Electronic health records (EHRs) have undoubtedly improved patient care and medical billing, but they have also highlighted the importance of accurate patient matching. Providers and payers often have distinct ways of identifying the same patient, and patients may even refer to themselves by different names (e.g., Robert, Bobby, Rob).
Name variations make it difficult to track patients, and the challenge is compounded by different patients’ having the same, or similar, first and last names. EHRs and health information exchanges (HIEs) increase the risk of duplicating and spreading mismatched patient records, which in turn increases the risk of errors in medical billing — and even healthcare delivery.
The cost of patient mismatching
With the number of patient records a healthcare practice or hospital deals with daily, multiplied many times over a week or a month, it’s not hard to imagine occasional problems with mismatched patient identities. Whether due to a simple clerical error, such as a mistyped social security number, or two patients’ sharing the same name, matching mix-ups do occur. The main consequence is typically the time and expense of finding and correcting the error, but there are also potential ramifications for patient safety and healthcare outcomes.
Consider a situation in which a patient with a serious chronic condition is not given the medication they need because their records were confused with those of another patient. Or one in which a patient suffers serious complications after receiving treatment intended for a patient with a similar name.
Accurate patient matching is also imperative for the revenue cycle. Billing and successful claims processing depend on correct patient identification.
EHRs, HIEs, and a changing landscape for patient matching
Few things have changed healthcare delivery more than the advent of EHRs, and those changes have, for the most part, been helpful to providers, patients, and payers. But these records still reside in siloed, disparate systems. The next logical step is to merge these disparate systems into one universally accessible data hub. Initiatives to improve communication and interoperability are driving demand for the adoption of HIEs.
A HIE is designed to facilitate provider access to complete patient records to ensure continuity of care. But HIEs introduce additional — and more far-reaching — risks for patient matching errors.
Looking to the future
The demand for widespread HIEs emphasizes the need for accurate patient identification and matching. Because multiple providers can access the patient information in an exchange, a single error can be replicated across numerous healthcare systems. And each point and instance of access is another point of risk for the introduction of new identification errors.
A successful HIE will require standardized data elements and a uniform data capture method. When all EHR systems capture and store patient data in the same format, algorithms can match patient records across healthcare systems. Other solutions, including the use of national patient identification numbers, are also being considered for eliminating patient matching errors, streamlining billing and claims processing, and ensuring patient health and safety.
To learn more about accurate patient identification and matching strategies, contact TruBridge.
Written by Rachel Hayes