Matching Patient Records: The GAO Perspective

The long-awaited United States Government Accountability Office (GAO) report, Health Information Technology, Approaches and Challenges to Electronically Matching Patients’ Records across Providers, was released last week despite the government shutdown. The GAO interviewed 37 stakeholders including ONC, providers, AHRQ, and some organizations like Pew Charitable Trust and WEDI.

Honestly, I was disappointed in the lack of any new substance or advice. Perhaps the GAO’s mandate was very limited, as this stemmed from a 21st Century Cures Act provision.  The report referenced much of the work that has been trying to address the decades old patient record matching challenge. Below are a few of my observations.

Good citations and research.  I commend GAO for including numerous industry citations that substantiate the issue and lack of progress. Combined with the Pew Report, readers have one-stop shopping for sourcing issues, data points, and industry progress (or lack thereof). For example, a 2017 AHA survey found 74% of hospitals reported sharing clinical or summary of care records electronically, while in 2012 only 30% reported doing so. This growth certainly speaks volumes to the need for accurate electronic matching of records to facilitate care coordination. 

Varied opinions shouldn’t mean gridlock. It was interesting to note the conflicting opinions cited within the report about the role ONC should play in advancing activities such as data standardization and collaboration. I understand that differences of opinion are inevitable, but someone has to exert a leadership role lest we have this same conversation in 2029. 

No single effort will resolve the patient record matching challenge.  The report affirmed what many other groups and organizations have said — there is no silver bullet. It will take a multi-faceted approach to solve the patient record matching challenge. 

Quality is important.  All stakeholders interviewed by GAO shared the importance of quality data, which affirms what reports and whitepapers from ONC, Pew, RAND, HIMSS, and others have promoted. I fully agree. Let’s build quality demographic data at the start of the patient journey. Accurate, consistent, and complete information are essential to matching records across provider organizations. 

A new national healthcare identifier is not the answer.  The GAO paper noted that HHS shared that a new identifier would take decades to implement — and would not improve matching unless technical and non-technical challenges were solved first. Kudos to HHS for this synopsis.  Workflow, standards, privacy, consumer engagement, and a long list of considerations would have to be identified and addressed prior to a new identifier. I’ve worked with many countries that have national identifiers and can vouch for the complexity of deploying them and their limitations.

While the GAO report didn’t break any new ground, I remain optimistic about advancing patient matching. AHRQ began a study in 2017, which will run through 2022, to evaluate different approaches to record matching. This study appears to be more comprehensive and research oriented, thus we can hope that it will provide impetus for dramatic change. 

Regardless, many in the industry are ready to move beyond studies and reports and begin to act. As I discussed in my blog last week, the stakes are simply too high to continue to tread water. Let’s pick a solution component, such as referential matching or data standardization, and move!!