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Despite EHR, Patient ID Problems Persist

Scott Mace, for HealthLeaders Media, July 31, 2013

If you think that moving to electronic health records will eliminate mistaken identity in healthcare, you are mistaken.

This article appears in the June issue of HealthLeaders magazine.

The change from fee-for-service to coordinated care is challenging providers to solve a longstanding need to identify patients more precisely to avoid waste, fraud, and substandard care.  

For years, the healthcare industry has recognized the problem of errors related to improper patient identification. If you were to think that moving to electronic health records would eliminate mistaken identity in medicine, you would be, well, mistaken, according to a variety of healthcare executives interviewed for this story.

The reasons are many, but mainly boil down to incompatibilities between different vendors' EHR technology and the variety of identifiers generated by the other technological systems in use in hospitals and that come from many sources—everywhere from insurance companies to subsystems dedicated to labs or other diagnostics—and that have evolved in isolation from each other over the past 40 years.

"You have to be able to identify the patient across all the venues of care in order to be able to do analytics on the information to make sure that … the care is being delivered, and people are getting the care, and that they're getting only the care that they need in a cost-effective manner," says Frank Richards, CIO of Geisinger Health System, a system that serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.

Patient identification is a fundamental building block of the emerging accountable care organization trend, according to Bill Spooner, CIO of Sharp HealthCare, which operates four acute care and three specialty care hospitals with an approximate total of 2,000 licensed beds in the San Diego region.

"The important thing is to be able to get accurately identified patients into your database and to be able to link them out to your transaction systems so everybody knows who they are so you can effectively engage in care management," Spooner says.

The United States in particular faces a hurdle that other developed countries do not: By law, the U.S. Department of Health and Human Services is prohibited from establishing a national patient identifier.

Providers are coping in several ways. Technology exists to flag suspected duplicate identities with varying degrees of certainty. Some are turning to technology offered by suppliers of their electronic health records.

Other providers are relying upon technology that has been employed by payers for years. And for those systems that can make the technological jump, patients are now being positively identified during every visit using smart cards with photo IDs attached, or even by biometric means, such as fingerprint, palm, or retinal scans.

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2 comments on "Despite EHR, Patient ID Problems Persist"


John Trader (8/1/2013 at 10:48 AM)
Although this is an informative article, it contains inaccuracies about the use of biometrics for patient ID in healthcare. First, the healthcare industry is not using fingerprinting and retinal scans for patient ID. Fingerprinting brings too much of a stigma of criminality for it to be a viable modality plus it requires physical contact with a hardware device which doesn't bode well for infection control in a hospital setting and retina scanning is too invasive and expensive to use as a means of identification. I think that perhaps what Scott meant to say was iris recognition biometrics, which is in fact being used by many hospitals across the country. Second, he mentions the use of palm vein biometrics for patient ID in the context that it is a biometric identification solution that will uniquely identify a patient which in fact, it is not completely. Palm vein biometrics rely on what is called 1:Few segmented identification which means that when a patient enrolls, and then is subsequently scanned when they come back into a medical facility, the back end search does not encompass the entire EHR system, but rather a segmented list of patients. This is not a true way of eliminating duplicate medical records and preventing fraud and medical identity theft at the point of service. When you mention biometric technology, it is vital that a factual explanation of the science behind the technology is properly presented so there isn't a continual perpetuation of misinformation and health care facilities can make educated decisions on what technology is the most appropriate to invest in. It's unfortunate that proper research and due diligence on biometrics wasn't conducted for this article, and what would have been more appropriate is not to even have mentioned biometrics at all if it isn't accurately described.

flp (7/31/2013 at 12:26 PM)
Great piece...and one of the reasons why systems in health care are more costly and complex. This issue first came up when hospitals installed IBM 1440 computers, circa 1960. And what if the patient uses an alias? Or shows up comatose in the ER? The real price (to the public) of a true EHR that can follow you everywhere is a unique person identifier – using biomarkers, cards, whatever. ONC is big on continuity /coordination of care, yet has not even ventured into this quagmire with any MU criteria...wonder why? It's not a technical problem, it's a political problem. Not an issue for other countries, but here in the USA it's a non-starter. So we probably spend hundreds of millions on technology and human work-arounds in the name of privacy. Then blame healthcare organizations for 'wasting' money running inefficient uncoordinated systems. And don't blame the vendors. As a former vendor I can guarantee you that if the feds came up with a unique identifier every one of them would have it in their system in a week. I have been in the HIT world for over forty years and I will say if you can 'solve' this one, you could knock an easy 2% of the cost of healthcare. Funny everybody wants it, but nobody is willing to 'pay' for it. Frank Poggio The Kelzon Group