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By Erin Benson, MA, MBA

Matching a patient to his or her correct medical record is critical to the success of a healthcare organization. Attributing information to the wrong patient’s record or creating a duplicate record not only puts the patient’s safety at risk, but also decreases productivity and can lead to lower reimbursements.

Moreover, ensuring patient data integrity goes hand in glove with efforts to achieve interoperability. The Office of the National Coordinator (ONC) for Health Information Technology recently unveiled its strategic health IT draft plan on data sharing that presupposes that patients and providers trust in the integrity and safety of electronic health information. ONC’s interoperability goals will be hard to achieve for organizations that do not have records accurately linked to their patients, whose information is within the walls or systems of each healthcare organization and is not being linked correctly to one record for each patient. The goal of the ONC’s strategic plan is to give consumers access to the data, but who secures it and its integrity? And does the patient understand the implications of sharing the data?

How Patient Record Erosion Occurs

Duplicate and inaccurate patient records present challenges for provider operations and patient safety: health systems’ master patient index can have as much as 10-20 percent of duplicates and errors. Errors can result from providers using different data entry formats, data entry errors during patient registration, as well as normal demographic changes such as a patient moving or changing their name.

Using sensitive patient identification information such as a Social Security number to link patient records potentially exposes this clinically unnecessary data to fraud.

Various departments may inadvertently end up creating errors or duplicate records because they use different patient look-up methodologies. Mergers and acquisitions also introduce inaccuracies into the records, as records from disparate electronic health record (EHR) systems across hospitals, physician practices, and clinics are integrated but possibly not correctly linked and merged.

If information is spread across multiple record files within the system, it does not give either the patient or provider a complete picture of the patient’s health, undermining trust in the health system’s ability to handle data necessary to provide high-quality care. Implementation of unique patient identifiers and related technologies to identify and link each patient throughout disparate healthcare organizations should be part of the effort to achieve patient data integrity and facilitate interoperability. In fact, recent Pew Trust research confirms that patient linking can enhance interoperability, reduce costs, support innovation, and improve patient care and satisfaction.

Patient Safety, Outcomes Depend on Correct Records

Patient record errors pose a direct risk to patient safety. A study conducted by the Institute for Safe Medication Practices found that wrong-patient errors happen about once for every 1,000 prescriptions filled. At the top of the ECRI Institute’s 2019 Top 10 Patient Safety Concerns was diagnostic stewardship and test result management in electronic health records (EHRs)—indicating just how important it is to make sure information can be properly communicated to the clinical care team. That starts with getting that information attributed to the right patient record.

Patient data inconsistencies also generate numerous challenges as organizations seek patient care improvements, plan additional expansion, launch population health initiatives, implement new information systems, navigate payment policies, and assess organizational performance. Additionally, inaccurate population count and lack of updated contact information undermines other efforts to succeed in value-based care, including preventive care, social determinants of health (SDOH)-based outreach, and population health management.

A Trickle-Down Effect on Revenue, Patient Satisfaction

The accurate patient record issue extends to the financial health of an organization. Research found that 33 percent of all denied claims cost an average hospital $1.5 million annually—and the US healthcare system as a whole more than $6 billion a year. The loss was credited to incorrect patient record data, which often led to redundant testing and denied claims.

Having to repeat tests or have their benefits denied and care delayed is certainly cause for frustration for patients, who expect the same seamless and customer-focused experience in healthcare as they receive in retail, banking, and other services. Patients may be prompted to score providers lower on CAHPS surveys, which impact provider quality ratings and the ability to collect reimbursement. With rising high-deductible health plans, patients are becoming more attuned to the costs they have to pay directly before benefits kick in.

Solving the Challenge One Unique Patient Identifier at a Time

The good news is many organizations have taken notice and are focusing proactively on patient record integrity. Many stakeholders advocate for a national patient identifier; meanwhile, the industry can tackle the problem by capitalizing on unique patient identifiers to uniquely identify each patient, link records together as they come in from disparate sources on the same patient, and keep the patient’s contact information up to date. For example, referential matching technology uses unique identifiers and third-party data to pair duplicates, identify and resolve linking discrepancies, and provide continuous updates to the record.

Among healthcare organizations spearheading their own efforts to address preventable errors is the National Council for Prescription Drug Programs (NCPDP). Its members chose to use a vendor-agnostic universal patient identifier (UPI) to help ensure accurate identification of patients. LexisNexis® Risk Solutions LexID® is a unique patient identifier the industry partners will be able to use in their pharmacy billing and e-prescribing transactions to help avoid preventable errors.

The technology gives patients, hospitals, payers, physicians, and pharmacies the confidence to link records regardless of health IT systems to get a clear picture of the entire patient journey. Achieving an accurate view of the patient population through correct records builds the foundation for delivering high-quality and safe patient care and fulfills a prerequisite to interoperability.

 

Erin Benson, MA, MBA, is senior director, market planning at LexisNexis Risk Solutions, works with a focus on the development and execution of strategic planning for member identity and socioeconomic determinants of health solutions.

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