No solution currently exists that could achieve perfect or near perfect match rates across EHR systems for all patients, according to a report released Tuesday by the Pew Charitable Trusts. However, actions can be taken to better link records, to the benefit of patients and providers.
In the short term, Pew recommends clarifying government funding restrictions for unique identifiers, agreeing on standardized demographics, assessing privacy ramifications, continuing to research (and adopt) referential matching using third-party data and verifying phone numbers and other identifying information provided by patients.
To develop a stronger patient matching chassis, long-term opportunities include creating a single countrywide oversight organization, launching pilot projects for patients to use their own smartphones to help match records and determining the infrastructure and standards necessary to use biometrics and other more secure and effective patient-matching strategies.
Effective patient matching is among the necessary elements to move toward the elusive goal of interoperability. On that front, industry is eagerly awaiting proposed new rules laying out how HHS will curb providers from hoarding data via information blocking.
The 21st Century Cures Act requires the Government Accountability Office to take steps to reduce matching errors and HHS and the Office of the National Coordinator for Health Information Technology to support the nationwide exchange of health information.
EHRs can promote efficiency, but in the absence of standardization doctors are confronted with the question of whether they are worth the pain. Administration burden associated with EHRs are a leading cause of physician burnout and dissatisfaction, and problems with system implementation and operability can manifest in problems with patient care.
And for EHR systems to be effective, they need to be able to communicate effectively both intra and intersystem — a goal that depends on several factors such as desire of said institutions to share data and correctly link record to patient, according to Pew.
The report attempts to identify solutions to the latter dilemma, as patient-matching rates vary widely across the United States. Such inconsistencies can lead to safety problems and needless costs in repeat tests and delays in care.
Currently, matching is typically done through the use of algorithms, unique identifiers, manual review or a combination of those methods. Among the factors contributing to inadequate match rates are standardization variance, typos, unentered information, information changes and identity fraud.
Pew examined four main approaches for improvement. The first is in the realm of unique identifiers that identify an person and link to his or her records, such as biometrics. Biometrics (body measurements specific to a person, such as fingerprint or eye scan) are en vogue in European airports, for example, as a way to quickly and easily confirm someone's identity. However, such measurements can be stolen and, once compromised, can't be changed, for obvious reasons.
A second suggestion allow patients to ensure their records are matched correctly through a portal such as a smartphone app. However, patients would need to be motivated to participate for this strategy to have legs.
Pew also recommended standardizing demographic indicators across systems to promote interoperability and pinpointed referential matching, or using non-health related data from credit bureaus and other organizations, as a helpful scheme when other basic information such as address changes.
Pew researchers convened a series of panels, focus groups and interviews, including healthcare executives, yielded some interesting insight on how the C-suite views patient matching. Interorganization patient matching was found to offer the biggest opportunity for progress in their eyes.
Consistently, executives had a goal of 99% success rate in matching but no consistent method to measure progress to that goal, although many indicated they had already invested in software or employees to track matching.