Amazing how a trivial detail such as a postal address can cause so many headaches and so much waste. But in health care, a lack of address standardization is a major barrier to important aspects of care, including the sharing of patient records demanded by our trend to value-based care.
Part of the problem is provider laziness, because the US postal service offers a standard addressing process called CASS, and several services draw on it to ensure the correct use of abbreviations, ZIP codes, and other elements of the address. But many providers just enter into the databases and EHRs whatever the patient put down on a form during intake.
But each system also has its own fields for storing address information, and communication among them is complicated.
Now there’s a standard called Project USA, initiated and promoted by the Office of the National Coordinator (ONC) at HHS. I talked recenly with Brent Francom, senior product manager at Smarty, about efforts to get the health care field to adopt the standard and tools for making it work smoothly.
Smarty creates tools for address standardization used by many industries, such as real estate and retail. The Project USA standard was finalized in January 2022, and during the past year Smarty has been marketing its API-based service to health care.
They work mostly with vendors of EHRs and other tools used in health care, such as billing and intake systems. Smarty can integrate with these systems, which would make the Project USA standard available on a convenient basis to all users of those systems.
Users can submit addresses in batches to an API, or type in an address and take advantage of Smarty’s autocompletion. (Smarty is location-aware.) Smarty will verify that the address exists, put it into the standard CASS format, and store it in the clinical system.
Francom says that so far, unfortunately, there is little incentive for clinicians or vendors to adopt Project USA. HHS has not required its use, although they did make it a requirement for clinicians who want to join the Qualified Health Information Networks (QHIN) program. Payers, who would benefit from address standardization, have not required Project USA either.
But everybody has incentives to get this right. Let’s publicize the Project USA standard. It will eliminate waste by eliminating duplicates and confusion. It can improve patient engagement because everyone will know how to reach the patient. Mail order medications will clearly benefit. And patient records will be more interoperable, with benefits ranging from value-based programs to public health.
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