Government’s Project US@ working to standardize patient addresses across electronic health records

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Your mailing address could soon be used as a valuable tool to help health systems properly identify you and link disparate medical records held by different entities.

Since early 2021, the federal government has been working on Project US@ (pronounced “USA”), an initiative to establish a standard approach for representing patient addresses across all health IT systems. The effort, led by the Office of the National Coordinator for Health Information Technology (ONC), is believed to improve what is known as patient matching — the processes involved in correctly identifying patients and linking their medical records within and across systems.

Other groups partnering on this initiative include the American Health Information Management Association (AHIMA), the nonprofit industry standards development organizations X12 and HL7, the National Council for Prescription Drug Programs (NCPDP) and other members of the Health Standards Collaborative.

On January 7, 2022, the collective released Version 1.0 of the Project US@ Technical Specification for health IT developers. At the same time, ONC and AHIMA released the first version of the Project US@ AHIMA Companion Guide that offers health care industry-wide operational best practices related to accurate, timely capture and management of patient addresses. Health information professionals and others can also use it to enhance patient identification and matching.

“As mundane as [an] address may seem, it is often one of the key elements used for the purposes of patient matching and linking records, though other data like email and cell phone number are gaining in their use,” Steven Posnack, deputy national coordinator for health information technology at ONC, wrote in a December 2020 blog post announcing the project.

Currently, there is no standardized way to identify and link disparate patient records to provide a complete, longitudinal record-of-care. Authors of the technical specification noted: “Each patient interaction with a hospital, clinic, pharmacy, laboratory, commercial or government health insurer, and public health agency generates patient demographic data that is recorded, managed and exchanged differently. As a result, it is often challenging to accurately, consistently … and sufficiently capture, identify and automatically link a patient with their electronic health information for exchange.”

Research including a 2019 article in the Journal of the American Medical Informatics Association has demonstrated that address standardization can have a meaningful, positive impact on patient matching, especially at scale.

One of the key benefits of accurate patient matching is patient safety, Carmen Smiley, project co-lead, told AHCJ. Patients who fail to match or have their records commingled with others could, for example, be missing allergies from their records or have allergies listed that actually are for a different patient. A second benefit is interoperability, better enabling clinicians in different health systems to have the most complete and accurate information on each patient. Ideally, Smiley said, all patient addresses will be standardized to Project US@ so that patient-matching algorithms can recognize them in the same way.

Those involved in the project are also focusing on how to manage patients who are experiencing homelessness or in less stable housing, as well as those in extremely rural locations. The first version of the technical specification and companion guide begin to address those challenges, Smiley said, including metadata elements to support this information in exchange. For example, those patients could use a ZIP code in lieu of a full address or the address of a shelter or medical facility where they receive care.

With an eye on health equity, Project US@ underwent an assessment by experts with the Department of Health and Human Services’ Equity Technical Assistance Center, which provided suggestions, Smiley said. Project US@ is starting two targeted focus groups to expand its reach. One will address challenges among active military who move frequently and with veterans, many of whom receive medications by mail, Smiley said. The other focus groups will be held in partnership with the Indian Health Service, in part to explore how to accurately represent some American Indian and Alaska Native communities who live in extremely rural areas and may lack a mailable address.

“We’re working hard to find ways to support every patient’s address,” Smiley said.

The team is also building out a consumer engagement section in the companion guide to developing best practices and guidance for how to engage patients in their demographic data updates and maintenance to ensure the highest quality of data is available when it is needed most.

These and other additions will be in Version 2.0 of the technical specification and companion guide, expected to be released in 2023.

Journalists can follow the ongoing efforts at healthit.gov and AHIMA.org. The Project US@ website has helpful infographics that can be downloaded to explain the project to your audiences.

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