COVID-19 Magnifies Urgent Need for Patient Identification Strategies

COVID-19 Magnifies Urgent Need for Patient Identification Strategies

By Mary Butler

The absence of a unique patient identifier and a national strategy for improving patient identification is negatively impacting the US healthcare system’s response to the COVID-19 pandemic and is exacerbating racial disparities in patient outcomes, experts warned on Tuesday. In a Virtual Capitol Hill briefing hosted by members of Patient ID Now, officials from provider organizations, Congress, AHIMA, and health IT stakeholder groups discussed patient identification issues that have cropped up in coronavirus hotspots across the country as a result of faulty data.

The briefing, “Patient Matching: An Essential Tool in the Era of COVID-19,” featured Rep. Bill Foster (D-IL), who has sponsored legislation to lift the ban on federal funding for a unique patient identifier; AHIMA member Rebecca Way, RHIA, director of revenue cycle and business operations for Northwell Health; Abby Sears, CEO of OCHIN; and Aaron Miri, chief information officer at the University of Texas at Austin Dell Medical School. AHIMA CEO Wylecia Wiggs Harris, PhD, CAE, helped moderate the event.

While all webinar participants share a common advocacy goal of raising awareness for the patient safety implications resulting from patient misidentification, they all have also witnessed, firsthand, how the pandemic has magnified the situation. Northwell’s Way described problems her health system encountered during New York City’s unprecedented surge of COVID-19 patients this spring.

“We’re having a lot of issues with matching patient records. The pandemic brought it to the forefront by the sheer, massive increase in the volume of patients…we had drive-thru testing sites that are more prone to intake errors. Sometimes people that tested positive received the wrong test result, and that high volume caused turnaround issues,” Way said.

She also noted that inaccurate demographic data hinders contact tracing efforts, as undocumented patients are reluctant to share this type of information.

OCHIN, a nonprofit health IT services provider for 500 care delivery sites, closely monitors the pandemic’s impact on underserved populations and has identified some startling trends. Sears, their CEO, noted that 60 percent of the patients in their network have a chronic condition and half have a secondary diagnosis. According to OCHIN’s data:

  • Black patients make up 13 percent of OCHIN’s population and 21 percent of duplicate records, almost twice the expected rate
  • Hispanic/Latino patients make up 21 percent of the population that OCHIN serves, yet they make up 35 percent of the duplications, for almost twice the expected rate
  • 3 percent of OCHIN patients have experienced homelessness, but they account for 12 percent of mismatches and duplicates, or almost three times the expected rate
  • 1 percent of OCHIN patients are part of the migrant population, but account for 3.6 percent of OCHIN’s mismatch/duplicate population, at almost twice the expected rate
  • 2 percent of OCHIN patients are in the corrections system, but they make up 0.7 of OCHIN’s mismatch/duplicate population, which is over three times the expected rate

And among those seen in OCHIN member clinics:

  • Black patients were 2.5 times more likely than non-Hispanic white patients to have a COVID-19 diagnosis in the EHR
  • Hispanic patients were twice as likely as white patients to have a COVID-19 diagnosis in the EHR
  • COVID-positive patients were 1.7 times more likely to be homeless or housing insecure

Poor patient matching doesn’t just impact acute treatment of COVID-19 cases—it also will impact vaccinations when the US reaches that milestone. For example, Way pointed out, if employers make vaccination a condition of someone’s employment, what happens when a vaccination registry is unable to connect an individual with proof they’ve been vaccinated?

“If we can’t connect that to the patient record, there will be long-standing effect on employment. How can we study impact of vaccination if we can’t connect it back to the right patients?” Way asked.

Mary Butler ( is senior editor at the
Journal of AHIMA.

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  1. I’m sure more educated and involved people than myself are studying this issue. Is there someway to implement teams in different regions to assess each EHR, district or area (however needed). Have a full review of the people considered duplicated, flag them for a second review, research each for more information or clarification and move these to another area of the EHR or system that doesn’t calculate into the numbers needed. This way they can continue to be on record, but be isolated while being proven correct or incorrect.

    While this seems like a tremendous task, and it is, it would be the simplest, clearest way to detect these duplication issues and remove until they are providing none way or another. When completed and reviewed, they can be set aside or added back to the population in the EHR correctly.

    1. Hi Kimberly, I am a recent graduate of the health Information Management field. I am familiar with duplicate records in the EHR as well as the process of data cleansing to correct these records. The MPI team is mainly responsible for handling duplicate records and sometimes patient registration. The issue is that duplicate records are most often discovered by mistake (that is because a duplicate MRN does not simply mean it is in fact the same patient with two MRNs- it could be another patient’s information added to a record that was thought to be the same patient)only then can they be flagged as a possible duplicate. Duplicate records cause issues such as-information for a single patient existing in more than one area and an inaccurate view of a patient’s medical history. These records can’t necessarily be isolated due to a patient being currently admitted to a facility, also all patient MRNs must remain in the MPI. The duplicate records can however be flagged and visible to those who are authorized to view the record. This can sometimes be a lengthy or quick process it just depends on how much information is available and if the patient is currently admitted or discharged. Hope this helps.

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