More than 20 years since the Institute of Medicine (IOM) issued its groundbreaking report, “To Err is Human: Building a Safer Health System,” patient safety remains top of mind throughout health care.
It’s one reason why patients undergoing surgery are repeatedly asked by doctors, nurses and other care providers along the way to verify their name, address, date of birth, the condition for which they are being treated and other information.
It also explains why the Joint Commission sets annual patient safety goals for nine health care categories: ambulatory; assisted living community; behavioral health and human services; critical access hospital; home care; hospital; laboratory services; nursing care, and office-based surgery. The first goal in all: “Identify patients correctly.”
Still, treatment errors attributable to mistaken identity happen. According to the Radiological Society of North America (RSNA), radiology’s largest professional organization, the healthy kidney of a patient at St. Vincent’s Hospital in Worcester, MA, in 2016 was mistakenly removed by a surgeon who mistook the CT scan of a different patient with the same name as that of the patient on the operating table. The surgeon had accessed the scan through an electronic health records (EHR) system at another facility, but he had neglected to use another identifier, such as an address, along with the patient’s first and last name.
This is not an isolated example. An ECRI Institute study found more than 7,000 patient identification events in its database over a period of about 2.5 years. The Pew Charitable Trusts in 2018found that matching accuracy can be as low as 80% within health care facilities and as low as 50% between facilities, even if they employ the same electronic health records system.
In the same RSNA article, Eliot Siegel, MD, professor of diagnostic radiology and nuclear medicine and vice chair of information systems at the University of Maryland School of Medicine, said the statistics, and the tragic example of the kidney patient, emphasize the need for more advanced identity resolution in radiology — like the use ofreferential matching technology.
Referential matching leverages a reference database with access to millions of public records to deliver far more accurate and confident patient ID matches than solutions based only on two or three patient identifiers.
By embedding this type of identity resolution and patient matching into their own technologies, IT vendors can better ensure the data collected in or passing through their solutions is accurate.
Interoperability among EHRs has increased significantly in recent years, but errors still occur, especially when considering incomplete patient duplicate records, or fragments. What if a medication is only listed in a patient record fragment, not the full patient record, so the provider misses that the patient may have an adverse reaction to a new prescription? Or if a key lab result is tied to another record duplicate for the patient, resulting in a critical missed diagnosis? Even with the most popular EHRs, small missing details like the absence of a middle initial, the use of a shortened version of a full name (Joe versus Joseph), and even shared birthdates increase the risk for record duplication, fragmentation, and other matching errors.
It doesn’t matter whether a patient is getting an annual physical, refilling a prescription, or undergoing open-heart surgery; matching errors based on inaccurate records can be serious —even disastrous. Providers require 100% proof, 100% of the time, that the patient they’re about to treat is the same patient who requires their help.
Knowing who is who can have high stakes for patient safety and clinical decision making. Verato offers the only referential matching solution built for healthcare — with industry-leading and independently verified accuracy — to help power patient safety across the healthcare ecosystem.