GAO Report on Patient Matching: Nothing New Under the Sun
On January 15, 2019 the US Government Accountability Office (GAO) released a new report to Congress, Health Information Technology: Approaches and Challenges to Electronically Matching Patients’ Records across Providers. This report is in response to mandate in the 21st Century Cures Act for the GAO to study patient matching. To develop this report, GAO reviewed available literature and interviewed more than thirty-five stakeholders (who are not identified) over the course of a year.
I have written several blogs and a feature article on patient matching developments in the US. Similarly, this new GAO report is an excellent retrospective on industry efforts over the past several years. It includes a clear statement of the problem, good discussion on both barriers and progress to date, insights from the stakeholders interviewed on their practical issues, and a review of various initiatives by the Office of the National Coordinator for Health Information Technology (ONC) over the past several years. The footnotes alone are worth the read as they contain excellent sources and side comments.
But there are some gaps. Missing is any real advice on how to move forward, where to place investments, and how the US healthcare industry should approach this problem. Also missing is any mention of the excellent work done within public health agencies and public health registry projects on this problem – those stakeholders appear to be missing from those interviewed. For example, the immunization information system (IIS) community has conducted at least two major efforts to study, understand and improve the patient matching capabilities and success of its registries. First, in 2006, the Connections Community of Practice convened a work group and developed the Unique Records Portfolio, an exhaustive practical guide to record matching and linking issues and strategies. In 2011, Centers for Disease Control and Prevention (CDC) convened a Patient De-duplication Expert Panel which met for several years and also developed detailed recommendations and best practice guidance published in 2013.
The instructions to GAO included the need to determine whether ONC could improve patient matching by taking specific steps (and some suggestions were offered in the Act), but I see no attempt by GAO to make such recommendations. Instead they rely fully on stakeholder observations which continue to evade consensus leaving us right back where we started.