This article appears in the June issue of HealthLeaders magazine.
The change from fee-for-service to coordinated care is challenging providers to solve a longstanding need to identify patients more precisely to avoid waste, fraud, and substandard care.
For years, the healthcare industry has recognized the problem of errors related to improper patient identification. If you were to think that moving to electronic health records would eliminate mistaken identity in medicine, you would be, well, mistaken, according to a variety of healthcare executives interviewed for this story.
The reasons are many, but mainly boil down to incompatibilities between different vendors' EHR technology and the variety of identifiers generated by the other technological systems in use in hospitals and that come from many sources—everywhere from insurance companies to subsystems dedicated to labs or other diagnostics—and that have evolved in isolation from each other over the past 40 years.
"You have to be able to identify the patient across all the venues of care in order to be able to do analytics on the information to make sure that … the care is being delivered, and people are getting the care, and that they're getting only the care that they need in a cost-effective manner," says Frank Richards, CIO of Geisinger Health System, a system that serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.
Patient identification is a fundamental building block of the emerging accountable care organization trend, according to Bill Spooner, CIO of Sharp HealthCare, which operates four acute care and three specialty care hospitals with an approximate total of 2,000 licensed beds in the San Diego region.
"The important thing is to be able to get accurately identified patients into your database and to be able to link them out to your transaction systems so everybody knows who they are so you can effectively engage in care management," Spooner says.
The United States in particular faces a hurdle that other developed countries do not: By law, the U.S. Department of Health and Human Services is prohibited from establishing a national patient identifier.
Providers are coping in several ways. Technology exists to flag suspected duplicate identities with varying degrees of certainty. Some are turning to technology offered by suppliers of their electronic health records.
Other providers are relying upon technology that has been employed by payers for years. And for those systems that can make the technological jump, patients are now being positively identified during every visit using smart cards with photo IDs attached, or even by biometric means, such as fingerprint, palm, or retinal scans.