Sragow Howard Michael, Bidell Eileen, Mager Douglas, Grannis Shaun
Express Scripts Inc, Franklin Lakes, NJ, United States.
Express Scripts Inc, St. Louis, MO, United States.
JMIR Med Inform. 2020 Nov 20;8(11):e23353. doi: 10.2196/23353.
The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements.
We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records.
We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the 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 serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes.
Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication.
Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support.
与其他高收入国家不同，美国目前没有全国统一的患者唯一标识符来促进健康信息交换。出于安全和隐私方面的考虑，国会在1998年禁止政府颁布患者唯一标识符。2019年颁布的卫生与公众服务部资助法案要求卫生与公众服务部向国会报告其关于患者身份识别的建议。虽然有因患者身份误认导致医疗保健数据不完整的轶事，但迄今为止，尚未有足够的大规模分析来衡量患者唯一标识符可能为患者护理带来的改善。这种缺乏衡量的情况使得政策制定者难以在安全和隐私问题与潜在改善的价值之间取得平衡。
我们试图确定由于药房福利管理人员使用通用患者标识符而发现的严重药物相互作用警报的频率，并估计由于药房福利管理人员尚未充分共享患者记录而未发现的严重药物相互作用。
我们对一家使用唯一患者标识符的全国性药房福利管理人员在2016年9月1日至2019年8月31日期间提供给零售药房的严重药物相互作用警报进行了回顾性研究。我们将每个警报与相关处方进行比较，并确定是否需要唯一患者标识符来识别交叉警报。我们将每个警报的处理方式分类为覆盖、放弃或替换。利用交叉警报率和样本量，我们推断出美国严重药物相互作用警报遗漏率。我们进行了逻辑回归分析，以确定与交叉和警报结果相关的因素。
在4970万患者中，3年内共发生了242,646次严重药物相互作用警报。其中，2388次（1.0%）跨越保险并被发现，原因是药房福利管理人员使用了唯一患者标识符。我们估计，由于信息未交换或药房福利管理人员未使用唯一患者标识符，美国高达10%的严重药物相互作用警报未被药房福利管理人员发现。这些信息差距每年可能导致美国多达6000名患者接受禁忌药物治疗。
跨不同数据源的全面患者身份识别有助于保护患者免受严重药物相互作用的影响。为了更好地保护患者，医疗服务提供者应（1）采用全面的患者身份识别策略，（2）共享患者处方历史以改善临床决策支持。
