By Edward Yang

A new study published in the Journal of Medical Internet Research (JMIR) finds unique patient identifiers help to reduce adverse drug interactions.

Analyzing data of roughly 50 million patients and 1.5 billion claims over a three-year period, researchers at Express Scripts and the Regenstrief Institute found that 10 percent of serious drug-to-drug events in the U.S. go undetected by pharmacy benefit managers (PBMs) that do not use a unique patient identifier. This means that up to 6,000 Americans annually are receiving contraindicated medication, the study determined.

“When patients transition to a new insurer or pharmacy benefit manager, their identity and historical prescription data do not seamlessly follow. Subsequently, pharmacy benefit managers may lack both identifying information and historical data,” wrote the study authors.

In the absence of a government-issued national patient identifier, researchers recommend that PBMs and providers adopt a comprehensive patient identification strategy and facilitate routine sharing of a patient’s prescription history to diminish the number of harmful drug-to-drug interactions.

Why medication safety matters

Adverse drug events cause approximately 1.3 million emergency department visits in the U.S. each year. Adverse drug interactions also impose a considerable financial burden, contributing to $3.5 billion in excess U.S. healthcare costs annually.

While some drugs combinations can make a medication less effective, others can have life threatening consequences. According to the Food and Drug Association (FDA), an estimated 106,000 deaths occur every year due to adverse drug reactions.

Without a comprehensive patient identity management strategy, researchers of the JMIA study state that the prospective drug utilization review (DUR) process—by which pharmacy benefit managers and dispensing pharmacists examine an individual’s list of medications—is prone to miss serious drug interactions. To minimize the risk of an adverse drug event, researchers stress that pharmacy benefit managers must have access to comprehensive medication history data.

EMPI technology for medication reconciliation

Patient matching and interoperability are critical aspects for safely prescribing and dispensing prescription drugs. However, the ability to link and share medication history across pharmacies and healthcare providers remains an ongoing challenge.

To identify patients at-risk for drug interactions and facilitate opportunities for medication reconciliation, an entire patient’s care history, including prescription data, must be exceedingly reliable and complete.

Fortunately, there is a technical solution to the problem. An enterprise master patient index (EMPI) compares and links records from any given system and creates a unique enterprise identifier. The unique identifier generated by the EMPI ensures that each and every patient in the network has one and only one record. This helps a health system determine, for example, if “Jonathan McDonald” in one EHR is indeed the same patient as “John MacDonald” in another.

As an essential tool for promoting information exchange and coordination of care across systems and locations, an EMPI can validate an individual’s entire medical history including previous and current medications, as well as immunizations, lab work, x-rays, and the names of primary care doctors and specialists seen over time.

Many state and regional HIEs, including the Nebraska Health Information Initiative (NEHII) and healtheConnect Alaska, utilize NextGate’s EMPI to connect to their state’s prescription drug monitoring program (PDMP) to give their members access to an accurate, comprehensive picture of a patient’s controlled prescription drug history. While PDMPs serve to track controlled substances, many PDMPs face the same patient matching and interoperability challenges when it comes to accessing an individual’s medication history.

Timely access to accurate, comprehensive patient data is essential for PBMs, payers, pharmacies, and care providers to make informed decisions and improve patient safety. Use of tools that provide high-quality information at the point of treatment is imperative for managing, prescribing and dispensing medications. As longitudinal medical records and robust interoperability become imperative for population health management and value-based care, the need for enterprise identity management technologies will become progressively in-demand.

As providers and PBMs continue to invest in data-driven tools, the hope is they’ll utilize EMPIs to help them aggregate fragmented patient information, improve record matching, and provide a fully updated and accurate view of the patient journey.

To learn more about how NextGate’s EMPI can help you gain access to the most accurate, up-to-date patient data, click here.

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Edward Yang is COO of NextGatethe global leader in healthcare enterprise identification. You can reach him at