it appears that it is a combination of different persons, be sure that it is brought to the attention someone who can rectify the discrepancy.
Billing staff should be trained in Red Flags that may signify potential identity theft.
For additional information, see: Client Identity Integrity: A White Paper by the HIMSS Client Identity Integrity Work Group, at:

Apply the principles described above to other identification systems:

Provider identification systems should include the providers’ National Provider Identifier (NPI). NPIs are applicable to both individual providers and entities. If any provider with whom you are exchanging health information does not have an NPI, direct them to the National Plan and Provider Enumeration System (NPPES):
Medical device identification systems should ensure accuracy for the exchange of information about devices, for both individual client care and U.S. food and Drug Administration (FDA). On September 20, 2013, the FDA announced a final rulefor the unique device identification system (UDI) that, once implemented, will provide a consistent way to identify medical devices. See:
Health plan identification systems should include the new Health Plan Identifier (HPID) and Other Entity Identifier (OEID), which have been required sinceMarch 29, 2013. Refer those without such an identifier to:

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