Addressing Cultural Variations Helps Get Patient Names Right

During the COVID pandemic, Maria Hewett, MBA, RHIA, realized that more needed to be done to address cultural variations in patient names.

“In the Hispanic culture, the way we have our name is our paternal last name comes first and is followed by the maternal last name,” says Hewitt, who is QA/MPI Reconciliation Coordinator for San Diego Health Connect. “When people were registering patients, we were having difficulty when they were being tested and vaccinated. We might have three generations, and the only difference would be the date of birth. Sometimes, they would not even give me the date of birth. So, it was one of those things: Who did they test?”

Hewitt and other health information (HI) professionals have worked with AHIMA to make uniform naming conventions. As a result of their efforts, earlier this year AHIMA issued the 2026 Patient Naming Framework, which was revised from the 2023 publication. The 2026 update reflects an expanded scope, deeper operational guidance, stronger cultural inclusivity, and tighter alignment with national interoperability standards.

The framework is designed for everyone involved in the lifecycle of patient demographic data — from the executive who sets policy to the patient whose care depends on accurate identification. For HI professionals, it provides an authoritative reference for developing and auditing organizational naming policies, and it supports Master Patient Index (MPI)/Enterprise Master Person Index (EMPI) governance, duplicate management, and staff training.

Getting Names Recorded Accurately

Mismatches and duplicate or overlapping records contribute to fragmented care, delayed treatment, billing inefficiencies, and heightened privacy risks.

“It was that sort of inconsistency that prompted me to join AHIMA’s endeavor of making uniform naming conventions,” Hewitt says.

A 2022 study by the Patient ID Now Coalition — New Perspectives On The Patient ID Problem In Healthcare showed organizations spent an average 110 hours per week resolving patient identity issues, more than one-third are spending $1 million annually on patient matching, and 70 percent agreed or strongly agreed that patients undergo or receive duplicative or unnecessary testing or services due to difficulties in managing patient identities.

Underserved populations are disproportionately affected by duplicate records, with Black and Hispanic/Latino individuals experiencing significantly higher rates of duplication. This exacerbates existing health inequities and underscores the urgent need for inclusive and equitable data management strategies.

Getting a patient’s name correct the first time in healthcare records supports better clinical decisions, smoother care coordination, and the kind of privacy and trust that patients and clinicians rely on. One way that AHIMA’s 2026 Patient Naming Framework strives to accomplish that is by providing expert guidance on cultural variations in naming.

AHIMA recommends capturing each name within the appropriate respective field; FIRST, MIDDLE, and LAST as identified on the approved government-issued ID/legal documentation including passports. Ensure that multi-part name components follow the AHIMA recommendations for multi-part names.

A Diverse Nation

HI professionals need to stay attuned to the nation’s changing cultural diversity and demographics, say Hewitt and others on the AHIMA naming framework committee. According to the U.S. Census Bureau in 2023, most U.S. citizens speak the following languages:

• English
• Spanish
• Chinese (Mandarin or Cantonese dialect)
• Tagalog (Philippine/Pilipino dialect)
• Vietnamese

A 2023 Census report found there were an estimated 45.3 million foreign-born people living in the United States, making up 13.7 percent of the nation’s population. These residents made up over one-fifth of the state populations in California, New Jersey, New York, and Florida.

The growing Hispanic population made up about one-fifth of the US population in 2023, making it the second largest group after the non-Hispanic White population, Census data show. California, Texas, Florida, and New York had the largest Hispanic populations.

“In Texas, maybe there are 2,000 Maria Garcias, and about 40 to 50 have the same birth date,” says Vivian Thomas, RHIA, CHDA, CHPS, CPHQ, CDIP, CPHIMS, who was part of AHIMA’s naming convention group. “You have to make sure you have the right match, and the cultural variance for Hispanics is very significant, and also for the Asian population.”

An example of a patient naming challenge: the common Vietnamese surname Nguyen can also be spelled as Nuyen, a one-letter difference that can lead to identity confusion.

“When you have different appellations of names that are mismatched within the healthcare system, the care that's rendered can be risky if it’s matched to the wrong record,” Thomas says.

Spanish and Asian Naming Conventions

To help HI professionals address cultural variations, AHIMA’s 2026 Patient Naming Framework expanded to Spanish, Chinese, Tagalog, and Vietnamese naming conventions. It also provides a Chinese surname reference table with the eight most-frequent surnames and dialect variants.

The section on Spanish-speaking naming conventions includes the following guidance:

• Married women may choose to use their husband's last name following their paternal last name and add the word "de."
• Because healthcare may have been accessed prior to marriage, it is important to cross reference the name through an Alias Name Field when possible.
• A female divorcee may choose to retain an ex-husband's last name or return to her other given name (i.e., maiden). Cross reference names when possible.
• When a patient has two last names, do not enter one of the Last Names as a Middle Name. Enter both last names in the Last Name field.
• Some Hispanic first names are preceded by Maria and another first name, e.g., Maria Eugenia — enter both names as first name.
• Do not use nicknames as First or Middle Name; document them in a separate field as "Preferred Name."
• When patient names differ between insurance cards and legal documents, use the legal name and record the insurance card information as an alias.

The framework also notes that Chinese naming starts with surnames (or family names) before the first name or given name. Most Chinese surnames are one syllable. Children bear the father's family name, and women do not change their surnames after marriage.

Navigating Technology Issues

When applying naming conventions, HI professionals also should consider how an electronic health records (EHR) system may create additional challenges.

“Many EHRs and other systems that are used sort of have this Western-Eurocentric design where a patient would have a first name, a middle name and a last name,” says Carmen Smiley, an independent consultant who was part of AHIMA’s naming convention group. “But as populations change, the older way of thinking about patients’ names has become more problematic. I have many relatives who have four or five names, but the systems where their patient records are registered don't accommodate all of that.”

Healthcare organizations can reduce naming errors by recognizing and addressing cultural variations, HI professionals say. Training and educating staff about such variations is an important step to help ensure that the right patient gets the right healthcare.

“I recommend they read and implement the naming policy but also learn from each other and learn from your patients,” Smiley says of HI professionals. “The naming framework is bringing awareness to everybody.”

Damon Adams is content production editor for AHIMA.