Patient-matching effort needs standards and smartphones

As patient identification and matching errors continue to put patient safety at risk, industry groups say healthcare organizations should renew their focus on the problem and consider new ways to solve it.

A heavier reliance on patients, perhaps by asking them to collect health information on their smartphones (as Apple already enables for patients of certain health systems) could be one solution, according to the Pew Charitable Trusts, which on Tuesday was one of two groups that released a report on patient matching and patient ID.

The industry needs to take certain steps first, according to Pew, which offered suggestions based on patient focus groups and interviews with healthcare executives. Those include assigning a unique identifier to every patient. But first, the government must clarify how it can fund the development of those identifiers. HHS is prohibited from using federal funds to create a unique patient ID, though the Office of the National Coordinator for Health Information Technology can offer "technical assistance" to the private sector.

Providers, for their part, must agree on standard demographics and understand privacy implications. And developers and others must continue to work on referential matching using third-party data.

In the long run, Pew suggests, a single group might lead a national strategy for patient-matching.

"This organization would identify and encourage adoption of certain standards—such as on biometrics or use of smartphones—by health care organizations and technology developers," according to Pew.

Without a better approach to patient matching and patient identification, errors might persist, with providers potentially incorrectly diagnosing patients or ordering duplicate tests, among other problems, according to the Joint Commission, which released an advisory on Tuesday.

Properly identifying patients and linking them to their records has long been a challenge for the industry. Estimates place patient-matching accuracy around 90%. That's high, but if the industry doesn't figure out the remaining 10%, it will continue to struggle with interoperability, which depends in part on accurately linking patients to their records, according to Pew. "Improvements to matching are essential to realizing the potential of an interoperable healthcare system where patients and clinicians have data when and where they need them," according to the organization.

For that to happen, providers must be able to pull up their patients' records and to trust that each record is being linked to the correct patient. And for that to be possible, organizations must not engage in data-blocking, an issue the ONC is expected to release a rule about later this fall.

Currently, healthcare organizations use algorithms, unique identifiers and manual processes to match patients to their records. Sometimes, EHR vendors include matching capabilities in their software. Healthcare organizations, armed with their own matching software, sometimes also work with the interoperability groups Commonwell Health Alliance and Sequoia Project (which, along with the Care Connectivity Consortium, recently updated a framework for patient identity).

Problems with these techniques can arise in multiple places at multiple times, according to the Joint Commission. Patient-identification errors might occur when providers enter one patient's information into another patient's record, for instance. Or they might occur when providers don't successfully separate the resulting patient record. Duplication—of both records and orders—can also result.

To avoid those errors, providers must accurately capture patient information, they must link that information to the correct patient and they must present the information in a way that further improves matching, according to the Joint Commission.

"In implementing technology, we have to be mindful that technology alone can't solve the problem," said Gerry Castro, project director in the Joint Commission's Office of Patient Safety. Instead, providers must integrate digital tools into "strong processes," he said.

But before that, vendors must perform usability testing, Castro said.

Among the other recommendations the Joint Commission offered are having clinicians help configure EHRs to cut down on distractions during documentation and standardizing the way providers identify patients and record their information.

The Joint Commission also recommended that health systems monitor their EHRs to sniff out identification errors.