One Patient. One ID. Why It’s Time to Get Serious About a Single Patient Identifier

For decades, healthcare has struggled with a paradox: technology keeps advancing, yet interoperability keeps falling short. Patient records still don’t follow patients. Systems still don’t talk to each other. Lives are still put at risk because the basics—like knowing who the patient is—are still broken.

It’s not because we lack innovation. It’s because we lack unity.

While the latest buzz around TEFCA and QHINs coming out of HIMMS 25 is helping push the industry toward better data-sharing, the case for a Single Patient ID (SPI) has never been stronger.

Let’s talk about why.

First, a quick refresher on the problem

In most industries, your identity is stable, portable, and widely accepted. Take your pick: bank accounts, your airline rewards number, even your social media logins. They’re all unique, and interoperable.

But in healthcare?

• Hospitals still fax medical records.

• Staff manually reconcile duplicate patient charts.

• Patients are often asked to repeat their history during a visit.

We’re running a multi-trillion dollar healthcare system on mismatched data, redundant tests, and outdated infrastructure.

It’s not just inefficient, it’s dangerous.

Why TEFCA & QHINs Move Us Closer but Not All the Way

The introduction of TEFCA (Trusted Exchange Framework and Common Agreement) and QHINs (Qualified Health Information Networks) is a major leap forward. We’re finally seeing a formal framework that supports real-time, nationwide data exchange between EHR vendors, payers, and government systems, and signals of adoption are there from the big players.

Reciprocity is the game-changer. If Hospital A pulls patient data from Hospital B, then B must share back. That kind of bidirectional accountability helps solve one of interoperability’s biggest challenges to date: data hoarding.

Here’s the catch: QHINs still don’t solve the patient identity problem. They just improve how data moves, assuming you know whose data you’re looking for. Without a unique patient identifier, even the best interoperability networks are still vulnerable to:

• Misidentification errors

• Duplicate records

• Incomplete patient histories

The pipes are getting better, but the water is still mislabeled.

Why We Still Need a Single Patient ID

We’ve tried every workaround: EMPI systems, probabilistic matching, even biometrics. But at best, these solutions offer 90% accuracy, which sounds great until you consider that the other 10% represents real patients, real misdiagnoses, and real consequences.

A Single Patient ID, securely issued and universally recognized, would:

✅ Eliminate duplicate records and mismatched charts

✅ Enable seamless data exchange across systems

✅ Reduce medical errors and redundant testing

✅ Empower patients with greater control over their health data

It’s a simple idea. But as we’ve seen, simple doesn’t always mean easy.

The Soviet Pencil & The American Pen

You may have heard the story: NASA spent millions developing a pen that could write in zero gravity. The Soviets? They used a pencil.

Is it apocryphal? Maybe. But the lesson holds true: Sometimes the simpler solution is the smarter one.

Direct messaging in EHRs is a great example. It’s not flashy. It’s not a massive new infrastructure. But it works—and we’ve underutilized it for years while chasing bigger, more complex solutions.

A Single Patient ID is our version of the pencil: straightforward, effective, and within reach.

So Why Haven’t We Done It?

Because regulation has blocked it. Congress has included language in appropriations bills for over 20 years that prevents federal funding from being used to develop a national patient identifier, citing privacy and surveillance concerns.

Critics argue that a universal ID could be abused. But so could a paper chart left in a waiting room. And meanwhile, the status quo is actively harming patients.

Every other major industry has figured this out. Why not us?

Does TEFCA Kill the Case—or Embolden It?

Here’s the irony: TEFCA and QHINs don’t diminish the need for a Single Patient ID—they highlight it.

If we’re going to build a nationwide network for health information exchange, then we need a solid foundation.

That foundation starts with getting identity right.

It’s like upgrading the highway system without requiring drivers’ licenses. You can pave better roads, but the risk of confusion and collisions still remains.

What Happens Next? Two Paths Forward

We have two options:

1️⃣ Regulate It – Congress could finally lift the funding ban and authorize the creation of a national SPI, governed by privacy-first standards and modern cryptographic security.

2️⃣ Design It Ourselves – Industry players (EHR vendors, payers, health systems) could voluntarily agree to a shared patient ID standard, much like the way credit card networks were formed.

Either way, waiting is the worst option.

The cost of fragmentation is too high.

Final Thought: One Patient, One ID

This isn’t about choosing between TEFCA and a Single Patient ID. It’s about understanding that both are necessary.

QHINs improve the highways. A Single Patient ID ensures we know who’s driving.

It’s time we stopped accepting 90% as good enough.

One patient. One ID. One interoperable system. Let’s stop over-engineering the solution—and just solve it.