How Project US@ Fits into the U.S.’s Developing Health IT Infrastructure

Project USA logo

Developers and stakeholders continue to build-out the United States’ healthcare IT infrastructure. As they do, all are aware that best practices and standards for data collection—which includes how data is collected, stored, used, and accessed by patients and providers—requires consistent implementation across the entire healthcare system.

A critical component of the health IT infrastructure is patient matching, or more specifically, the methods and standards used to represent patient addresses. Standardizing exactly how a healthcare provider should record a patient’s name, street address, and zip code may seem mundane on the surface. But this information is critical for precisely linking records to the correct patients and subsequently managing their health records safely and securely.

Put another way, we know the rapid adoption of electronic health records (EHRs) is a key innovation allowing patients and clinicians the ability to access complete and up-to-date medical information. But the potential for EHRs to better coordinate care no matter where a patient moves can become compromised if records don’t link to patients consistently and accurately across the many hospitals and offices where a person seeks care.

In prior years, the approach to representing patient addresses was largely left to the implementer, with no specific guidelines or constraints. Many providers used third party tools, resources, and ultimately various methods for normalizing address representations. The United States Postal Service is one such resource, but it was not uniformly used across the healthcare system and there were glaring limitations as detailed in the ONC’s 21ST Century Cures Act Final Rule:

“While the U.S. Postal Service Postal Addressing Standards include a single representation for certain data elements (such as rendering apartment as apt, building as bldg, floor as fl, etc.) they also allow variations for other data elements, such as “acceptable” and “preferred” spellings and abbreviations for street and city names. This may result in multiple “valid” addresses. To reconcile this variation, the U.S. Postal Service provides a file listing preferred city and State combinations as well as a file of street name and zip code combinations and the resulting aggregated address would then require manual reconciliation.”

‘Multiple valid addresses’ and ‘manual reconciliation’ across the U.S. healthcare system is clearly not ideal for ensuring accuracy in patient matching. There was also no standard for updating patient information if someone moves. Taken together, research has shown that match rates between healthcare organizations can be as low as 50%, even when they share the same EHR system.

A standard approach for representing patient addresses across all health IT systems was needed to improve patient matching using accurate address information. Enter Project US@, the “Unified Specification for Address in Health Care.”

In December 2020, ONC announced a collaboration with Health Level 7, the National Council for Prescription Drug Programs, X12, and members of the Health Standards Collaborative to develop a unified specification for representing patient address in health care. The goal was to create the standard in one year, and Project US@ released the Final Version 1.0 of the Project US@ Technical Specification on January 7, 2022.

Software developers who design and maintain health IT systems—in addition to staff and medical providers who record patient addresses—now have guidance for how to enter, verify, and store patient address information. This standardization is a critical step for ensuring patients are always matched with their correct health record, no matter where they are seeking care. It also means having standardized patient matching across all points of receiving care, from telehealth to online scheduling to point-of-care office visits.

Project US@ and the value of accurate patient matching also extends beyond visits with providers. Standardized patient addresses can also ensure correct delivery of prescriptions, medical supplies and insurance claims, while preventing wrong prescriptions, incomplete lab records, and unauthorized access to information. It also ensures that providers’ computer systems can easily manage health records safely and securely.

Bottom line: Project US@ represents an “industry-wide approach to representing patient addresses that is consistent across a spectrum of clinical and administrative transactions,” which ultimately makes it beneficial to developers and stakeholders in the nation’s health IT infrastructure.

This article is authored by
Quandary Peak Research

Based in Los Angeles, Quandary Peak Research provides software litigation consulting and expert witness services. We rapidly analyze large code bases, design documents, performance and usage statistics, and other data to answer technical questions about the structure and behavior of software systems.