What is a "Unique Patient"?

The phrase "Unique Patient" occurs more than 50 times in the Hitech Requirements document.  In Meaningful Use requirements, it is part of the definitions for problem lists, medication allergies, active medication list, recording demographics, recording changes in vital signs, recording smoking status, checking insurance eligibility, and even across some of the quality reporting standards.  For physicians and other EP's, the requirements for "providing timely access to health data" and "sending follow up visit reminders" also reference "unique patient". 

So ... is there a common description for "unique patient"?  The first definition is found on page 1860 of the Federal Register.  It states:

“A unique patient means that even if a patient is seen multiple times during the EHR reporting period they are only counted once."

This definition is made under the requirement related to maintaining problem lists for each "unique patient".  In subsequent references, unique patient is either not separately defined, or actually refers back to the "problem list" source.  In some cases, unique patient is further defined (i.e., by age, gender, etc.), but never is the basic definition modified. 

The net effect of this definition, in most cases, is to relax a requirement.  For example, recording active medication list needs to be done at least once for each Unique Patient,  a qualifying hospital would only need to record active medication once for a patient, regardless of how many times that patient was admitted. 

Jay Fisher | @JayRFisher

Comments

[Jay R Fisher]

The answer to this question is generally embedded in the description of a given measure. For example, CPOE requires "The number of patients in the denominator that have at least one medication order", Record Demographics requires "Number of unique patients admitted to". I took a quick pass through the measures, and saw none requiring "Unique Patients Discharged". The key is to read the "denominator" description on each measure.

[Kathleen Kosztowny]

Does a patient who has not been discharged qualify in the unique patient #'s? Or is it only discharged?

[Chris Coleman]

Here is a relevant CMS EHR Incentive Program FAQ that addresses your question. Per the FAQ, the EP should include this patient in their denominator and numerator counts:

CMS FAQ ID: 10665 Date: 06/06/2011

Question: For the Medicare and Medicaid EHR Incentive Programs, when a patient is only seen by a member of the eligible professional's (EP's) clinical staff during the EHR reporting period and not by the EP themselves, do those patients count in the EP's denominator?

Answer: The EP can include or not include those patients in their denominator at their discretion as long as the decision applies universally to all patients for the entire EHR reporting period and the EP is consistent across meaningful use measures. In cases where a member of the EP's clinical staff is eligible for the Medicaid EHR incentive in their own right (NPs and certain physician assistants (PA)), patients seen by NPs or PAs under the EP's supervision can be counted by both the NP or PA and the supervising EP as long as the policy is consistent for the entire EHR reporting period.

[K Whitehall]

For the Core Measure- Patients with an active Medication and a medication order entered.

We have a provider that questions her results. However, the SQL query does not lie. It shows who prescribed, for whom and when.
Their question is based on Unique Patient. If the system looks at a Unique patient/encounter, and on that Unique patient encounter the MA prescribed the med- will then the doctor never ever get credit for prescribing a medication on this patient during the reporting period? It appears to look that way.

[Jay Fisher]

Only one visit is needed, to count as a unique patient.

[Alan Madick]

What if a patient is seen only once during the reporting period. Do they count in the denominator or do they need at least two visits?