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Developing the COVID-19 vaccine was the first monumental milestone on a long and arduous journey to achieving vaccination of the entire U.S. population.  

One of the barriers to achieving this task is the absence of a reliable, scalable way to uniquely identify each individual before or after they receive the vaccine. Furthermore, in the absence of this unique identifier, it is extremely difficult to reliably use existing state or regional data repositories to identify and prioritize vaccination of individuals who share clinical and demographic characteristics which put them at high risk for COVID-19 morbidity or mortality.  

As patients traverse the healthcare system they frequently “touch” multiple organizations and as a result, there is a significant overlap in the patient records across these entities. Our inability to accurately match patient records renders these data repositories ineffective in supporting an efficient and accurate vaccination strategy. 

The Social Security number (SSN) was created in 1936 for the sole purpose of tracking the earnings histories of U.S. workers, for use in determining Social Security benefit entitlement and computing benefit levels. Almost 454 million unique social security numbers have been created since the program’s inception. As it was the only available, universal and unique identifier, the SSN quickly became broadly used for multiple purposes – many banking, financial and legal transactions rely heavily on the use of SSNs. For a time, healthcare organizations broadly relied on SSNs to uniquely identify patients. Unfortunately, as the crime of identity theft became more prevalent, use of the SSN for general purposes has been discouraged and the use of the SSN has been limited to interactions with governmental agencies and in major financial transactions. In this context, many healthcare organizations no longer collect social security numbers and if they do, they are not displayed or utilized in day-to-day clinical activities or interactions.

For over two decades, there has been a call for the creation of a National Patient Identifier (NPI). The House of Representatives and the Department of Health and Human Services (HHS) have debated an NPI system extensively. The initiative was never undertaken due to concerns regarding safety and privacy, as well as concerns about the costs associated with undertaking a project of this magnitude. In June 2019, the House voted to end the ban that bars HHS from funding NPIs, but this bill was never written into law.  It would have provided the HHS the ability to evaluate a full range of patient-matching solutions and enable it to work with the private sector to identify a solution that is cost-effective, scalable, secure and one that protects patient privacy.  

In spite of this congressional resolution, the progress on creation of NPIs has been slow.  Even if material progress is made in the upcoming administration, this likely will be too slow to impact the urgent COVID-19 vaccination challenge we are facing. One can only hope that the COVID-19 pandemic and the challenges it has presented may provide the necessary energy of activation that will finally propel forward the long overdue creation of a National Patient Identifier.  

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Dr. Betty Rabinowitz headshot

Dr. Betty Rabinowitz, MD FACP

Chief Medical Officer

Dr. Betty Rabinowitz was appointed as our chief medical officer on April 19, 2018. She brings to this position more than 25 years of extensive clinical experience and expansive knowledge of population health and value-based practice transformation. In her role, Betty is tasked with helping NextGen Healthcare promote and improve our solutions in support of our clients’ provider performance, clinical outcomes, patient satisfaction, and financial efficiency.

Betty joined the NextGen Healthcare family in August 2017 as one of the founders and the former chief executive officer of EagleDream Health, the cloud-based analytics and population health management solutions we now know as NextGen® Population Health, which drives meaningful insights across clinical, financial, and administrative data to optimize ambulatory practice performance.

Born in Johannesburg, South Africa, Dr. Rabinowitz graduated from Ben-Gurion University Medical School in Israel, where she also completed a residency in Internal Medicine. She came to the United States in 1990 for a fellowship in Medicine and Psychiatry at the University of Rochester School of Medicine, where she became a professor of clinical medicine. In addition, Dr. Rabinowitz served as the medical director of the University of Rochester’s Center for Primary Care, overseeing clinical operations and population health management for the university’s large employed primary care network. In 2020, she was named on the list of the Top 25 Woman in Healthcare Software by the Healthcare Technology Report.