7 Reasons Why Patient Matching Failures are Dangerous

Stephanie St. Thomas

Stephanie St. Thomas, Director of Marketing

7 Reasons Why Patient Matching Failures are Dangerous

As the healthcare industry continues to push toward interoperability, one key component is still lagging, causing cracks in the foundation of any successful data framework: Patient identity matching.

Duplicate or falsely matched patient records are still being created at an alarming rate, with an average hospital system seeing a duplication rate of 10% according to AHIMA. Every missed match has a trickle-down effect, compromising and threatening patients, providers and payers. Below we explore why existing solutions haven’t yet solved these issues, and why the Verato Universal MPI is uniquely suited to help solve each use cause:

  1. Patient safety:

92% of duplicate medical records are created at registration, according to a study by Johns Hopkins Hospital. New duplicate medical records lack the longitudinal history of the existing medical record, leading to medical errors and poor clinical decisions.

  1. HIPAA security:

According to HHS, there have been 152,759 HIPAA breach complaints. Wrong physical addresses or falsely overlaid records can cause a patients’ sensitive information to be sent to the wrong recipients – and can cost up to $50,000 per instance.

  1. Quality reporting:

Stars, HEDIS and payer performance contracts all hinge on accurate quality reporting. In order to provide a clear picture of each patient’s illness severity over time, providers and payers need the ability to link supplemental data to core data profiles – data that is notoriously thin or sparse.

  1. Care coordination:

One of the most critical use cases for interoperability is the need for cross-enterprise care coordination. Providers across an affiliated network (and heterogeneous EHR systems) need to reference the same patient with certainty and without compromising patient privacy.

  1. Patient experience:

In today’s interconnected world, patients are frustrated by the lack of coordination and communication across healthcare. Linking all patient interactions within a health system to streamline patient communication can solve many patient experience headaches.

  1. Unnecessary utilization:

A recent AHIMA study showed that on average, repeated tests or treatment delays added $1,100 to the cost of the patient’s care. In addition to sharing information today, providers need the ability to link patient identities to a prior point in time.

  1. Value based care initiatives:

As reimbursement is increasingly tied to a provider’s ability to impact health outcomes, it is critical for a provider to gain visibility into the patient’s full utilization. Missing clarity on lab tests for a patient can be the difference between achieving a performance bonus and paying a penalty.

 Related Content: Watch this webinar to learn how the radically different “Referential Matching” approach to patient matching can help organizations dramatically improve their patient matching

Why conventional master patient index (MPI) solutions aren’t able to solve these problems:

Current matching solutions, like conventional MPIs, rely on demographic data to search for records. But errored, changed or missing demographic information, such as last names or phone numbers, can easily cause a mis-match.

Conventional MPIs are also unable to match if demographic data is missing from one file. Thin or sparse demographic data is a primary feature of new data sets, such as patient portals, pharmacy claims and lab data.

An error in matching demographic data at any point can cause a duplicate or false overlay. Duplicates and false overlays greatly compromise patient safety and privacy, and lead to increased costs. Many healthcare organizations invest in teams of data stewards to help resolve duplicates that an MPI cannot match. But these potential matches accumulate faster than data stewards can keep up, resulting in massive backlogs of stewardship tasks and thousands of duplicate records – severely impeding the ability to accurately report quality performance or for timely enhancements to the care continuum.

Why the Verato Universal™ MPI is better:

The Verato Universal MPI is pre-populated with pre-mastered and continuously-updated demographic data spanning the entire U.S. population. It uses a new matching technology called “referential matching” to leverage this database as an answer key to match and link identities.

Because of this greater accuracy, the Verato Universal MPI is able to see-through false, thin, or old data errors that existing matching technologies miss. The Verato Universal MPI is cloud-based, meaning it can make matches continuously and in near-real-time, allowing payers and providers to easily develop a more complete patient picture.


Contact us to learn more, or read about how larger healthcare trends demand a new patient identity architecture in our White Paper by clicking here.


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