A recent article on the challenges posed by mistakes in patient identification was rather pessimistic about the amount of progress that has been made in the field (see: Fail-safe patient ID matching remains just out of reach patient-id). This boils down to the challenge of ensuring that the EHR record of "Mary Smith" who is admitted today is uncorrupted by data from a different "Mary Smith" who was admitted to the hospital yesterday. Below is an excerpt from the article. It's long so read the whole thing if you are interested.
[D]igital technologies—electronic health records in particular—have greatly exacerbated the challenge of ensuring that clinicians not only accurately identify patients but match them to their medical records. There's a lot more data flowing around and between health systems now than ever before. At a time when healthcare organizations are looking for every advantage to cut costs while improving quality and safety, patient matching is a challenge that can cause problems on a lot of levels. When a hospital has a patient's correct health record, it not only provides better care but it can cut down on the costly inefficiency of having multiple records for one patient or a single— erroneous—record for one patient. Estimates of patient-matching accuracy vary, but most say that it hovers around 90%. The problems posed by the remaining 10% are costly, both in terms of safety and money....
[H]ealth systems are searching for a combination of digital and manual fixes. They're using tools that run probabilistic matching on records, and they're also training patient access staff to match records by hand. Most health systems use a combination of demographic information and internally assigned patient identifiers to match patients to their records. At Geisinger Health, for instance, staff use a master patient index database that spans the entire enterprise to match patients to their records. Every day, several people work to keep the master patient index data “clean” so it can probabilistically match patients correctly more than 90% of the time....Just because a patient has a name matching one of the clinic's records doesn't mean that patient is the one who's in the records.... Some health systems are layering software on top of their EHRs to address the problem, at least internally.....In early 2018, Apple launched a new version of its Health app that allows patients of certain health systems to download their health records onto their iPhones. It's one big step toward making patients the agents of interoperability.
Here is a definition for the enterprise master patient index:
An enterprise master patient index (EMPI) is a database that is used to maintain consistent and accurate information about each patient registered by a healthcare organization. It may link several smaller MPIs together, such as those from outpatient clinics and rehabilitation facilities. An EMPI can also aggregate patient data contained in separate systems within one facility.
The search for as solution to the patient ID problem has been exacerbated by the broad adoption of EHRs with a single system spanning a large health system and scores of people responsible for the correct patient ID when entering data. I have blogged about the Apple initiative, mentioned in the first excerpt, that enables patients to view their EHR records with their iPhones (see: Apple Getting Traction with Its App to Access EHR Records with iPhones). Unfortunately, I don't think that making patients the "agents of interoperability" for monitoring the quality of their own records is a practical solution to this problem. Too few patients will use such a system and its not practical to ask them to scan their entire record and determine if any of the entries possibly belong to another patient. The sole solution to the problem is the adoption of universal health identifier such as that being used in countries like Australia but there is little chance of such a system being adopted in the U.S. One reason is that there is too much distrust of the government at this time, exacerbated by the political rhetoric of Donald Trump.
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