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● Electronic Health Records

This isn’t my

of duplicate, mismatched or overlaid patient records has lead to medical errors of varying severity. Despite the proliferation of electronic health record (EHR) systems, advances in integration capabilities and numerous technical and procedural checkpoints to avert medical errors, problems still occur at a disturbing rate, emphasizing the need for more sophisticated approaches to match and link the right patient to the right data. A client shared a real situation that illustrates the point:


A provider searching for a patient record chooses one from a list of candidate records on a screen. If the patient is present, the provider can ask a few questions to verify that the record belongs to that patient. Based on the information provided in the record, a medical care decision is made and medication is prescribed. However, that particular patient record, though accurate, is incomplete. T e patient’s allergy information is contained in a separate record created at the time of registra- tion and assigned a diff erent medical record number. When the patient takes the newly prescribed medication, it causes a reaction that requires a visit to the emergency room. T e reliability and consistency of patient information is also a contributing factor to the success of today’s eff orts to improve patient care through greater collaboration. T e chal- lenge, however, is that diff erent settings use diff erent patient identifi ers. As entities share more EHRs with accountable care organizations (ACOs), health information exchanges (HIEs), patient centered medical homes (PCMHs) and other connected care initiatives, the opportunity for data mismatches increases. What was once an error limited to a single setting can now be propagated across the continuum of care and corrupt data in other systems. Healthcare entities must therefore undertake a

10 March 2013

information! T e impact of accurate identity management on patient safety. By Richard Garcia

e’ve heard the stories and read our facility’s reports on patients receiving treatments based on information in someone else’s health record. The frequent occurrence

Richard Garcia is industry solutions strategist, NextGate. For more on NextGate Solutions: www.

rigorous review of their current patient identifi cation proce- dures and data governance policies to ensure data integrity. T e accurate identifi cation of a patient is not a trivial task, and it becomes more complex as the number of applications, facilities and data exchange partners increases. One reason for the identity challenge is the multiple points at which patient information is collected. Each entry point is an opportunity for data entry errors, such as misspellings and transposition of characters. Another reason is the normal change in demo- graphics, such as residential moves and changes in employment and insurance. T e various permutations of names can be an especially diffi cult issue, including aliases, nicknames, hyphens, spaces and unfamiliar spellings. Senior and junior designations and multiple births require extra attention. T e result of these complexities is often duplicate patient

records. In one scenario, multiple medical record numbers are assigned to the same patient, essentially fragmenting the patient’s clinical information among several, disparate records. In another scenario, two or more patients can be assigned the same medical record number, causing clinical information for both patients to be combined. T e most common approach to patient identity manage- ment utilizes the master patient index (MPI) of an existing core application, such as an EHR, hospital information sys- tem (HIS) or practice management system. T e MPI assigns a patient identifi er and keeps track of patient demographic information known to that system. Sometimes, the MPI can also store information on a patient that originated in another system, but that depends on the interface capabilities of the applications. Since these MPIs are most often just an embedded in-

frastructure component designed for the host application, they provide only basic capabilities and are not sophisticated enough to handle the requirements of cross-application or multi-facility patient identity management. When trying to


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