Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Technology
June 08, 2019 01:00 AM

As the care continuum expands, patient-matching remains a problem

Healthcare industry still searching for best way to fix the 
patient-matching process

Jessica Kim Cohen
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Patient hands' illustration
    iStock/Modern Healthcare Illustration

    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.

    The CMS outlined possible approaches for promoting private-sector patient-matching efforts in a request for information from the industry
    • Validating a patient-matching algorithm that hits a certain percentage of accurate matches
    • Validating a particular patent-matching software solution that hits a certain percentage of accurate matches
    • Promoting more standardized data elements 
    • Expanding its recent Medicare ID card effort by requiring an agency-wide identifier that's used for all beneficiaries 
    • Connecting electronic health record systems with outside data sources for identity proofing 
    • Using patient-generated data to complement patient-matching efforts 

    Source: The CMS

    Algorithms and software

    Two of the approaches involve computer program validation—either at the software level or the algorithm level—and build on the traditional way healthcare organizations have matched patients with their records. 

    This provides some benefits, according to Watkins. “There’s usually different weights associated with each field” in an algorithm, as opposed to when an employee checks an entry form manually, he said. “For example, if you’ve got the Social Security number, then it’s close to 100%” certain that the program has the right match. “But, if you’re missing it—which can be the case—there’s other weights associated with telephone number, address.”

    Healthcare organizations vary in their use of patient-matching algorithms or software. But the federal government doesn’t have a program to validate such tools, a feature desired by some. A lack of consistency in the tools used at different organizations might contribute to problems with mismatched records.

    Even if two organizations are using two high-quality patient-matching solutions, there’s the potential for patients to slip through the cracks.

    “If I’m using an algorithm that gets 96% right, and (my colleague) is using an algorithm that’s 97% correct … it doesn’t mean the 4% and the 3% (inaccuracies) match up,” explained Ray Deiotte, chief data officer at Centura Health in Centennial, Colo. For Deiotte, that means a national patient-matching strategy would need to establish a consistent way to match patients across organizations.

    But healthcare IT groups took issue with the request for information’s language of requiring a “particular” algorithm or software, arguing that it would hinder development of new solutions. That type of mandate would be a mistake, and likely “have the chilling effect of stifling innovation,” said Eric Heflin, the Sequoia Project’s chief technology officer. Instead, he suggested the CMS help the industry establish principles and best practices to inform patient-matching strategies.

    The College of Healthcare Information Management Executives, too, suggested that a better way for the federal government to intervene would be by requiring vendors to share patient-matching accuracy rates with providers, so they can make informed decisions. “Our (members) have found that’s not easy to come by,” said Mari Savickis, CHIME’s vice president of federal affairs.

    Data standards

    Another approach, establishing a set of consistent data elements for healthcare organizations to use in patient-matching programs, seemed like a useful and realistic path for the CMS to take, according to healthcare leaders—at least as a first step.

    Setting standard formats for demographic data proved the “biggest opportunity to immediately impact matching rates,” according to a white paper the Sequoia Project released last year. It’s “one of the easy things we can do to dramatically increase patient-matching quality, without having a national identifier or without ripping out technology and replacing it,” said Heflin, who served as a member on the federal Health IT Advisory Committee’s U.S. Core Data for Interoperability Task Force.

    The Sequoia Project also found adding supplemental identifiers, such as driver’s license numbers, helped to boost patient-matching rates to more than 95%, according to the white paper.

    One of the reasons many healthcare experts support standardized data is because it provides a foundation for other patient-matching approaches to build upon—for example, establishing a core set of data for algorithms to use. NextGate, a vendor of patient-matching solutions such as an enterprise master patient index, agreed that national standards would prove helpful for its services.

    “That, to us, is huge,” said Dan Cidon, NextGate’s chief technology officer. He said consistently documenting a patient’s cellphone number and current address would prove helpful for many programs. “That kind of consistency would really improve the match rate that we see today, and that’s with existing technology,” he said. “It’s really more like a process change.”

    The approach, however, would require getting organizations across the U.S. to agree on a standard to use. In its request for information, the CMS suggested using the U.S. Core Data for Interoperability—a standardized set of data elements proposed by the Office of the National Coordinator for Health Information Technology.

    But figuring out what data elements are best for patient-matching might be an ongoing conversation. According to a study published in the Journal of the American Medical Informatics Association, setting standards for many elements—such as date of birth, telephone number and Social Security number—didn’t improve match rates. However, standardizing addresses specifically to the format used by the U.S. Postal Service did prove helpful.

    Medicare ID cards

    Beginning last year, the CMS kicked off its effort to replace the Social Security numbers on Medicare ID cards with separate beneficiary identifiers.

    Most healthcare leaders who spoke with Modern Healthcare agreed that expanding these Medicare beneficiary identifiers agencywide would be helpful for patient-matching, but they stressed it’s just another data point.

    Tom Leary, the Healthcare Information and Management Systems Society’s vice president of government relations, noted that Medicare ID cards were created with an express purpose—and it wasn’t patient-matching. The randomly generated 11-character Medicare beneficiary identifiers are meant to cut down on identity theft and fraud risks associated with sharing Social Security numbers.

    “The Medicare number is a step in the right direction for security reasons, but it’s also only one of many data points about an individual,” he said, adding that although a single identifier sounds appealing, programs that integrate multiple data points will likely be more useful. “The idea of a single number being a solution isn’t something that’s right around the corner.”

    That’s particularly true given the shift to value-based care and a growing interest in the role social determinants of health play in patient care. Jaime Bland, CEO of the Nebraska Health Information Initiative, said a CMS-wide identifier would likely be helpful when matching out-of-state patients with their medical information, but highlighted the work the health information exchange would still have to do to match patients with a range of organizations in the region.

    “It would definitely be helpful,” Bland said of an expanded Medicare beneficiary identifier program. “But we’re trying to match across not only what healthcare is generating, but also all of the community resources, which are not traditional healthcare settings. They have identifiers of their own.”

    That’s why data standards remain a more sustainable solution, from her view.

    “We don’t necessarily need a unique identifier if we could just be consistent in the data elements that are collected,” she said.

    Seeking a reference

    Referential matching, or using external data sources to support patient-matching decisions, is a popular approach among IT vendors—it’s part of how NextGate and the Nebraska Health Information Initiative match patients, for example. The method involves using publicly available third-party data, such as information from credit bureaus and the U.S. Postal Service, to verify a patient’s identity.
     

    Verato, a patient-matching startup that claims to have pioneered referential matching, uses external information from public records to create a more comprehensive view of a patient’s demographics, including their previous names and addresses. The company subsequently uses this data to corroborate its matches and reduce duplicate records held within the same organization, Verato CEO Mark LaRow said.

    However, LaRow cautioned that referential matching, again, is only a piece of the puzzle.

    “External data by itself is not the answer,” he said, 
noting that Verato combines third-party data with referential-matching algorithms to fuel its decisions. As a result, he—like CHIME’s Savickis—advocated for the CMS to create a way to validate the accuracy of patient-matching technologies across the board, so that vendors applying different types of approaches could be compared head-to-head.

    Providers, however, voiced some concerns about using data not owned by their own organization when matching patients, particularly when it comes to connecting this information to the EHR, as suggested by the CMS.

    “I think it’s intriguing, but it’s fraught with some challenges,” Marc Probst, CIO at Salt Lake City-based Intermountain Healthcare, said of referential matching. “If you don’t control those outside data sources, then you also don’t control the format of that data. When you bring it in, it may not be in the format that you think it is.”

    Patient-generated data

    The CMS ended its request for information with an open-ended question: “To what extent should patient-generated data complement the patient-matching efforts?” For healthcare leaders, it’s an interesting question—but still, just a question. And much of the answer depends on what type of patient-generated data the agency is referencing.

    Patient-input demographic data, for example, might not prove helpful.

    Healthcare organizations have found that information patients enter about themselves via patient portal often has to be revalidated, Savickis said. “People could be mis-keying information. That happens all the time,” she said. “I think there’s some work to do before that can get to a place where, from a matching standpoint, it can be used.”

    Beyond standard demographic data, an emerging form of patient information that might prove useful for matching is using biometrics, or physical characteristics, to identify patients. For example, recognizing patients based on fingerprints or facial scans, similar to how many consumers unlock smartphones today.

    In a recent report, the Pew Charitable Trusts found patients consistently expressed interest in using biometrics for patient-matching.

    “Innovative approaches like the use of biometrics … should be examined, though there’s likely a longer implementation time,” said Ben Moscovitch, the Pew Charitable Trusts’ project director for health IT. One of the considerations healthcare organizations would have to consider with biometrics is the potential trade-off with privacy risks, depending on how data is stored and transferred.
     

    Deiotte at Centura Health said as organizations begin to discuss consolidating patients’ demographic, medical, social determinants, consumer and now biometric data to fuel patient-matching decisions, there are two priorities to balance: having enough data to match the patient appropriately, while also reducing the risk of data being exposed in a cybersecurity incident.

    “Our potential for risk and spillage becomes that much higher, because it’s kind of a one-stop shop for all of that information,” he said. “We have to balance the risk with the reward.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    IBM Quantum System One at Cleveland Clinic_4_0.jpg
    Cleveland Clinic, IBM unveil quantum computer
    Dr. Alice Zheng
    Women's digital health sector poised for growth, venture capitalist predicts
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Health IT Strategist (HITS) Newsletter: Sign up for the latest IT and medical technology news delivered 3 days a week (M, W, F).
     
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing