Legislation on key COVID-19 challenge includes policies referenced in paper

The nation’s pandemic response has been undermined by roadblocks in the digital systems meant to move patient records between hospitals, doctor’s offices, laboratories, and public health agencies. New policies can help address the gaps.

By Ben Moscovitch, Shaun Grannis, and John D. Halamka

The nation’s pandemic response has been undermined by roadblocks in the digital systems meant to move patient records between hospitals, doctor’s offices, laboratories, and public health agencies. These technical obstacles are complex and long-standing, but federal leaders have near-term options to ease them, as explained in the June article, “Better patient identification could help fight the coronavirus.” To date, gaps in demographic data such as phone numbers and addresses have hampered contact tracing efforts and could undermine vaccine distribution in the future.

In a promising step, federal legislation introduced in August would seize opportunities necessary to improve the accuracy of patient data central to effective COVID-19 contact tracing and vaccination programs. The Patient Matching Improvement Act, sponsored by Senators Maggie Hassan (D-NH) and Bill Cassidy (R-LA), takes aim at a major challenge for electronic health record systems (EHRs): The ability to correctly identify data about the same person and exchange it.

The bill’s introduction followed a June Senate committee hearing, during which Sen. Hassan heard testimony from Dr. Joseph Kvedar, editor of Nature Digital Medicine, and questioned him about patient matching solutions. The senator subsequently sent a letter to the Department of Health and Human Services and the U.S. Postal Service (USPS), requesting the adoption of the USPS address standardization to improve matching—an immediate step that would improve the nation’s response to COVID—as explained in the earlier article.

Up to half the time, public health authorities may not receive phone numbers, addresses, and other data they need to conduct contact tracing during a pandemic or to merge records for the same person to ensure they have accurate case counts. Variations and errors in mailing addresses often prevent record systems from accurately identifying patients. Research by two of our article’s coauthors found that EHRs across the nation would correctly link tens of thousands of additional records a day if they consistently formatted patient addresses according to Postal Service specifications.

Fortunately, USPS maintains a web-based tool that formats addresses according to its standards; retailers and other businesses can use the service for free. However, the Postal Service’s terms of use deny access to health care organizations.

The Hassan-Cassidy bill would require USPS to make the tool accessible at no cost to health care organizations, defined to include state and local health departments and registries that collect vaccination records and other health data. The proposal allows unlimited use of the tool by these organizations and lets them request address standardization for records individually or in large batches. The latter requirement is crucial to efficiently format data in the billions of records already held in EHRs.

The bill also instructs federal agencies to adopt the USPS address specifications in key regulations. The Department of Health and Human Services would make the format a requirement in its guidance for labs reporting COVID-19 test results. The Office of the National Coordinator for Health Information Technology would update its federal certification criteria for EHRs, ensuring that these products store and exchange patient addresses in the USPS standardized format. The Electronic Health Record Association, major developers of EHR products, and the Healthcare Leadership Council, a coalition of health systems and technology developers, have all expressed support for this change, provided they have access to the USPS formatting tool.

More consistent address formatting won’t solve the patient-matching challenge, but it would strengthen the health data infrastructure needed to beat the current pandemic and those in the future. Whether by legislation or other means, the Postal Service and its standards should not be left on the shelf amid this global emergency.


Ben Moscovitch

The Pew Charitable Trusts, Washington, DC, USA


John D. Halamka

Mayo Clinic Platform, Rochester, MN, USA


Shaun Grannis

Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA