7 Reasons Why Patient Matching Failures are Dangerous

Thought Leadership

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 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 18% according to Black Book Market Research. Every missed match and duplicate record 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 case:

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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

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

Conventional matching solutions, like the MPI modules found in EHRs, and the enterprise master patient index (EMPI) solutions from vendors like IBM® and NextGate®, rely on demographic data to match patient records. But errored, changed or missing demographic information, such as last names or phone numbers, can easily cause a missed match.

Conventional MPIs and EMPIs are also unable to match if demographic data is missing from one patient record – and this problem is becoming more common, as 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 record – or worse a false overlay. Duplicates and false overlays greatly compromise patient safety and privacy, and lead to increased costs. Many healthcare organizations invest in teams of health information management (HIM) professionals to help manually resolve records suspected to be duplicates by EHR, MPI, and EMPI technologies. But these “potential duplicate records” often accumulate faster than HIM staff can keep up, resulting in 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 uses a totally new approach to patient matching called “Referential Matching” that is a quantum leap more accurate than the matching technologies found in conventional EHR, MPI, and EMPI systems.

Rather than directly comparing the demographic data from two patient records to see if they match, the Verato Universal MPI instead matches that demographic data to its comprehensive and continuously-updated reference database of identities. This proprietary database contains over 300 million identities spanning the entire U.S. population, and each identity contains a complete profile of demographic data spanning a 30-year history. It is essentially a pre-built answer key for all patient demographic data.

By matching records to this database instead of to each other, Verato can make matches that conventional patient matching technologies could never make—even patient records containing demographic data that is out-of-date, incomplete, incorrect, or different.

The Verato Universal MPI is also a HITRUST-certified SaaS solution. Simply put, it is the most accurate, easiest to implement, most secure, and most cost-effective EMPI solution on the market, 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.