--- id: "coronavirus-smarter-crowdsourcing:recommendations/national-patient-identifiers" type: "GovLab policy recommendation" title: "National Patient Identifiers" url: "https://coronavirus.smartercrowdsourcing.org/recommendations/national-patient-identifiers" summary: "Governments should take steps toward developing a unique health identifier/national patient identifier system (UHI/NPI) that unambiguously identifies each individual and links her to her health records, including test results." source: "The GovLab (coronavirus.smartercrowdsourcing.org)" licence: "Creative Commons Attribution-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-sa/4.0/)" --- # National Patient Identifiers Governments should take steps toward developing a unique health identifier/national patient identifier system (UHI/NPI) that unambiguously identifies each individual and links her to her health records, including test results. - Part of: [Smarter Crowdsourcing in the Age of Coronavirus](https://coronavirus.smartercrowdsourcing.org/), [all recommendations](https://coronavirus.smartercrowdsourcing.org/recommendations) ## Strategy 1 Conduct feasibility studies. Governments should appoint a group of government and external experts to conduct a feasibility study of jurisdictional and private/public context and document legislative opportunities or barriers to moving forward with a UHI/NPI system. - Timeframe: 1-3 Months (immediate) - Audience: Private Sector, Academia, Government Workers - Type: Technology/Innovation, Partnerships - Strategy page: https://coronavirus.smartercrowdsourcing.org/strategies/conduct-feasibility-studies.-governments-should-ap ### Actions governments should take (strategy 1) 1. Identify key stakeholders from government institutions, insurance companies, hospital/healthcare systems, provider networks, academic community and the public 2. Establish study timeline as less than 3 months from first meeting 3. Commission this group to develop a comprehensive assessment in the allotted time frame ensuring that the assessment includes analyses of: current system, regional differences, key stakeholders, regulatory opportunities, and recommendations for a path forward ## Strategy 2 Standardize data entry fields across existing systems. Governments should work with partners to standardize data elements across health IT systems so that data is easily shareable between systems. - Timeframe: 1+ years (structural change) - Audience: Private Sector, Healthcare Providers, Nonprofits - Type: Policy/Legislative/Regulatory, Data, Partnerships - Strategy page: https://coronavirus.smartercrowdsourcing.org/strategies/standardize-data-entry-fields-across-existing-syst ### Actions governments should take (strategy 2) 1. Convene stakeholders who manage Electronic Health Record systems in the country and encourage a cost benefit analysis of current system(s) 2. Identify specific opportunities to make immediate improvements to interoperability (such as standardizing similar fields across systems) 3. Identify specific opportunities to make long-term improvements to interoperability (such as inter-system identifiers) ### Examples from around the world (strategy 2) 1. Brazil’s Unified Health System (SUS) uses a [National Healthcare Card](https://www.saude.gov.br/acoes-e-programas/cartao-nacional-de-saude), assigned to patients to keep track of medical records. The card, which has recently been digitized into an [electronic National Health identification card system](https://www.angloinfo.com/how-to/brazil/healthcare/health-system) with a personal identification number, allows healthcare providers to access a patient’s medical information anywhere in the country. This is possible due to a central database accessible from any public or private hospital within the Unified Health System network. ## Strategy 3 Develop,advocate for and pass legislation. Governments should mandate adoption of standards providing for a standard national health identifier for each individual,employer,health plan,and health care provider for use in the healthcare system. - Timeframe: 6-12 Months (long) - Audience: Private Sector, Academia, Healthcare Providers - Type: Policy/Legislative/Regulatory, Data, Partnerships - Strategy page: https://coronavirus.smartercrowdsourcing.org/strategies/develop,advocate-for-and-pass-legislation.-governm ### Actions governments should take (strategy 3) 1. Identify key legal and regulatory bottlenecks restricting adjustments to patient identifier systems 2. For regulatory barriers, consider updating regulations to better support interoperability, standardization, and the framework needed for a UHI/NPI system 3. For existing legislation, develop proposed replacement legislation and advocate for this legislation through the appropriate legislative processes and procedures ### Examples from around the world (strategy 3) 1. Estonia has one of the most [highly-developed national ID-card systems](https://e-estonia.com/solutions/e-identity/id-card/) in the world, Every citizen in Estonia has an online e-health record that can be tracked, and linked to a person’s electronic ID-card. The health records are secured with KSI Blockchain technology and are used to ensure data integrity. The information is only accessible to authorized health personnel. 99% of health data, prescription information and electronic billing in healthcare are digitized. The [Electronic Health Record](https://e-estonia.com/solutions/healthcare/) is a nationwide system that integrates data from diverse healthcare providers into a common record accessible to patients and doctors as a single electronic file. The system functions as a centralized, national database that retrieves data from various providers with different systems and presents the information into a standard format via the e-patient portal. ## Strategy 4 Adjust existing data collection processes. Governments should advance the use of regularly collected demographic data elements for patient matching and identification such as phone numbers,mailing addresses,or email addresses. This will ensure that public health authorities have up-to-date contact information when receiving reports from laboratories,hospitals,and other testing sites. - Timeframe: 6-12 Months (long) - Audience: Private Sector, Academia, Healthcare Providers, Government Workers - Type: Policy/Legislative/Regulatory, Data, Partnerships - Strategy page: https://coronavirus.smartercrowdsourcing.org/strategies/adjust-existing-data-collection-processes.-governm ### Actions governments should take (strategy 4) 1. Identify standardized demographic data fields in existing systems such as phone numbers, email addresses, home addresses, social security numbers or voting IDs 2. Develop guidance for laboratories, hospitals, and healthcare providers on how to more consistently capture these important fields 3. Rely on existing data structures where possible, such as those maintained by telecom providers, voting registries, or social security administrators ### Examples from around the world (strategy 4) 1. Estonia has one of the most [highly-developed national ID-card systems](https://e-estonia.com/solutions/e-identity/id-card/) in the world, Every citizen in Estonia has an online e-health record that can be tracked, and linked to a person’s electronic ID-card. The health records are secured with KSI Blockchain technology and are used to ensure data integrity. The information is only accessible to authorized health personnel. 99% of health data, prescription information and electronic billing in healthcare are digitized. The [Electronic Health Record](https://e-estonia.com/solutions/healthcare/) is a nationwide system that integrates data from diverse healthcare providers into a common record accessible to patients and doctors as a single electronic file. The system functions as a centralized, national database that retrieves data from various providers with different systems and presents the information into a standard format via the e-patient portal. ## Strategy 5 Establish a single organization to manage and oversee the UHI/NPI system. Governments should establish a single organization with the responsibility to oversee and advise on ways to improve patient matching and incorporate new technologies and approaches as they emerge. This organization would identify and encourage adoption of certain standards—such as on biometrics or use of smartphones—by health care organizations and technology developers. - Timeframe: 1+ years (structural change) - Audience: Government Workers - Type: Policy/Legislative/Regulatory, Data, Partnerships - Strategy page: https://coronavirus.smartercrowdsourcing.org/strategies/establish-a-single-organization-to-manage-and-over ### Actions governments should take (strategy 5) 1. Appoint a special advisor on health informatics to oversee the development of identifier projects for the interim until an organization is established and functioning 2. Identify the preferred organizational affiliation of this group and how it will fit into existing government agencies and structures 3. Coordinate with international partners to learn about best practices and key steps for development and implementation ## Strategy 6 Implement a UHI/NPI system. Governments should roll out a comprehensive and single UHI/NPI system that integrates,delivers,and manages health information technology systems across all health care institutions,including the ability for individuals to access and control their own health records. - Timeframe: 1+ years (structural change) - Audience: Private Sector, Academia, Civil Society, Healthcare Providers, Government Workers, Nonprofits - Type: Policy/Legislative/Regulatory, Partnerships - Strategy page: https://coronavirus.smartercrowdsourcing.org/strategies/implement-a-uhi/npi-system.-governments-should-rol ### Actions governments should take (strategy 6) 1. Actions listed above are all essential preconditions for this recommendation to be accomplished ### Examples from around the world (strategy 6) 1. Estonia has one of the most [highly-developed national ID-card systems](https://e-estonia.com/solutions/e-identity/id-card/) in the world, Every citizen in Estonia has an online e-health record that can be tracked, and linked to a person’s electronic ID-card. The health records are secured with KSI Blockchain technology and are used to ensure data integrity. The information is only accessible to authorized health personnel. 99% of health data, prescription information and electronic billing in healthcare are digitized. The [Electronic Health Record](https://e-estonia.com/solutions/healthcare/) is a nationwide system that integrates data from diverse healthcare providers into a common record accessible to patients and doctors as a single electronic file. The system functions as a centralized, national database that retrieves data from various providers with different systems and presents the information into a standard format via the e-patient portal.