全球智库信息集成服务系统

This report identified ten potential patient-empowered solutions to improve record matching, evaluated them using 11 criteria, and proposed a three-stage solution combining elements of several approaches.

• Implementing a voluntary universal identifier.
• Using a public key as an identifier.
• Expanding the use of existing government-issued identifiers.
• Adding knowledge-based identity information.
• Adding biometric data.
• Having patients verify identity information.
• Using consumer-directed exchange.
• Using health record banks.
• Having patients manually verify record matches.
• Having patients supply record location information.

These potential solutions varied greatly in the level of detail and experience being tested. Application of evaluation criteria found notable strengths and weaknesses with every solution and, on balance, a reasonable argument could be made to further develop most of them. Given high uncertainty as to the extent to which any specific solution can ultimately succeed, further investigation, development, and pilot testing of a range of solutions are warranted.

Despite widespread adoption of electronic health records and increasing exchange of health care data, the benefits of interoperability and health information technology have been hampered by the inability to reliably match patients and their records. The Pew Charitable Trusts contracted with the RAND Corporation to investigate "patient-empowered" approaches to record matching — solutions that have some additional, voluntary role for patients beyond simply supplying demographics to their health care providers — and to select a promising solution for further development and pilot testing. After extensive consultation with a variety of experts, researchers did not identify a "silver bullet" or achieve consensus on a single solution. Instead, this report recommends adopting a three-stage approach that aims to improve the quality of identity information, establish new smartphone app functionality to facilitate bidirectional exchange of identity information and health care data between patients and providers, and create advanced functionality to further improve value. The report also suggests that because the solution contains multiple components involving diverse stakeholders, a governance mechanism likely will be needed to provide leadership, track pilot tests, and evaluation, as well as to convene key stakeholders to build consensus where consensus is needed.

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Objective Analysis. Effective Solutions.