Would National Patient Identifiers Work?

Right now,  healthcare organizations have to go through some pretty tricky maneuvers to link patient data across varied systems and settings.  It’s possible to connect patient info electronically through database hacks, but more often than not, matching patients to clinical data gets done by hand.

Given the insane complexity of the existing system, would it make sense to create a national patient identification number for every U.S. patient?  The question is worth revisiting, given the immense level of error and wasted time generated by the existing system. After all, not only would putting an NPI in place make it easier to track patients within a hospital or health system, it would simplify the rollout of HIEs dramatically, wouldn’t it?

Dr. Robert Rowley of EMR vendor Practice Fusion notes that the biggest enemies of establishing a National Patient Identifier are privacy advocates who feel that an NPI would expose patients to greater risk of breaches or misuse of data.

But is that a realistic concern? Probably not. I agree with Dr. Rowley, who asserts that it’s hard to imagine that PHI would be at greater risk simply because of how it’s indexed.  As he notes, PHI breaches are nearly always often haphazard affairs in which a laptop is stolen than Big Government or corporate conspiracies. (If you’re afraid the government is covertly siphoning your health data off to study it, not having an NPI won’t protect you, anyway.)

No, the real barrier to this kind of administrative simplification measure is time, money and resources, the same barriers that hold back any other proposed HIT project.  It’s hard to imagine the resources that would be involved in instituting such a system — the idea makes my head hurt — and I have to assume it’d be several years before it was anything like mature.

Still, it’s good to bear in mind that at least some members of the public are afraid that creating an NPI would compromise their privacy. If the only barrier to improving patient matching in our EMRs is technical, that’s one thing — but if it’s patient fears, that’s another thing entirely. Sometimes, it’s good to remember that most of the world doesn’t think like a health IT exec.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Even if it were a good idea, I don’t think the majority of Americans would cooperate. Nor should they.

  • In the Netherlands we use a ‘civilian service number’, similar to the US social security number, that can identify every person in the NL, we get that number when we’re born and health organisations are required to check if they’ve got the right data of that person and the right person in front of them if they get treatment with this number (BSN in Dutch). Maybe you should check how we deal with the privacy issue in the NL? This number can then be used to transfer data and make sure you have the right person when you transfer data.

  • Petra,
    Thanks for the feedback. I’ve had a number of people comment about this idea on Twitter worried about security issues with this idea. Has the Netherlands had any privacy and security issues with their identifier?

  • There probably was a discussion but it was a couple of years ago. The number is used in communication between civilians and the government and health care organisations. The Dutch wikipedia-article explains this: http://nl.m.wikipedia.org/wiki/Burgerservicenummer

    Who can ask your BSN is strictly controlled to avoid abuse.

    The advantage in the NL is that we have a system where every citizen has to be registered at birth. This data is also used for electronic censuses because a census like in the UK and US is not really needed do to this system. So we’re less wary of government and accepted the system pretty easily. For example we’re obliged to carry ID from the age of 12. This had some more discussion about privacy but is mainly used to enforce law about buying cigarettes and alcohol and to identify yourself when you’re caught commiting some crime. I know that in the UK there is a big discussion about this.

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