In an ideal healthcare system, every patient’s journey is seamless, vital information is always accurate and accessible, and care is truly personalized. Yet, as highlighted in a recent webinar with Banner Health, the reality is often far from this vision, plagued by a pervasive and often dangerous issue: inaccurate patient identity data. This deep dive explores the critical nature of this problem and offers insights into how organizations like Banner Health are tackling it head-on.
The hidden dangers of mismatched identities
A person’s healthcare data is sourced from different systems, supplied by varied entities, and maintained over many years. Changing addresses, mistyped birthdates, and common names shared by other patients can make it difficult to compile an accurate, up-to-date view of a patient.
As discussed in the webinar, a staggering 14% of people in the US don’t have a unique name and birthdate combination, and 30% of identifying data is out-of-date, incorrect, or incomplete. This isn’t just about inconvenience; it’s about patient safety, operational efficiency, and financial wellbeing.
Megan Pruente, IT Director of Person Identity Management at Banner Health, shared insightful statistics from her own organization. Banner Health found over 2,000 patients with the exact same first name, last name, and date of birth. She warned that relying on limited data points for identification drastically increases the risk of overlays—instances in which two different people share the same medical record, leading to potentially catastrophic errors. Other times missing or incorrect data is observed but not automatically updated.
Pruente is part of an American Health Information Management Association (AHIMA) work group focused on naming conventions. She recounted two examples shared in the group that highlight the potentially fatal consequences of not seeing a patient’s full story. In one, an unidentified trauma patient arrived at the emergency department with self-inflicted wounds; although a provider recognized the patient and previous suicidal tendencies were noted in the patient’s official medical record, the “John Doe” chart was not updated with the patient’s name. While not uncommon, as changing names mid-treatment can cause delays downstream, it led to a tragic outcome.
In another story shared with the AHIMA work group, a woman’s sister fraudulently used her patient ID card to request OxyContin, leading to incorrect drug-seeking documentation in her medical record. The record was not corrected until the woman became aware of the fraud attempt over a year later. These aren’t isolated incidents; they’re stark reminders of the human cost when patient identities are compromised.
The far-reaching impact on healthcare operations
The ripple effect of poor patient identity management extends across the entire healthcare ecosystem, impacting patients, clinicians, and administrators alike. For healthcare professionals striving to deliver outstanding care, understanding these impacts is crucial:
- Financial drain: Inaccurate data costs healthcare organizations dearly. A Black Book study reveals repeated medical care due to duplicate records costs hospitals nearly $2,000 per inpatient stay. Denied claims resulted from inaccurate identity data costs the U.S. health system over $6.7 billion annually.
- Compromised care delivery: Incomplete care histories, missed allergies and medications, and the commingling of different patients’ data can lead to serious medical errors and suboptimal treatment.
- Administrative burden: Redundant tests, duplicated procedures, and the immense operational effort required to reconcile errors drain resources. Banner Health’s Health Information Management (HIM) team alone works on an average of 800 duplicates a day. For HIM professionals and operations managers, this underscores a monumental task that diverts valuable time and resources from other critical functions.
- Negative experiences: From frustrating registration processes for patients to clinicians struggling with incomplete charts, the impact on satisfaction and trust is significant. Patient experience leaders understand that seamless identity management is foundational to building patient loyalty and engagement.
A trifecta of solutions: People, process, and technology
Solving this complex challenge requires a holistic approach that integrates people, processes, and technology.
Technology plays a crucial role in laying the foundation. Advanced Master Data Management (MDM) platforms, often incorporating an Enterprise Master Person Index (EMPI), are designed to unify disparate data points and create trusted 360-degree views of individuals. The webinar highlighted that cutting-edge solutions now feature:
- Extraordinary accuracy: Utilizing sophisticated algorithms and reference data to match and resolve patient identities with high precision.
- Native data enrichment: Going beyond basic demographics to include crucial insights like social determinants of health, offering a more holistic view of the patient.
- Digital identity verification: Ensuring that individuals are who they say they are when accessing systems or services, bolstering security and trust.
- AI-powered data governance: Ensuring the accurate, up-to-date version of data is delivered where and when it’s needed, automating critical data management tasks.
Artificial Intelligence (AI) is also emerging as a powerful tool in this field. It’s recognized as a huge driver for the need for accurate patient identity, as high-fidelity, complete, and unified data is the bedrock for any effective AI or machine learning initiative in healthcare. Furthermore, AI is being incorporated into patient matching algorithms to:
- Reduce manual review queues: AI can learn from human decisions to automate and suggest accurate matching for records that are close but not definitively the same person, thereby significantly reducing the burden on data stewards.
- Enhance decision-making transparency: Efforts are underway to explain the matching decisions being made by AI, fostering trust and enabling better oversight.
However, even the best technology needs the support of well-defined processes and dedicated people. Robust HIM teams, clear naming conventions, and proactive chart correction processes are essential to prevent and manage identity discrepancies.
Pruente also highlighted the critical task of actively managing false positives, noting that many organizations face significant challenges in this area. She underscored the importance of deeply analyzing algorithm performance and thresholds to minimize incorrect matches. Addressing common causes of false positives, such as twin data patterns, junior/senior data patterns, and overlaid data patterns, are key areas of focus for technology providers.
Making the business case: A strategic imperative
For healthcare leaders and managers, making the business case for investing in robust patient identity solutions can be difficult, but it’s a strategic imperative. As discussed, aligning these initiatives with broader organizational goals can unlock significant investment. Without accurate, unified, and complete data as a foundation, the promise of advanced technology in healthcare cannot be fully realized. Professionals looking to champion these changes within their organizations should articulate the benefits not just in terms of data quality, but also in terms of patient safety, operational efficiency, and the enablement of future-forward initiatives.
Learn from the experts
The patient identity problem isn’t just an IT issue; it’s a fundamental challenge impacting every facet of healthcare. Understanding its complexities and the transformative power of effective solutions is critical for any healthcare professional striving for better patient experiences, improved outcomes, and enhanced operational efficiency.
To dive deeper into this crucial topic and learn actionable strategies from industry leaders, watch the full webinar. Hear firsthand insights from Banner Health on how they’re tackling these challenges head-on and discover how a comprehensive approach to patient identity can revolutionize your organization’s operations.
