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Despite EHR, Patient ID Problems Persist

Scott Mace, for HealthLeaders Media, July 31, 2013

Duplicate-detecting algorithmic technology is generally known as enterprise master patient index technology. "It's all matching on information that you have on the patient, so name, address, telephone number, cell phone number," Richards says. "There are algorithms that run that give you a score of how sure the system is that this is the same person coming from multiple different institutions."

Geisinger is a textbook example of why, in the EHR age, EMPI is still in use. "Epic's master patient index works very well in the Epic world, which is in our case pretty big," Richards says. "We have about 9,500 users on any given day using the Epic system. We have their inpatient/outpatient, many of their specialty modules—ED, OR. We probably run 12 or 15 of their software modules here, and they have very good master patient index for all those. It will track multiple medical record numbers from different sources."

But when Geisinger first installed Epic, it didn't reconcile Epic medical record numbers effectively with other external systems in use, not only within its provider system but now increasingly with its health information exchange. "So let's say that we purchase a hospital that has another billing system or another lab system or something," Richards says. "Epic, at least as we installed it originally, was not capable of taking calls from an external system, reconciling the numbers in its database, and interacting with that system," Richards says.

So, for the past 15 years and continuing today at a cost of $1 million a year, Geisinger maintains an EMPI separate from Epic to reconcile the non-Epic patient identifiers.

"We'd need an army of people to check every one of these, so it's well worth it," Richards says. "So once I've identified that person A from hospital X is the same person from Geisinger, I'll then capture their identifier, their medical record number, from hospital X and so I'll have that forever, and so the next time I don't have to match on all of these parameters. I know that this person coming from this organization has this patient identifier. Over time, it gets more efficient."

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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