2 steps to improve positive patient identification & lower the rate of duplicate records

On average, clinicians spend 28.2 minutes per shift searching for correct patient records, according to an Imprivata-sponsored Ponemon Institute survey of 503 healthcare executives and providers.

In a webinar sponsored by Imprivata and presented by Becker's Hospital Review, Beth Haenke Just, president and CEO of Just Associates, and Aaron Miri, CIO and vice president of government relations at Imprivata, discussed how to achieve enterprise master patient index integrity and positive patient identification.

If a patient is misidentified during a medical visit, a clinician or registrar might pull up incomplete or incorrect medical records, or even begin composing a new record, not realizing the patient has an existing record in the system. And misidentifying a patient can lead to significant consequences: The majority of providers (86 percent) know of or have witnessed a medical error due to patient misidentification.

Incorrect identification can also impact a health system's bottom line. According to the survey respondents, roughly 35 percent of all denied claims result from inaccurate patient identification or information, costing the average hospital $1.2 million each year.

Challenges with manual patient identification

Duplicate records are not anomalies, according to Ms. Just. In a review of 112 provider organizations, the ONC determined roughly 8 percent of records in a typical master patient index are duplicates. A survey by the American Health Information Management Association substantiated this finding, with most respondents indicating that their organization had a greater than 8 percent duplicate record rate.

"I've talked to people who say, 'I don't get why this is such a hard problem. Why can't you identify a patient easily? Just ask them their name or their date of birth,'" Ms. Just said. However, demographic data — like last name or home address — can change. "Last name, first name, date of birth, gender are simply not enough to identify that patient when you have databases with millions of records."

The No. 1 cause of patient misidentification is incorrect identification at registration. Three major attributing factors are difficulty finding a patient medical record (68 percent), searching for a patient and finding duplicate medical records for the same person (67 percent) and pulling up an incorrect record with the same name or date of birth (61 percent), according to the Ponemon Institute survey.

However, Mr. Miri noted another root cause for patient misidentification — the patient. "It can be really difficult for registrars to find the correct chart by asking a list of questions to patients or families," he said. "A very troubled mom or dad may bring in their kid who's very sick, and they want to get their kid seen. They're not worried about making sure the street address is accurate."

Although widespread, Ms. Just emphasized these problems are important for healthcare facilities to address. "One mistake is a bad thing, but when you're talking about the severity of this kind of error, you could be treating the patient for the wrong disease, operating on the wrong body part or the wrong side," she said. "That's a really big cause for alarm."

2 factors for successful patient identification

1. Address current duplicate records. Hospitals often wait for a "trigger" to undergo a comprehensive EMPI clean-up effort — such as an EHR implementation, facility acquisition or even patient safety event — but Ms. Just emphasized the importance of launching this type of project as a proactive, rather than a reactive, measure.

"It's always better to get your house clean before you start adding more data or records to it," she said. A master patient index might accumulate duplicate records from a range of day-to-day processes, from data entry errors to lack of data standardization, making a medical record clean-up all the more necessary. "We're certainly seeing higher and higher rates of duplication and overlaid medical records."

The average timeframe for an EMPI clean-up effort is about 6 months, according to Ms. Just, although the process varies. "They can be done — in smaller, simpler situations — in six to eight weeks. In large organizations that have hundreds of thousands of records and multiple systems that have to be fixed, it could take a year."

As a best practice, Ms. Just suggested working with a consulting firm, like Just Associates, to facilitate an EMPI clean-up. "Having a good, experienced team is critical to supporting this process," she said, adding that consulting firms would also focus on "knowledge transfer," or educating a facility on common root causes of its existing duplicate records.

2. Avoid future duplicate records. Undergoing a comprehensive EMPI clean-up effort is the first step to improving patient identification. But relying on intermittent EMPI purges to improve patient identification is not an efficient use of time or resources. Instead, a long-term solution to lowering the rate of duplicate records will involve implementing new standards or processes. "You can do what you're doing today, which are a lot of manual processes," Mr. Miri said. "Or, really, you can use technology."

Mr. Miri said a long-term commitment to positive patient identification necessitates an accurate solution at the point-of-care, to ensure "two levels of cleanliness" — an accurate set of existing records and a method for accurately identifying patients at their point of entry. One solution leverages biometric technology, which recognizes patients based on physical characteristics.

Imprivata's biometric identification platform, for example, identifies patients using palm-vein recognition, since palm-veins are "there from birth," according to Mr. Miri. To use the PatientSecure platform, patients enroll by undergoing a biometric palm scan, which is permanently linked to their medical record at the hospital.

At all future appointments, the patient simply scans his or her hand at the hospital's registration desk and provides his or her date of birth to flag the correct patient record. "We're not going to solve the patient identity issue by any one silver bullet," Ms. Just said. "But, certainly, using more and more technology solutions is going to help us radically improve this problem."

Listen to the webinar recording here.

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