Last month, the Office of the National Coordinator for All Pages Health Information Technology (ONC) released its first Project US@ Technical Specification draft for public comment. The initiative aims to improve patient matching, while supporting interoperability, privacy and safety, by issuing a unified address standard throughout healthcare. The draft is the result of months of work by dedicated healthcare stakeholders, including Danny Cidon, vice president of research and emerging technologies in Co-Creation Lab, to establish a lasting, industry-wide standard for formatting patient addresses consistently across clinical and administrative systems.
Momentum around standardizing demographic addresses for patient matching has been building over the past two years, with research from Pew Charitable Trusts which found that formatting addresses using guidelines from the U.S. Postal Service could boost medical record matching by 3 percent. Last November, Senator Maggie Hassan petitioned ONC to develop policies for standardized address data given the importance of accurate patient demographics in this ongoing pandemic.
Why patient matching and identification must improve
Today’s successful health practices require the collection and exchange of accurate patient data. But the effects of the global pandemic have brought to light an issue that has long been on the global health agenda: patient misidentification.
Increases in patient volume have made it difficult for staff to collect accurate contact details from patients, and with low levels of interoperability across health entities, professionals risk more errors occurring at every point in the care continuum.
These types of mistakes can lead to a plethora of costly effects for patients across the care continuum: administrative waste, medical errors, duplicate procedures, billing issues, and adverse drug interactions.
How can address standardization help?
The global health agenda aims to ensure that all people obtain the health services they need. But in the age of digital transformation, delivering excellence in patient service doesn’t come easy.
Improved health care quality and safety demands, at the very least, better data quality on the physical location of both services and populations served. However, in the age where patient data is entering health systems in different formats, this knowledge does not always come in the most organized, digestible format. Outcomes like duplicate records, incomplete profiles, and incorrect diagnosis, become the very basis behind some of the more costly data-driven healthcare errors.
Conscious of the need for a unique patient identifier, experts are leaning on location data as the latest method to advance patient identification efforts. Organizations such as the ONC and HL7 have outlined the need for a universal standard for interoperability of health systems, but there are still many obstacles to overcome.
Project US@ was launched in December 2020 to help health officials and experts establish a universal criterion for patient address data, aims to make United States Postal Service (USPS) address-formatting tools available for use by health providers.
However, the 21st Century Cures Act outlines several limitations with using the USPS standard, stating: “While the US Postal Service Postal Addressing Standards include a single representation for certain data elements (such as rendering apartment as apt, building as bldg, floor as fl, etc), they also allow variations for other data elements, such as ‘acceptable’ and ‘preferred’ spellings and abbreviations for street and city names. This may result in multiple ‘valid’ addresses. … Because of the variation, the required use of reference files, and the manual reconciliation necessary for implementation, we have not adopted the US Postal Service Postal Addressing Standards as a required standard for the address Data Elements within the USCDI.”
The Postal Service’s database has generally been plagued by poor data quality due to inconsistent updates and misconducted street reviews. Addressing is complex and relying on incomplete or inaccurate location data is not enough to end the patient matching crisis. In times like these, trusting an address software specialist to reduce variation in data formatting and completion is the best path forward toward universal address standardization.
Addressing is complex
Across the 249 countries and territories, there are approximately 6,500 spoken languages, 139 character scripts, and more than 130 different address formats that are continuously changing.
Variations in address structure, complex address formatting/order and data decay (the percentage of people that move every year equates to 14 percent of the population or roughly 40 million), are a few of the obstacles hindering our effort to fully understand the complex nature of verifying addresses.
The extent of address utilization is critically dependent on the quality of the data. This implies the requirement for all data to be verified, enhanced, and standardized to a single standard but variations in the methods used to collect and store patient data in EHR systems makes it especially challenging. For example, some might record “Avenue” while others use “Ave.” While this distinction may seem like a harmless nuance, the damage can be detrimental when applied to patient care. Consider a street address, one of the most commonly used geographic identifiers for a patient. This address information can be used to communicate with past and current patients, validate patient identities for treatment, or can be converted into locations on a map through geocoding to direct patients to further care. If an address is recorded incorrectly during the point of capture or is not maintained consistently across the health organization, it limits the ability to share information between systems.
The ultimate goal: Interoperability
To date, interoperability has remained more of a distant promise than a reality. Limitations of USPS forced sharing of data filled with data gaps globally and internally mean that a golden record is far from reach without new innovation.
One innovation that is making headway is address intelligence technology. Address enhancement, standardization and normalization procedures are critical components of the address data validation process. Linking EHR systems or Enterprise Master Patient Indexes (EMPIs) to address verification APIs holds great promise for addressing some of the location-based obstacles standing in the way of developing a universal standard.
Rhapsody began utilizing this technology through its partner Loqate as a key component of our market-leading EMPI platform. Using address intelligence, we can ensure that the correct address is recorded at the point of entry, before entering the EMPI, and reliably formatted to a single standard to eliminate data quality issues. During the data enrichment part of the process, health professionals can gain another key variable for pinpointing location via geocoding: the geographical latitude and longitude coordinate of an address that is generated and appended automatically. These coordinates can also be used for reverse geocoding, allowing patients to identify neighboring providers in their community for in-network physician searches and referrals.
Address verification standardizes each captured address, detecting validity of the address while correcting spelling errors, adjusting abbreviations, and populating missing information (such as ZIP code). This ensures that each address is formatted appropriately so the location data is always accurate, standardized, and up to date.
The path forward
By validating and standardizing mailing addresses according to a global reference dataset that is curated from trusted data sources across the globe, health entities can deliver an even higher degree of patient data and matching accuracy to customers.
But first we must seek to improve the quality of our matching through the construction of a single best address format and best record.