How a single patient identifier slashes errors, theft & fraud

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Misidentifying patients presents a potentially catastrophic situation for any healthcare organization, opening the door to medical errors, identity theft and payment fraud.

In the average EHR system, between 8 percent and 12 percent of records are duplicates, leaving ample room for improvement in effective patient identification. Duplicate records can cause misdiagnoses, unnecessary tests and inappropriate treatments, according to the American Health Information Management Association. Names and birthdates can fare poorly as the sole identifier sources, as overlap between various patients likely exists. And turning to Social Security for a tried-and-true identification tactic is becoming increasingly less reliable, as fewer providers are collecting such information due to liability concerns.

Patient misidentification is a serious problem in and of itself, but healthcare's new outcomes-based payment paradigm only extends its repercussions. Without the appropriate patient data at the point of care — due to pulling incorrect medical records or making decisions based on incomplete medical histories — providers fall short of delivering optimal care and patients' outcomes and privacy are compromised.

"[Duplicate records], coupled with medical identity theft and payment fraud, are compromising the integrity of health data," says Tom Foley, director of Lenovo Health's Global Health Solution Strategy.

Medical identity theft impacts 26 percent of U.S. consumers and of those affected, 50 percent paid an average of $2,500 in out-of-pocket costs per incident, according to a 2017 Accenture survey. Many organizations are dedicating efforts to strengthen the backend of health IT to prevent breaches, but Mr. Foley argues leaders should pay just as much attention to the frontend. While the backend includes the server and database, the frontend needs to protect from misuse of data that came from the back-end or other inappropriate sources.

"We need to think differently about how we approach data integrity in the frontend," explains Mr. Foley. "Eliminating duplicate records, medical identity theft and payment fraud — which can be done today — will transform the quality of data and have a domino effect on decision support, achieving quality outcomes and/or maintaining wellness."

One possible solution to this data problem is the single patient identifier, which integrates with an EHR to assign every patient a personal sequence of characters. As patients move from one healthcare organization to the next, this identification follows them, stamped to every medical record, fostering a seamless continuum of care.

"Organizations can change the experience model by applying tools that can share a patient's information across multiple settings, so he only has to supply the information once," says Mr. Foley. "One would say that's not innovation, that's just applying technology where it makes sense to enhance the experience of the patient."

Intended to offer a comprehensive snapshot of a patient's health, medical records are far from delivering a complete medical history. When the medical record process rolls back to the beginning each time patients walk through the doors of a new medical facility, their medical progress and safety is put at risk due to a staggered care continuum. It seems logical for patients' medical records to go with them wherever their health may lead, but patients repeatedly fill out the same information at every appointment.

To address this patient identity conundrum, Lenovo teamed up with LifeMed ID in 2016 to bring its Authoritative Identity Management Exchange (AIMe) to the market. Mr. Foley remembers most organizations argued they did not have a patient identity problem, so the company tweaked its pitch to emphasize the greater medical record problem.

"[Organizations] did have a data integrity problem, medical identity theft problem, medical fraud problem and duplicate medical record problem," he explains. "We as vendors do a better job communicating the value of our solutions in context of which business problems we solve."

The solution features the Lenovo Health Authoritative Identity Management Exchange, streamlining the patient identification process by offering:

• Patient identity validation
• Insurance eligibility verification
• Consent forms and payment processing
• A virtual clipboard to improve patient intake efficiency

The AIMe solution creates trusted patient ID tokens and connects those ID tokens to the correct medical records. Patients are then verified and the technology automatically invokes the correct medical record.

Leveraging a single patient identifier solution to complement EHR systems will drive interoperability across the continuum of care.

"Hindsight being 20-20, the one fundamental construct we should have integrated in the health IT ecosystem is a deterministic patient matching construct coupled with the universal patient identity platform — as the Enterprise Master Patient Index is a significant contributor to data quality," Mr. Foley concludes.

Lenovo Health is supporting a three-day innovation summit in partnership with Becker's Healthcare, from June 6-8.

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