NCPDP pursues a ‘universal patient identifier’

Pharmacy-level patient identification could have implications for pharma manufacturers


As of mid-year, the National Council for Prescription Drug Plans (NCPDP), a standards-setting organization for pharmacy-related practices, is halfway to its goal of attaching a unique code to nearly all US patient identities, the “universal patient identifier” (UPI). (As of June, it was around 150 million records.) the project has been years in the making; NCPDP announced a partnership with Experian, one of the leading data aggregators, in 2016, but the service is meant to be vendor-agnostic and as proof of that, LexisNexis Risk Solutions, a competitor, was also voted in by NCPDP members in late 2018 as an authorized provider as well.

According to NCPDP sources, pharmacies routinely have identifiers for their customers, but there are often duplicate records, or multiple records at different locations of the same chain, let alone being able to identify the same customer between two different chains. The same disconnect occurs between pharmacy clients and hospital clients, even where prescriptions are involved. The UPI will be able, in time, to accurately verify the identity of these clients (by name, social security number, address, and date of birth). Hospitals and other healthcare providers have the same problem across locations or between organizations. Besides the wasted labor to continually cross-check identity, the lack of consistency can result in medication errors, less patient followup and less of a chance to address medication non-adherence.

An NCPDP working group has developed a method to communicate a UPI by utilizing a spare field in the NCPDP Telecommunications Standard (which has been the standardized method for reporting and adjudicating prescriptions for years). Pharmacies and health systems can upload a set quantity of records which are run against either Experian’s Universal Identity Manager, or LexisNexis’ LexID, for cleansing and verification. The basic service is provided at no charge; both Experian and LexisNexis can provide more frequent uploads, or matching the record with other data managed by those organizations, with an upcharge.

Experian touts its UIM service as something that “goes beyond the limitations of conventional deterministic or probabilistic methods to achieve higher matching rates” between stored and uploaded patient information. At LexisNexis, Brian Eidex, director, pharmacy, says that his company’s extensive data collection relating to financial services enables client records to be developed more extensively for Medicaid patients, who tend to lack bank accounts (the so-called “unbanked”) and can be harder to identify accurately as a result. LexisNexis has also developed a comprehensive profile of some patients with extensive financial and social data; this in-depth profile could have value, for example, in identifying patients who might be non-adherent. All that being said, the UPI (as well as Experian’s UIM and LexisNexis’ LexID) are managed in a HIPAA-compliant manner; actual patient clinical data is not shared or transferred.

The subject of patient identification has been a longstanding issue in healthcare; last month, the House of Representatives approved an effort to end the ban on funding patient identification projects (something that has been in effect since the mid-1990s); a Senate appropriations bill, S.1895, also provides for federal funding (this bill is currently in committee). The NCPDP UPI is a step toward solving the identification problem, and ultimately is likely to become part of a future comprehensive standard. For pharma—which usually deals in de-identified patient data, there could be opportunities in clinical trial recruitment and execution, and in enabling better care coordination.