As digitization of the healthcare system increases, issues around data exchange and medical records exchange make patient identification more challenging than ever.
In the absence of a unique patient identifier system, doctors use a patient’s name and birth date to identify them, and there can be hundreds or thousands of identical or similar names and dates in EMR systems. Get it wrong, and a diagnosis or treatment may be missed — sometimes with dire consequences.
The lay of the digital land
Each system and database that a patient is in has a different identifier that is unique in that database, whether it’s a medical record number or an account number. A problem arises when that same number is in somebody else’s record or account in another database.
Moreover, when patients are transitioned from one organization to another that has a different EMR system, an error in matching the patient with their correct self could cause critical information to be lost or inaccurate information to be put into their record.
“We know that transitions in care are particularly high risk for adverse events anyway, and a lot of that is because information’s not flowing well,” says Dr. Tejal Gandhi, president and CEO of the National Patient Safety Foundation.
In 2012, the College of Healthcare Information Management Executives surveyed its members and found that 20% could relate a serious adverse event back to patient identification problems.
The challenge of patient identification is not new. When HIPAA was signed into law in 1996, it called for the Secretary of Health and Human Services to look into creating a standard unique health identifier for each individual in the U.S. Two years later, however, Congress prohibited HHS from spending any money on the solution, and the ban has continued to this day.
CHIME maintains a patient ID program is crucial to improving quality of care and reducing unnecessary costs due to patient misidentification.
In January, CHIME launched a $1 million global competition — the National Patient ID Challenge — to incentivize innovators to design a private, accurate, and secure way to identify patients. As of Wednesday, there were 295 innovators and 26 teams of innovators registered across 32 countries.
Submissions for the first phase of the competition, known as Concept Blitz, are due April 27. From those, three winners will be announced in early June. The final innovation round runs from June to November. CHIME will announce the winning solution in February 2017.
The seed for the challenge was planted at the CHIME Fall Forum in 2014, explains Matthew Weinstock, director of communications and pubic relations at CHIME. Peter Diamandis, founder of X Prize Foundation, asked board members what kept them up at night. The resounding response was patient identification and patient matching: How can providers be sure when a patient walks through the door that they will be correctly identified 100% of the time and will matched to the right record?
“And Peter suggested maybe this platform of crowd sourcing, going out to the innovator community, is the way to solve this problem,” Weinstock says.
Mark Probst, vice president and CIO of Intermountain Healthcare and CHIME’s 2016 board chairman, believes the time is ripe for a unique patient identification system. What has been holding the movement back until now has been leadership and commitment by a national organization, particularly with the federal budget prohibition. “As a country, we haven’t been willing or able to tackle the problem, and no one has really taken it on,” he says.
Another challenge to patient identification is the lack of standards, which makes information coming into an EMR difficult to assess or verify. A unique identifier would create that standard.
“Inside Intermountain Healthcare, I’m usually dealing with issues that might be a human error in a key stroke or a registration chart that’s selected because the name and address and birthdate were so close,” Probst says. “When it comes from outside our organization, it’s much more difficult to make sure we’re getting the right patient. They may just send me Sally Smith and a birthday versus everything I need to run the algorithm to correctly match the patient.”
The repercussions of misidentification go beyond patient safety. Patient satisfaction takes a hit when the wrong person is scheduled for an exam or billed for a procedure they didn’t have, and providers have to spend time and money setting the record straight.
Salt Lake City-based Intermountain Healthcare did an internal analysis several years ago and found it was spending about $5 million a year cleaning up medical records and trying to develop solutions to the problem. “That’s $5 million we could spend on direct patient care versus kind of wasted money,” Probst says, adding the figure is probably somewhat higher today.
In a recent survey conducted by the American Health Information Management Association (AHIMA), more than half of health information management professionals said they work on reducing duplicate patient records at their facility, and 72% of those said they do so on a weekly basis. At the same time, only 47% of respondents had a quality assurance step in their registration or post-registration process, AHIMA said.
Hospitals also stand to loose reimbursement dollars if discharging patients rate them poorly on consumer assessment surveys. The ACA included Hospital Consumer Assessment of Healthcare Providers and Systems scores in the calculation of value-based incentive payments under the Medicare inpatient hospital-based purchasing program.
LexisNexis has been following the patient identification issue closely and thinks it may have a solution: the LexID technology. The data analytics company has used the system internally for years, but about seven years ago realized that it could have broader value in the marketplace.
“The LexID identifier is a noninformation-bearing integer. It’s not like a social security number, it can’t be decoded, and it doesn’t bear any information or even when it was issued,” says Kathryn Bardeen, director of product management at LexisNexis Risk Solutions. Rather, the focus is on consistency and persistence over time as an identity changes and events change.
The system also uses statistical algorithms to assess not just transposition of number in a birth date, for instance, but also the likelihood of hitting one digit over another due to where they’re located on a keyboard. “All of these are contributing factors in being able to assign that ID to the appropriate person,” Bardeen says.
There are efforts to overturn the federal budget ban, too. Last month, AHIMA launched a petition to remove the prohibition and allow for development of a voluntary patient safety identifier. “Accurate patient identification is critical in providing safe care but the sharing of electronic health information is being compromised because of patient identification issues,” the petition states. It needs 100,000 signatures by April 19 to garner a formal response from the White House.
And on Capitol Hill, the Senate Health, Education, Labor and Pensions Committee is working on a medical innovation bill that, among other things, calls on the General Accountability Office to conduct a study of the challenges of patient mismatching and patient identification. The legislation, a companion to the 21st Century Cures Bill the House voted to approve last summer, could reach the Senate floor as early as next week, HELP Committee Chairman Lamar Alexander (R-TN) told The Hill.
Patient privacy and security concerns remain a hurdle in any national patient ID system, which is why CHIME made retaining peoples’ privacy a key criteria of its challenge. Probst says many of the leaders around privacy concerns are excited about the initiative because it does attempt to tackle the issue.
“We need to have secure systems regardless of what information is in them,” says NPSF’s Gandhi. “That being said, the safety benefits of doing this far exceed the risks.”