Matching patients with their medical information sounds like a simple concept, but it’s not. The practice is plagued by such issues as typos, missing data, similar names and new addresses—resulting in match rates as low as 80% within the same facility, according to the College of Healthcare Information Management Executives.
That means 1 in every 5 patients may not be linked with the correct record.
It also leads to higher costs. Patient-matching remains a multi- billion-dollar problem in the U.S., with inaccurate patient identification accounting for $1,950 in duplicative medical care costs per inpatient and $1.5 million in denied claims per hospital each year, according to a survey by Black Book.
Ensuring patients are linked with the correct medical information has become a particular challenge in the era of value-based care, when health systems and insurers are tasked with not only matching patients within their own organizations, but also across the continuum of care. That makes patient-matching integral for interoperability, said Mariann Yeager, CEO of interoperability not-for-profit the Sequoia Project.
Patient-matching is a “fundamental function of being able to get the right records, for the right person, at the right time, so that timely decisions can be made about his or her health,” she said. “There has to be a mechanism to ensure that you’re actually getting a copy of the records for the right person.”
Part of the challenge with patient-matching is that it tends to rely on staff filling in a few key fields—such as name, address and date of birth—when a patient presents at a hospital. That leaves room for human error from both staff and patients. A few seemingly small, but consequential, problems could involve inconsistencies in the way addresses are written, if a patient has recently moved to a new home, or if a name or date of birth is entered with a typo.
“If there’s some kind of error in entering those fields, either when the patient’s coming in or in a previous entry, the matching can go awry,” said Brendan Watkins, administrative director of enterprise analytics at Palo Alto, Calif.-based Stanford Children’s Health.
To ease patient-matching struggles, many countries have issued a national ID number for patients, said Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center and international healthcare innovation professor at Harvard Medical School.
The U.S. is not one of them. “The United States has no national healthcare identifier and has no nationwide patient-matching strategy,” Halamka said. “That means every single organization figures it out on their own.”
In fact, Congress for decades has prohibited HHS from putting funds toward developing a unique patient identifier, citing issues related to privacy and security. To work around this, the CMS in February issued a request for information seeking industry input on how it can best support private-sector efforts to improve patient-matching. The RFI was part of a broader proposed rule on interoperability.