Executive Summary
Incorrect or missing data in electronic health records is one of the top 10 patient safety concerns identified in a recent ECRI Institute report. Inaccurate registration information can harm patients in these ways:
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Test results might be sent to the incorrect physician.
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The wrong patient’s information might be added to another patient’s account.
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Incorrect dosages can be given if outdated weights in registration systems are shared with pharmacy systems.
Registration accuracy is “a very significant issue in terms of patient safety,” warns Bill Marella, director of patient safety reporting programs at ECRI Institute, a Plymouth Meeting, PA-based organization that researches approaches to improving patient care.
“One transposition of a social security number or a patient’s first or last names could result in wildly different versions in how their encounter with the healthcare system goes,” says Marella.
Incorrect or missing data in electronic health records, including registration systems, was named as one of the top 10 patient safety concerns in healthcare, according to a recent ECRI Institute report. (The complete report is available at http://bit.ly/1F6juEm.)
“We’ve had a number of reports dealing with bad information captured during the registration process,” Marella says. (See story in this issue on actual registration errors that were reported to ECRI institute.)
Errors caught too late
Many patient access employees have no idea that the demographic information they’re obtaining influences what kind of care people receive.
“They may think they are capturing information that just affects billing. But that is no longer true,” says Marella.
In many cases reported to ECRI Institute, mistakes made at the time of registration aren’t caught until days later. “They go to cut the patient’s arm band off. When they go to put a new one on, they realize the information is not right,” says Marella.
Every piece of data collected at the point of entry is used by other hospital staff, clinical and non-clinical, throughout the patient’s stay, emphasizes Sue Ojeda, CHAM, senior manager of revenue cycle management at Tucson (AZ) Medical Center (TMC).
Here are some practices that can prevent registration errors:
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Be sure registrars understand that the information they obtain affects the patient’s care, long after they are no longer in contact with the patient.
Marella says, “These reports are coming to us from the patient safety officers in the hospitals. Having them talk to registration professionals about errors that have occurred in their facility might really bring the point home.”
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Have an enterprise master patient index.
This index reduces the likelihood of creating duplicate records or associating the current patient with another patient’s information.
“Those are the best systems out there for trying to prevent these errors on the front end and help to validate the information that gets sent to HIEs [health information exchanges],” says Marella.
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Simplify the interfaces between systems used by patient access.
“If you are procuring a new IT system, one thing to look at is how it uses data from the ADT [admission/discharge/transfer] system,” says Marella. For example, if the ADT system stores patients’ first and last names as discrete fields, while an interfaced system stores the names as one field, with last name followed by first name, this difference creates a potential failure point.
“The fewer translations that are made across the dozens of interfaces that exist across a hospital, the less opportunity there is for error,” explains Marella.
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Ensure that the patient is identified at the first point of contact.
Ojeda reports, “We recently implemented a new process in our registration areas requesting that all patients presenting for services be photographed.”
Patients can opt out if they choose, but few do so. Staff use this scripting: “Effective July 13, 2015, TMC would like to take your picture for your electronic health record. This new process will help us ensure we have proper identification prior to your service today and in the future. This will also help us protect you from insurance fraud due to identity theft and/or misrepresentation. You have the option to decline or defer having your photo taken, but we encourage you to do so for your own protection.”
Ojeda says, “Over time, we hope to get a picture on every patient’s electronic health record.”
Patient access supervisors trained every employee on how to position cameras and how to save the photo to the patient’s medical record.
“This decreases the number of potential patient identity thefts,” says Ojeda. “It also ensures proper identification prior to the patient’s services being rendered.”
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Sue Ojeda, CHAM, Senior Manager, Revenue Cycle Management, Tucson (AZ) Medical Center. Phone: (520) 324-1155. Fax: (520) 324-2855. Email: [email protected].
