JMIR Publications

ABSTRACT

Background:

The United States, unlike other developed countries, currently has no national unique patient identifier (UPI) to facilitate health information exchange. Because of security and privacy concerns, Congress in 1998 prevented the government from promulgating a UPI. The Health and Human Services (HHS) funding bill enacted in 2019 requires that HHS report to Congress their recommendations on patient identification. While there are anecdotes of incomplete healthcare data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a UPI might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of those potential improvements.

Objective:

The study sought to determine the frequency in which serious drug-drug interaction alerts (SDDIs) are found because a pharmacy benefits manager (PBM) uses a universal patient identifier (UPI); and estimate SDDIs undiscovered because PBMs don’t yet fully share patient records.

Methods:

We conducted a retrospective study of SDDI alerts provided from September 1, 2016, to August 31, 2019 to retail pharmacies by a national PBM that uses a UPI. We compared each alert to the contributing prescription and determined whether the UPI was necessary in order to identify the alert (“crossover alert”). We classified each alert’s disposition as override, abandonment or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing SDDI alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes.

Results:

Among a population of 49.7M patients, 242,646 SDDI alerts occurred in three years. 2,388 (0.98%) crossed insurance, and were discovered because the PBM used a UPI. We estimate that nearly 10% of serious drug/drug alerts in the U.S. go undetected by the PBM because of information un-exchanged or the PBM not using a UPI. These information gaps may contribute to up to 6000 patients in the U.S. annually receiving a contraindicated medication.

Conclusions:

Comprehensive patient identification across disparate data sources can help protect patients from SDDIs. To better safeguard patients, providers should a) adopt a comprehensive patient identification strategy and b) share patient prescription history to improve clinical decision support.