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:
- The Joint Commission;
- National Academy of Medicine;
- ECRI Institute;
- National Patient Safety Foundation;
- Bipartisan Policy Center; and
- Pew Charitable Trusts.
Extent of Patient Mismatching Unknown
“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.
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