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Is Petitioning Congress the Answer to Achieving Accurate Patient ID?

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Hat tip for the recent efforts by the American Health Information Management Association (AHIMA) to launch a petition drive that will move Congress to lift the federal legislative ban that has prohibited the U.S. Department of Health and Human Services (HHS) from participating in efforts to find a patient identification solution. It’s a noble effort and adds fuel to the hot fire burning in the industry to solve the persistent and dangerous problem of achieving accurate patient identification in healthcare. We understand that the effort to improve patient identification in healthcare has many downstream benefits to the entire industry including (but not limited to):

— Revenue cycle management
— Patient safety
— Health information exchange
— Population health

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AHIMA’s efforts to petition Congress to life the federal moratorium on funding research on developing a national patient identifier may not do much to adequately solve the problem.

The fact that organizations with the clout of AHIMA and CHIME have contributed their powerful voices to the battle of improving patient ID in healthcare is advantageous to the end goal of finding a universal solution that can be adopted collectively throughout the industry. AHIMA and CHIME’s efforts are working to garner more attention to the persistent patient matching problem in healthcare and sparking more discussions about how to solve the problem. Often relegated as a back seat initiative in favor of other healthcare technology initiatives (e.g. – ICD-10, EHR implementation, interoperability), we have always believed that improving patient identification in healthcare should be higher on the priority list.   

AHIMA’s initiative has merit, but is advocating the use of a credential predicated on the concept of presenting something you have or know the answer to solving the patient identification problem in healthcare? One of the reasons that the healthcare industry has struggled with accurate patient identification is that legacy methods of identifying patients have proven to be easy targets to exploit. Human identification generally falls into three distinct categories:

  • “What you know” – address, phone number, date of birth
  • “What you have” – insurance card, driver’s license, passport, government issued identity
  • “Who you are” – biometrics

Traditional identification methods generally rely on asking a patient what they know or what they have but we already know that these are frequently abused and easy sources to commit fraud. Just look at the continued rise in cases of medical identity theft at the point of service – an estimated 2.3 million Americans or close family members had their identities stolen during or before 2014, and a large number of these cases involve family members stealing or sharing medical insurance credentials.

In geographic locations throughout the country where a large percentage of the patient demographic may share similar names, providing a false name or multiple variations of a name at the point of service in order to defraud the system is common. An example widely used throughout the industry to illustrate this is the Harris County Hospital District in Houston where among 3.5 million patients, there are nearly 70,000 instances where two or more patients shared the same last name, first name and date of birth. Among these were 2,488 different patients named Maria Garcia and 231 of those shared the same birth date.

In geographic locations throughout the country where a large percentage of the patient demographic may share similar names, providing a false name or multiple variations of a name at the point of service in order to defraud the system is common. An example widely used throughout the industry to illustrate this is the Harris County Hospital District in Houston where among 3.5 million patients, are were nearly 70,000 instances where two or more patients shared the same last name, first name and date of birth. Among these were 2,488 different patients named Maria Garcia and 231 of those shared the same birth date.

Pushing Congress to lift the federal moratorium on funding research on developing a national patient identifier may lead to a solution that requires patients who opt-in to bring this credential with them when seeking medical treatment. In the absence of incorporating an additional identification credential that relies on “who you are,” simply creating another individual authentication credential that relies on “what you know” or “what you have” leads us down the same path of abuse and fraud. After all, in theory the national patient identifier would be similar to a social security number or other credential that is subject to being stolen, shared, or swapped just like current methods of identification. Do we really want to allow this to happen? Seems as if this solution would be the equivalent or rearranging the deck chairs on the Titanic. 

Moving forward, the smarter way to solve the identification crisis in healthcare is to adopt technology that identifies patients by who they are, or some sort of a combination of what you have or what you know with who you are. For example, the use of biometrics for patient identification – already a proven technology that patients accept and significantly reduces duplicate medical records, overlays, medical identity theft, and fraud – would be a more sensible way to identify patients to alleviate the problems caused by misidentification. 

Lobbying Congress to lift the moratorium on funding research to develop a national patient identifier won’t solve the patient ID problem in healthcare unless the industry realizes that it must move away from antiquated identification methods that rely on what you have and/or what you know and instead shift to identifying patients by who they are. Unless this is part of the equation, healthcare will continue to spin it’s wheels in the effort to solve the vexing problem of how to achieve 100% accurate patient identification.

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AHIMA Survey on Patient Matching Illustrates HIM Burdens, Frustrations

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The following post was submitted by Brad Marshall, Enterprise Development Consultant with RightPatient®

AHIMA Sheds Light on Patient Matching Problems in Healthcare

The American Health Information Management Society (AHIMA) released details of a survey yesterday that revealed over half of Health Information Management (HIM) professionals still spend a significant amount of time reconciling duplicate medical records at their respective healthcare facilities. The survey went on to reveal some very interesting statistics on patient matching and linking patient records, illustrating the burden that duplicate medical records have not only on HIM staff, but the dangers care providers face who increasingly rely on access to accurate, holistic patient data to provide safe, quality care. One particular stat that jumped out at us was:

“…less than half (47 percent) of respondents state they have a quality assurance step in their registration or post registration process, and face a lack of resources to adequately correct duplicates.”

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A recent survey of HIM professionals by AHIMA illustrates the problems that duplicate medical records have on accurate patient matching in healthcare.

This is an area of particular concern due to the fact that our research has shown that many healthcare facilities spend tens, sometimes hundreds of thousands of dollars per year reconciling duplicate medical records but very few have technology in place to prevent duplicates in the future. It’s encouraging that accurate patient matching in healthcare seems to finally be getting the attention it deserves, due to the digitization of the industry, the shift change from fee-for-service to a value based payment system and a burgeoning healthcare ecosystem laser focused on improving both individual outcomes and population health. AHIMA’s survey supports this assertion by stating:

“Accurate patient matching “underpins and enables the success of all strategic initiatives in healthcare…”

Equally concerning is the fact that less than half of HIM professionals surveyed have any type of patient registration quality assurance policy in place and only slightly over half of survey respondents could accurately say what their duplicate medical rate actually is. Not to mention the fact that HIM professionals spend entirely too much of their time reconciling duplicate medical records, with 73% reporting that they work duplicates “at a minimum of weekly.” 

As more healthcare organizations and facilities begin to understand that accurate patient matching has a major impact on other downstream activities, it is encouraging that the issue is finally getting the attention it deserves helped in part by the efforts of AHIMA, and CHIME’s national patient identification challenge which is scheduled to kick off this month.  It’s clear that the healthcare industry is slowly coming to the realization that many new initiatives borne from the HiTech Act and Meaningful Use (e.g. – population health, ACOs, health information exchanges, interoperability) don’t really have any hope to succeed in the absence of accurate patient identification. 

Duplicate Reconciliation Unnecessary Burden on HIM?

Early last year, we wrote a blog post on How Accurate Patient Identification Impacts Health Information Management (HIM) which highlights the exorbitant amount of time HIM spends reconciling duplicates and the opportunity cost this brings. For example, time spent on duplicate clean up and reconciliation could instead be allocated to coding for reimbursement and preparing, indexing, and imaging all paper medical records – a critical component in the effort to capture and transfer as much health data as possible to a patient’s EHR.

The fact of the matter is that as health data integrity stewards and medical record gatekeepers, HIM professionals are better served spending their time ensuring proper and accurate reimbursement and medical record accuracy then reconciling duplicates which should have never been created in the first place. HIM staff perform one of if not the most critical functions in healthcare by ensuring health data integrity, especially in light of the increasing reliance of often disparate healthcare providers need to access a complete medical record that includes as much information as possible.

As we noted in the post last January:

“…many hospitals have expanded responsibilities vis-à-vis Meaningful Use, EHR implementation, and meeting Affordable Care Act requirements, and it has become disadvantageous to continue devoting any time at all to duplicate medical record and overlay reconciliation. Biometric patient identification solutions open the door to re-allocation of HIM FTEs to more critical functions such as coding, reimbursement, and reporting. Simply put, implementing biometrics during patient registration is opening the door for HIM departments across the industry to provide a larger and more productive support role to meet the shifting sands of reimbursement and address the need to move towards quality vs. quantity of care.”

Conclusion

We could not have summed up the issue of duplicate medical record creation and reconciliation and inaccurate patient matching in healthcare more succinctly than this quote from AHIMA in the survey summary:

“Reliable and accurate calculation of the duplicate rate is foundational to developing trusted data, reducing potential patient safety risks and measuring return on investments for strategic healthcare initiatives.” 

Trusted data. Isn’t this the backbone of the new healthcare paradigm? Certainly we can’t expect to achieve many of the purported advances in healthcare in the absence of clean, accurate health data. It’s time to eliminate duplicate medical records forever, and establish cohesive, quality assured patient matching in healthcare.

What are your biggest takeaways from the AHIMA report on accurate patient matching in healthcare?

Brad Marshall works for RightPatient - the industry's best biometric patient identification solution.Brad Marshall is an Enterprise Development Consultant with RightPatient®. With several years of experience implementing both large and small scale biometric patient identification projects in healthcare, Brad works closely with key hospital executives and front line staff to ensure project success.