By Andy Aroditis, CEO, NextGate
Twitter: @NextGate
Twitter: @andyaroditis
Accurate patient identification is fundamental component to safe care delivery. Yet, providers remain daunted by electronic health record (EHR) systems that contain errors and fail to communicate or transmit information effectively. The issue of poor patient identification becomes exponentially more problematic and dangerous as more data is generated and more applications are introduced into the healthcare environment.
With increased use of technology in relatively every aspect of healthcare, subsequent risk imposed on patient safety is only expected to grow. Take for example, a recent incident at Virtua Our Lady of Lourdes Hospital in New Jersey. On November 18, a 51-year-old patient underwent a successful kidney transplant. However, the kidney was supposed to go to another patient that had the same name and was of similar age.
Fortunately, the intended patient received a successful transplant six days later and both individuals are doing well, but these stories are not new and sadly not uncommon. According to the ECRI Institute, the risk of wrong-patient errors is ever-present for the multitude of patient encounters occurring daily in healthcare settings. When evaluating more than 7,600 events from 181 healthcare organizations, ECRI Institute found that patient identification errors in the EHR were quite frequent, leading to injury and even death.
Specifically:
- 72% occurred during patient encounters; another 12% occurred during intake,
- Just under 50% involved diagnostic procedures or treatment,
- 5% involved diagnostic procedures (lab, pathology, x-rays),
- 22% involved treatment (medications, procedures, transfusions), and
- 9% led to temporary or permanent harm, and two deaths.
ECRI Institute noted the identification errors likely represent a fraction of the wrong-patient errors that actually occurred. Further, the study only reviewed patient matching errors within a facility; it did not examine error rates when healthcare providers shared data outside of their own systems.
Reliance on EHRs for patient matching is no longer sufficient
The explosion of EHRs and clinical applications over the last decade have placed a premium on ensuring individuals are accurately and consistently matched to their data. While roughly $35 billion of U.S. taxpayer dollars has been spent on digitizing health records, the disjointed and competitive nature of EHR systems contributes to a flood of duplicate and disparate medical records. This means that individuals receiving care from more than a single provider in the network often have medical records in several other locations. Large-scale M&A and consolidations exacerbate the issue, as acquired EHR systems often reside in silos.
Information contained in EHRs is also predominantly inconsistent. This is because different systems capture patient demographic information in different ways. For instance, some EHRs will include hyphens, apostrophes and suffixes in last names; others don’t. This makes it extremely challenging to tie patient information from other facilities together.
Without consistently and correctly matching individuals to their data to enable a complete record of a one’s health history, patients will continue to suffer the consequences.
In October 2018, the Joint Commission issued a national safety advisory on avoiding patient identification and matching errors. The alert cautions that while EHRs can provide ready access to and facilitate the sharing of data, it can also cause patient safety risks, such as providing treatment to the wrong patient and mistakenly putting a test into another patient’s medical record.
Master patient indexes (MPI) within EHRs remain exceedingly limited in their ability to compare and link records from external sources, especially those outside of the network. According to a report by Pew Charitable Trusts released last year, EHR match rates within facilities are as low as 80 percent‑—meaning one out of five patients may not be completely matched to his or her record. When exchanging records outside the organization, match rates can be as low as 50—even when the providers are running the same vendor EHR.
The inability for EHRs to consistently match patients to their data can have dire consequences, leading to inappropriate medications being dispensed, incorrect diagnoses, erroneous test results and increased risk from redundant medical procedures. According to a 2016 National Patient Misidentification report, 86 percent of 500 nurses, physicians, and IT practitioners surveyed reported that they witnessed or knew of a medical error that was the result of patient misidentification. In 2012 a CHIME report found that 20 percent of CIOs surveyed had patients harmed in the prior year due to identification mismatches.
The right technology can maximize matching
Patient data matching functionalities within EHRs lack the complexities to unify information from disparate and external systems. Those that fail to integrate or communicate with one another exacerbate inefficiencies, causing needless redundancies and generating millions of duplicate and incomplete records resulting in patient safety errors, skewed reporting and analytics, administrative burdens, and lost revenue.
Most data entry errors are preventable but without a centralized data matching system in place to automate record de-duplication and data integrity, hospitals are increasingly placing patients at risk and barring physicians from making informed, life-saving decisions. Hospitals and health systems that aren’t running an efficient enterprise master patient index (EMPI) are operating EHR systems fraught with duplicates and inaccurate patient information.
According to a 2018 survey by Black Book Research, hospitals without an EMPI in place for managing patient identification reported duplicate record rates of 18 percent within their organization and 24 percent when exchanging records out-of-network. This is because EHRs were designed for a single vendor-based environment and lack the sophisticated algorithms for linking data across various sources and settings of care. The absence of just a single medication in an individual’s medical record can greatly impact a decision made by a clinician.
Leveraging an EMPI is an industry best practice essential for promoting safety and interoperability and helping evolving healthcare enterprises map an individual’s entire care journey. As a centralized, vendor neutral platform for enabling bidirectional access to patient information, an EMPI is critical tool in ensuring data flows freely and accurately from provider to provider.
EMPIs that leverage location intelligence and geocoding to verify addresses allow organizations to standardize and authenticate address data in real-time, thereby avoiding risks associated with duplicate record creation and identity fraud. Seamless integration of location intelligence technology enables front-end, real-time address capture as well as backend batch address verification and enhancement. EMPIs with address verification technology can reduce address entry time by up to 78 percent, prevent data entry errors at the point of capture by more than 20 percent, and enables batch processing of more than 3 million address records per hour.
EHR-level requirements can only go so far; ultimately the core identity of a patient and basic associated demographics should not be in the control of any single system. Rather this information must be externalized from such insulated applications to maintain accuracy and consistency across all connected systems within the delivery network.
Patients deserve better
Every patient record has a real life behind it, with real world consequences if that record is incomplete or inaccurate. Clinicians and other care providers miss opportunities to improve one’s health when that individual’s medical data is incomplete, outdated or not easily accessible.
Each year, as many as 440,000 Americans die from preventable errors in hospitals, and dependence on EHRs for matching decisive health information is no longer acceptable. If we are to deliver on the promise of a fully integrated, highly interoperable healthcare system, employing specialized patient identification technology will ensure patients—and an organization’s reputation—are protected.
As healthcare consolidation continues to soar and organizations strive to create a more clinically integrated environment, patient identification across the continuum will become even more difficult and more critical. To keep pace, organizations must engage in a more comprehensive patient matching approach. Leveraging the right technology, along with better processes, will be key.
This article was originally published on the NextGate Blog and is republished here with permission.