Why does my health record not follow me when I change providers?

The United States has no national patient identifier: Congress has blocked one since 1998 over privacy concerns, leaving institutions to match patients probabilistically using name, date of birth, and address. FHIR provides a standard wire format for health records, but without a reliable identity layer, the same person appears as a different record at every institution and merges or mismatches happen silently. The Office of the National Coordinator for Health IT reported in its 2026 Annual Meeting materials that only 43 percent of US hospitals routinely participate in all four interoperability domains. New federal mandates requiring FHIR-based prior authorization workflows beginning in 2026 are now exposing this identity gap at scale, with denied authorizations and broken care transitions as the direct cost to patients. Algorithmic matching exists but produces false positives and false