If there’s anything I like, it’s pushing the envelope a little. Not too much, mind you. Just the right amount. I think I did a good job with the title of this blog post. It’s a bit provocative, but I suspect I won’t get too much hate mail. It’s an odd question, really. Should your doctor care about your address? From a medical perspective, does it matter where you live?
I suppose I could end this post quickly: Yes, doctors should care about your address. Done. And cue curtain. But alas, what fun is that? In reality, the better question is, “Why should doctors care about your address?” I think there are two answers to this question, one much more obvious than the other.
Let’s start with the more obvious answer. Doctors must care about your address because where you live matters to your health. In the not-too-distant past, most physicians didn’t spend much mental energy or time on where you lived. Why should they? Heck, until very recently, you always saw your doctor at the office or in the hospital. Those were the only places where clinical care occurred. Your domicile wasn’t at top-of-mind for discussions of your hypertension or migraines. But those days are far behind us, thankfully.
We now have evidence to support what we always knew deep down inside: what we clinicians can do to help heal our patients is dwarfed by the circumstances that our patients find themselves in. Your environment, your finances, your job: these all dictate so much of your health that we ignore them at our peril. We call these things social determinants of health. While there is no agreed-upon definition, the federal government states that “social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
Your address matters to physicians because your social determinants of health impact how much help we can offer. If you can’t afford your cholesterol medication, we shouldn’t be shocked when your coronary artery disease progresses unabated. If your opportunities for gainful employment are limited because you don’t have a car and the public transportation system is shoddy, all the therapy sessions to help you deal with your anxiety may only make a dent because at the end of the day, you still are reasonably worried about where your next meal may come from.
While we clinicians may not be able to directly affect a patient’s SDOH, our awareness of those conditions is essential. Your address doesn’t tell us what we need to know in and of itself, but it’s an excellent marker and should prompt us to ask the important questions and make the necessary referrals so that we do whatever we can to help.
There’s a less obvious – at least to me – answer to why a patient’s address is important. Your address is important because in this modern era of electronic health records (EHRs), we often struggle to find all your disparate medical information if we can’t match it up to its owner: you! And while your name, date of birth, and maybe even your social security number are great identifiers, your address is an essential data point. Guess what: if your doctor’s EHR lists your address as 1234 Fourth St and your hospital has your address as 1234 4th Street, the computers may have a difficult time linking those two accounts. In other words, minor differences that humans have no problems interpreting can be big problems for our silicon-based friends.
What happens if our patient matching software can’t match patients? If a patient gets a colonoscopy done at Hospital A and then sees a primary care doctor at Clinic B, without successful patient matching, that result won’t automatically show up in the physician’s EHR. That doesn’t mean it’s impossible to find that result; it just means it involves extra work which will only take place if the patient makes sure to give the relevant test information to their doctor. Population health also suffers with insufficient patient matching. It’s difficult to know how many people need a given service (vaccines, preventive care tests, etc.) if we can’t be sure which of our patients are at risk and haven’t had the recommended care. Matching patients in different systems has real-world implications.
Fear not because the federal government’s Office of the National Coordinator for Health Information Technology (ONC) is here to help. For real. I’m not being sarcastic, people! Along with industry, the ONC has developed Project US@. This project lays out rules and recommendations so that we all record patient addresses in a standard way. Project US@ has two objectives: to facilitate adoption and alignment through an industry-wide approach to representing patient addresses that is consistent across a spectrum of clinical and administrative transactions and to enhance performance of patient-matching algorithms through improved address quality.
If you read through the specifications – and I definitely recommend that you do – you’ll find that there are a bunch of persnickety details that can make all the difference when trying to match addresses. Here are some fun facts: NORTH E MAIN STREET is wrong; it should be NE MAIN ST. Another one? Glad you asked. SOUTHEAST FREEWAY NORTH is wrong; it should be SOUTHEAST FWY N. Seem random? It’s not. It’s all spelled out in the Project US@ specs. Following the rules will make it easier to get the right information to the right places.
Who will be doing this work of standardizing addresses? I think the proper question isn’t “who” but rather “what.” Registration folks are generally the ones who enter and verify patient demographic information such as address. Yet, this level of detail and sophistication is likely beyond most of us mere mortals. I’d predict that we’ll like have technology to help us do the standardization. Have you ever entered your address in a web form and then encounter a pop up that reads, “We found this preferred address. Should we use this?” When I see this, it’s typically because I typed in “123 Main Street” and the post office would prefer “123 MAIN ST.” Hopefully, software will help us follow the Project US@ standards.
Doctors and clinicians of all stripes need to focus on some non-clinical details that have the potential to have very “clinical” effects. Where our patients live and how we record their addresses in our systems can change our management of disease and disability. In our increasingly technical world, all the details matter. That seems great and horrible all at the same time. Welcome to 2022!