EXECUTIVE SUMMARY

Patient access departments are using education and technology to prevent the creation of costly and dangerous duplicate medical records. Consider these strategies to help prevent duplication:

  • Avoid rushing during the registration process, even during volume surges.
  • Ask patients to spell their names instead of making assumptions.
  • Meet with health information management to discuss ways to avoid duplicates.
  • Implement consistent policies organization wide.

Accurate patient identification always has been critical to providing the best patient care. “But in today’s digital medical record world, how do you properly identify patients who have common names or are unable to identify themselves?” asks Kelly Clasen, senior director of business operations at Middle Park Medical Center in Granby, CO.

Despite growing focus on the problem of duplicate medical records, the problem continues. “Hospitals all over the country are struggling with this daunting task — not to mention the safety and financial ramifications that can occur if a patient is actually misidentified,” says Clasen.

According to the ECRI Institute, 7-10% of patients are misidentified when their Enterprise Master Patient Index (EMPI) and electronic health records (EHR) are searched. Of this group, 9% experience an adverse event. According to a report conducted by the American Health Information Management Association (AHIMA), between 8% and 12% of EHR records are duplicates.1

“Still more patients may suffer medical errors due to missing health information in their records, or overlays that mingle multiple patients’ records together,” says Clasen. Below are some common factors causing duplicate medical records.

  • Traditional patient identifiers, such as oral demographic data, Social Security numbers, and patients’ addresses, can be mistyped easily.
  • Patients do not always give correct demographic information, and registrars sometimes fail to verify what they’re given.
  • Duplicates often are caused by patient access employees rushing during the registration process, in order to meet productivity goals or because patient volume is high.

Lesley Kadlec, MA, RHIA, CHDA, director of HIM (health information management) practice excellence at AHIMA, acknowledges, “There may be pressure to get the patient registered quickly in the hospital setting.”

Family members or caregivers sometimes provide information to registrars on behalf of the patient, but don’t know exact birthdates, middle initials, or insurance information. These identifiers may be important to match patients with their health information. 

“Hospital registrars may also face language or communication barriers with patients or their family members,” says Kadlec. Patients who are extremely ill, upset, or confused may be unable to provide accurate information. 

“In emergent situations, where the need for timely treatment of the patient is most critical, hospital registrars may have no other option but to rely on incomplete information,” says Kadlec. Registrars create a new patient record to allow the patient to get needed care as quickly as possible, and sort it out later.

Some patients use multiple names, shortened versions of their full name, or an initial for the first name with a full middle name. Others go by a nickname that is not similar to their legal name.

“These aliases have the potential to lead to creation of an EMPI duplicate,” says Kadlec. This is particularly common in the hospital setting, because the patient usually is not known by registrars.

Common surnames and variations in spellings also occur. “It is not unusual to have multiple patients with the same or similar first, middle, and last names, who are near the same age, often related, and sharing other identifiers,” says Kadlec.

Consider ‘Downstream’ Departments

Cleansing inaccurate patient records can be costly for hospitals. Clasen notes, “The average cost to resolve a single duplicate medical record is $100. If 8% of a hospital’s records are duplicates, the costs to clean their EMPI database and EHR records increase exponentially.”

At Longmont United Hospital, where Clasen was director of business services, the duplicate medical record rate decreased from 7% to 2% after palm vein recognition was implemented.

“This can not only improve overall patient safety and experience, but also improve financial outcomes,” says Clasen. Costly cleansing of duplicates and overlays were reduced, as were denied claims resulting from misidentification.

However, patient access should not rely solely on biometric technology. Adria Jones, special projects coordinator at Harris Health System in Houston cautions: “Employees still need to interview the patient.”

Registrars often assume they know how to spell the patient’s name just based on how the name sounds. Instead, says Jones, “Ask patients to spell or write out their name.”

Patient access employees need to be reminded continually of the importance of doing a thorough search of the patient’s medical record number.

“Emphasize the impact it has on patient safety, revenue delays, and time spent by all ‘downstream’ departments, such as HIM, to correct duplicate medical records,” says Jones.

The following steps are taken at Harris Health:

  • HIM reviews the duplicate medical record report and analyzes the potential reason for it.
  • HIM sends a weekly report to the management team of each department on all duplicates that occurred in that area.
  • Management educates the involved employees.

HIM created a patient search tip sheet specifically for patient access. “This explains the different way to search a patient in our system,” says Latrescia Brodie, RHIT, CHIT-PW, EMPI/HIM manager at Harris Health System. (See the steps taken by the patient access department.)

Use These Steps To Search For Patients

Creating new medical record number is last resort

Patient access employees at Harris Health System in Houston, TX, follow these steps to search a patient in the system:

STEP 1: Is the patient new or returning? Ask the patient if he/she has been seen at any of the hospital facilities.

  • If Yes, go to Step 2.
  • If the patient says No, still conduct a search for the patient before creating a new record. This is because the patient could have called the appointment center in the past but was never seen at any facilities. Use Step 2.

STEP 2: Proper patient name searches. Access the patient by using the following methods. Don’t assume you know how to spell the patient’s name. Ask the patient the spelling of their name.

  • Use the “3, 3” Process: Enter the first three letters of the last name, a comma (,), and the first three letters of the first name. Also enter the sex and date of birth. This will bring up a list of patients. Review this list to identify cases with other matching data elements, as the patient may have multiple medical record numbers.
  • Add additional letters to the first and last name and other known data elements, such as the patient’s Social Security number, to narrow the search.
  • Make sure all patients are loaded by using the scroll bar located on the right side. Before selecting the patient, make sure the demographic elements match the patient in front of you. If not, verify the demographic elements with the patient.
  • If unable to locate the patient, ask the patient if he or she goes by another last or first name.
  • If the patient isn’t present and you’re unsure how to spell the patient’s name correctly, enter the full patient name (click the “Sounds Like” box).
  • If the patient says he or she has been seen at your facilities and you are unable to locate the medical record number, proceed to Step 3.

STEP 3: Contact HIM. (Enter HIM contact number and hours of operation)

  • If HIM is unable to locate the patient or you’re unable to contact someone in HIM, go to Step 4.

STEP 4: After you have exhausted all search options, create a new medical record number.

HIM meets with patient access regularly to discuss duplicates and how to avoid them. “In a nutshell, communication, education, and good policies are the key tools to avoid creating duplicate records,” says Brodie.

Kadlec would like to see the creation of a national patient identifier that could be used by multiple providers and healthcare organizations: “This would enable accurate patient matching whenever information is exchanged.”

At the organization level, Kadlec says consistent policies and procedures “lay the critical groundwork for correct patient matching.”

A data integrity team can review and remedy duplicates and overlays in patient health records. “Timeliness is important in this work,” says Kadlec. “The data integrity team should quickly identify, review, and correct patient identification problems.”

REFERENCE

  1. http://perspectives.ahima.org/wp-content/uploads/2016/03/WhyPatient.pdf.

SOURCES

  • Latrescia Brodie, RHIT, CHIT-PW, EMPI/HIM Manager, Harris Health System, Houston.
    Phone: (713) 873-0759. Email: Latrescia_brodie@harrishealth.org
  • Kelly Clasen, Senior Director, Business Operations, Middle Park Medical Center, Granby, CO.
    Phone: (307) 699-2413. Email: KClasen@mpmc.org.
  • Adria Jones, Special Projects Coordinator, Harris Health System, Houston, TX. Phone: (713) 566-6712. Fax: (713) 440-1258. Email: Adria.Jones@harrishealth.org.