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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Pew and Massachusetts eHealth Collaborative Find the Frequency of Patient Mismatches Exceeds ‘Desirable Levels for Effective Data Exchange’

EMPIs may help clinical laboratories ensure their patients and medical records are properly matched with medical laboratory test results and specimens

Mix-ups between patients and their medical records, known in the healthcare industry as “patient mismatching,” happen far too frequently in hospitals and clinics worldwide. When surgery is involved, such mismatches can lead to deadly errors. However, clinical laboratories and pathology groups also must take steps to ensure patients, their medical records, and their biological specimens remain properly matched.

Once horrific incident in 2016 involved Saint Vincent Hospital in Worcester, Mass. Believing they were operating on a patient with a kidney tumor, surgeons mistakenly removed a healthy kidney from the wrong patient. The cause of the patient mismatch was a mix-up with CT scans. The two patients shared similar names, Managed Care reported.

Sadly, patient mismatching is not a new or rare problem. Patient mismatches often lead to delays, extra costs to fix duplicate information, and tragically, unnecessary surgery and inappropriate care, Healthcare Dive noted.

According to Managed Care, organizations working on solutions include:

Extent of Patient Mismatching Unknown

A recent study by Pew Charitable Trusts (Pew) in collaboration with the Massachusetts eHealth Collaborative (MAeHC) revealed that the rate of patient mismatching is difficult to measure.

“Incorrect matches could result in patients getting the wrong medicine, and failure to link records could lead to treatment decisions made without access to up-to-date laboratory test results,” Pew noted in an issues brief.

Pew and the MAeHC interviewed 18 hospital, medical practice, and health information technology exchange leaders. The respondents admitted that they are uncertain about the extent of the matching problem.

“They don’t know all the records that should be related and thus cannot understand what percentage of those are unlinked,” the researchers wrote.

Nonetheless, the researchers found that patient/record match rates fall “far below the desired level” for effective data exchange among organizations, Healthcare Dive reported. 

For pathologists and clinical laboratory managers, the Pew/MAeHC study had several key takeaways, such as:

  • “Match rates are far below the desired level for effective data exchange.
  • “An increased demand for interoperability—the exchange of electronic data among different systems—is fueling the desire for improvements.
  • “Match rates are difficult to measure.
  • “The methods in which records are received can affect match results.
  • “Different types of healthcare providers vary in their perspectives on the extent of the problem.
  • “Effective opportunities exist for organizations to more accurately link individuals’ health records.”

Other research studies suggest that patient match rates can fall to 50% or 60% when organizations share patients’ records between disparate healthcare network electronic health record (EHR) systems, the Office of the National Coordinator for Health Information Exchange (ONC) noted in a final report on the ONC’s Patient Identification and Matching Initiative. From experience, medical laboratories understand the challenges of matching information on a clinical laboratory test requisition to the right patient and can often see patient mismatches on a daily basis.

About $1,950 in medical care costs per patient during a hospital stay, and $1.5 million annually in denied claims per hospital, are associated with inaccurate patient identification, reported a survey conducted by Black Book Research.

“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. There has to be a mechanism to ensure that you’re actually getting a copy of the records for the right person,” Mariann Yeager (above), CEO of the Sequoia Project told Modern Healthcare. The Sequoia Project advocates for nationwide health information exchange (HIE). (Photo copyright: Value-based Care Summit.)

Why Patient-Matching is Difficult

Respondents to the Pew study reported that challenges to correctly matching patients with their records include:

  • Receiving patient records that an organization did not expect;
  • Urban health systems serving patients through multiple sites;
  • High costs associated with matching solutions; and
  • Differences in how organizations capture, use, and link medical records.

When humans manually input patient data, Mary Elizabeth Smith could be listed as M.E. Smith or Mary E. Smith or even Liz Smith. Such data, when filed differently, can result in duplicate records for the same person, or, as St. Vincent’s found out, patient mismatches that have dire consequences, Managed Care noted.

“If there’s some kind of error in entering fields (name, address, date of birth), either when the patient’s coming in or in a previous entry, the matching can go awry,” Brendan Watkins, Administrative Director of Enterprise Analytics at Stanford Children’s Health, told Modern Healthcare.

Patient-Matching Solutions at Clinical Laboratories    

Clinical laboratories also have tackled patient-mismatching and have devised processing software solutions that ensure patients are correctly identified and matched with the appropriate records and specimens.

For example, Sonora Quest Laboratories (SQL), a subsidiary of Laboratory Sciences of Arizona, developed an enterprise-wide master patient index (EMPI). As reported by The Dark Report, Dark Daily’s sister publication, “The EMPI underpins all the patient-centric services that tomorrow’s clinical laboratory must support to be successful at meeting the needs of ACOs, PCMHs [patient-centered medical homes], and other emerging models of integrated clinical care.”

Other solutions suggested by respondents to a previous 2018 Pew survey include:

  • Unique patient identifier: Adoption of a patient identification number could help matching efforts, though patients have expressed privacy concerns. The idea is to use smartphones to validate patient data using digit codes. However, respondents told Pew, not everyone has a smartphone.
  • Data standardization: Respondents said standardization of data elements and formatting could impact match rates. But agreement on which elements to use for the match would be needed.
  • Referential matching: Healthcare providers could follow the banking industry and use outside sources, such as credit bureaus, to verify addresses and other data. Respondents to the Pew survey balked at the cost. 

One other technology not mentioned in the Pew survey but previously reported on by Dark Daily is biometric facial recognition, which would aid providers in identifying patients and matching them with their records. (See “Canadian Company Prepares to Use Biometric Facial Recognition for Positive Patient Identification with an In-Home Prescription Drug Dispensing Device,” July 9, 2018.)

With advancements in technology and interoperability, medical laboratory leaders and other healthcare leaders may soon be expected to achieve patient and record match rates of 100%. Pathology laboratories with EMPIs and other solutions may be well prepared to meet those challenges.

—Donna Marie Pocius

Related Information:

A Mismatch Made in America

Provider Demand for Accurate Patient Matching is High, Pew Says

Enhanced Patient Matching Is Critical to Achieving Full Promise of Digital Health Records

Hospital and Clinical Executives See Rising Demand for Accurate Exchange of Patient Records

Patient Identification Matching Final Report

Improving Provider Interoperability Congruently Increasing Patient Record Error Rates: Black Book Survey

Care Continuum Expands and Patient Matching Remains Problem without Single Solution

Medicare and Medicaid Programs Patient Protection and Affordable Care Act Interoperability

Sonora Quest Builds EMPI to Serve Patients and ACOs

Canadian Company Prepares to Use Biometric Facial Recognition for Positive Patient Identification with an In-Home Prescription Drug Dispensing Device

Apple May Be Developing Mobile Device Technology to Monitor User’s Health and Transmit Data in Real Time

Industry analysts speculate that Apple might be planning to enter the EHR and healthcare related markets by transforming mobile technologies into gateway devices connected to providers’ EHR systems and patient data

Imagine a mobile device that monitors vitals while connected in real-time to healthcare providers, electronic health records (EHR), and clinical laboratories. One that measures the physical condition and emotional state of the user by casting light onto skin, and then records and transmits it with a swipe of the touch screen. Would such an innovation change how patients expect to interact with their providers? And how physicians, anatomic pathologists, and medical laboratories receive data from their patients? Certainly.

This is why US patents recently granted to Apple have caught the attention of industry analysts. Some speculate that the tech giant is planning to enter the mobile healthcare monitoring device, EHR, and healthcare data storage markets, as reported at Becker’s Health IT and CIO Review and Patently Apple.

How this would affect medical laboratories and anatomic pathology groups remains to be seen. But where Apple goes, industries follow. Thus, it’s worth following the company’s activities in the healthcare market.

Bringing Clinical Data, Medical Laboratory Test Results, to iPhone

Mobile devices launched the era of consumer-grade fitness wearables. It’s not uncommon for a smart phone or watch to capture and store a range of health data generated by users. This can include everything from heart rate and sleeping patterns to dietary logs and fertility tracking. But, to date, much of that healthcare data is user generated and does not integrate in any meaningful way with the majority of EHR systems. Nor does it enable communications with primary care providers or diagnostic services—such as medical laboratories or pathology groups.

This may soon change.

According to a CNBC report, a unit at Apple is “in talks with developers, hospitals, and other industry groups about bringing clinical data—such as detailed lab results and allergy lists—to the iPhone, according to a half-dozen people familiar with the team.”

The report states that Apple:

·       “Wants the iPhone to become the central bank for health information;

·       “Is looking to host clinical information, such as labs and allergy lists, and not just wellness data; and,

·       “Is talking with hospitals, researching potential acquisitions, and attending health IT industry meetings.”

Christina Farr, the report’s author, predicts that Apple could be preparing to apply its music industry model to the healthcare industry by, “Replacing CDs and scattered MP3s with a centralized management system in iTunes and the iPod—in the similarly fragmented and complicated landscape for health data.”

Former National Coordinator of Health IT for the Department of Health and Human Services, Farzad Mostashari, MD, ScM, rather enthusiastically noted the significance of the move, stating, “If Apple is serious about this, it would be a big f—ing deal.”

At a special event in September, Apple COO Jeff Williams (above) announced Stanford Medicine’s Apple Heart Study, which uses “data from Apple Watch to identify irregular heart rhythms, including those from potentially serious heart conditions like atrial fibrillation,” and, according to Williams, “notify users.” This is just one of several healthcare-related study collaborations Apple is exploring. It is not known if Apple is looking to collaborate with medical laboratories. (Photo copyright: Apple.)

Apple’s History with Healthcare Related Technology

Taken as a single event, these speculations might not convince industry leaders. However, Apple’s long-term investments and acquisitions show a clear trend toward integrating healthcare data into the Apple ecosystem.

Healthcare IT News noted that from 2014 to 2017 Apple:

·       Unveiled three different APIs—HealthKit, ResearchKit, and CareKit—designed to help capture, analyze, communicate, and integrate healthcare data with the Apple iOS and watchOS ecosystems;

·       Hired several MDs, including: Stephen Friend, MD; Rajiv Kumar, MD; Mike Evans, MD; Ricky Bloomfield, MD; and Sumbul Ahmad Desai, MD; and,

·       Engaged with the Argonaut Project and Health Gorilla (a centralized hub of healthcare data and information) suggesting a shift from wearables and basic device-based biometrics toward in-depth reporting, interoperability, and access to third-party healthcare data repositories—such as those in a person’s EHR or medical laboratory portal.

The Future of EHRs or Another Failed Attempt at Innovation?

Apple isn’t the only company to attempt such a system. Other efforts include Microsoft’s Health Vault and Google’s now shuttered Google Health. Another CNBC article notes that Amazon is also researching healthcare related options. “The new team is currently looking at opportunities that involve pushing and pulling data from legacy electronic medical record systems,” stated Farr. “The group is also exploring health applications for existing Amazon hardware, including Echo and Dash Wand.”

However, where most services fail to gain traction is user engagement. After all, if a system isn’t widely used or fails to offer benefits over existing systems, patients and service providers are not likely to go through the process of switching systems. Speaking with CNBC, Micky Tripathi, President and CEO of the Massachusetts eHealth Collaborative notes, “At any given time, only about 10% to 15% of patients care about this stuff. If any company can figure out engagement, it’s Apple.”

According to comScore, 85.8-million people over the age of 13 already own an iPhone in the US. The upcoming facial recognition features on Apple’s iPhone X might also provide the added security needed for those questioning the safety of their data. Should Apple succeed, communicating data between clinical laboratories, physicians, and patients might be both convenient and fast. More importantly, it might be the universal platform that finally provides health data access across the entire care continuum, while simultaneously improving access to providers and empowering healthcare consumers.

Of course, this is a few years from reality. But, we can speculate … would innovative medical laboratories have their patients’ lab test data hosted in the Cloud in such a way that patients and providers could access it securely, along with other protected clinical records?

Imagine how this would enable patients to have their complete medical record traveling with them at all times.

—Jon Stone

Related Information:

Could Apple Be Taking a Bite Out of EHRs?

Could Amazon or Apple Actually Make a Dent In the EHR Market?

Apple Extends Its Reach into Healthcare

Electronic device that computes health data

Apple Is Quietly Working on Turning Your iPhone Into the One-Stop Shop for All Your Medical Info

Wait! What? Amazon and Apple Eye Building EHRs

Apple Is Working with This Small Start-Up to Change How We Track Our Health

Timeline: How Apple Is Piecing Together Its Secret Healthcare Plan

Amazon Has a Secret Health Tech Team Called 1492 Working on Medical Records, Virtual Doc Visits

With Apple Consulting Argonaut Project on Health Records, Interoperability Could Get the Push It Needs

Apple Enlists Help of Startup Health Gorilla to Add Diagnostic Data to iPhones

University of Michigan Study Predicts that Majority of Physician Practices Will Lose Money on their EHR Systems

Research study shows opportunity for clinical laboratories to help client physicians get more value from their electronic health record systems

For the majority of physicians in the United States, implementation of an electronic health record (EHRs) system in their practice may turn out to be a money-losing proposition. That is one prediction made by researchers at the University of Michigan (UM), based on a study they conducted.

Among other things, these findings indicate that progressive clinical laboratories and pathology groups have the opportunity to leverage the interface between their laboratory information system (LIS) and the client physician’s EHR to deliver added value. That’s because pathologists, Ph.D.s, and laboratory scientists know many ways that physicians can improve how they order medical laboratory tests and act upon the results of those tests.


HIE 2.0 Approaches as HIE Connectivity Delivers More Value for Patients and Providers

Advances in HIE technology and performance could prove beneficial to clinical laboratories and anatomic pathology groups

Even before most clinical laboratories have substantial experience with a full-function health information exchange (HIE) serving their region, one HIE expert is predicting that the next generation of HIEs is soon to arrive and will deliver more functionality.

“We’re maturing from HIE 1.0 to HIE 2.0,” declared Micky Tripathi. “We’re in a new world now.” Tripathi is in a position to know. He is CEO of the Massachusetts eHealth Collaborative. He also participates on the boards and/or steering committees of the Information Exchange Workgroup of the HIT Policy Committee, the eHealth Initiative, and the New England Health Exchange Network (NEHEN). (more…)