It is time for a national strategy on patient identity
- Do you or any of your family members have an allergy to IV contrast dye or any medications?
- Are you on “blood thinners” (anti-coagulants)?
- Is your immune system compromised in any way?
If so, you should demand better methods of patient identification. Your life could depend on it – literally. What if you get sick or injured and present to an ER confused or comatose? How are we, as doctors and nurses, supposed to know the relevant history that allows us to accurately diagnose and treat you, safely and rapidly? I might order a CT scan with IV contrast or administer antibiotics that you are allergic to, causing a life-threatening reaction called anaphylaxis. I might not know you are at higher risk of bleeding due to those blood thinners and fail to diagnose a devastating and treatable intra-cerebral hemorrhage. Without knowing your history of immune compromise, I might not recognize and treat sepsis fast enough to save your life.
As a practicing emergency physician, I see the need for better patient identification on every shift.
Every aspect of patient care begins with proper patient identification. Every decision I make depends on the availability and accuracy of the information available. The bad news is that adverse events and patient harm happen every day because of poor patient identification. But the good news is that most of these events are preventable. And there is widespread, affordable and usable technology available to solve this problem today.
I firmly believe that we can work together to create a way forward that improves patient safety and ensures privacy and security at the same time. CHIME, the Pew Charitable Trusts, ECRI, and dozens of other organizational bodies, providers, and patient advocacy groups have all weighed in on this issue and made important contributions to drive these initiatives forward.
And now, this week, the Patient ID Now coalition released its Framework for a National Strategy on Patient Identity. As the Chief Medical Officer at Imprivata, which is a member of Patient ID Now, and a doctor actively struggling with the issues described above, I recognize the value of the framework and the power it could have to improve the quality and safety of patient care (while simultaneously improving revenue and reducing costs).
A growing problem
Almost a year ago, I wrote about how healthcare is always assessing risks and benefits: what is the situation – for a patient, an organization, or our nation – and will an action lead to more risks, or more benefits? Even in the initial stages of the COVID crisis, the benefits of positive patient identification were as clear to me as they have always been, with patient safety being at the top of the list. Clinicians like myself need to feel confident that we are accessing critical and complete information about our patients so we can provide the highest quality of care.
More than a year into the pandemic, we are starting to experience the benefit of having multiple vaccines available, and yet, the vaccine rollout process has highlighted the risks of not having a consistent, reliable, national approach to identifying patients and connecting them with their unique medical records.
Duplicate records have plagued health IT systems for decades, but Patient ID Now coalition members have reported that vaccine registrations have led to creation of thousands of duplicate records within a single system with a cost of $12,000 per day to resolve. The impact on health systems and individuals is severe, with vaccination sites not receiving vaccines – or patients not receiving their second doses – due to inaccurate record keeping.
Framework encompasses key elements
The broad nature of the Patient ID Now coalition positioned the working group that developed the Framework to acknowledge key challenges and consequences as well as elements of the strategy to address them.
At Imprivata, we have always talking about how the clinical and financial consequences of patient misidentification are intertwined. While Patient Safety is and should be the highest priority, problems such as duplicate records clearly have financial implications as well, including costs for clean-up, denied claim resolution, and bad debt write-offs.
We have also increasingly recognized the importance of patient experience, with 64% of patients likely to switch providers that did not meet expectations handling COVID-19, including patients who find errors in their medical records (as 1 in 5 do according to a Kaiser Family Foundation study).
Just as we at Imprivata have understood the problem to be multi-pronged, the strategy developed by Patient ID Now has multiple pillars, including privacy, security, standardization, equity and sustainability. First and foremost, though, it lists accurate identification and matching, which aligns with Imprivata’s approach.
Identity proofing, whether in person by a Patient Access staff or remotely, precedes linking the biological person with an electronic medical record. Imprivata accomplishes this with biometrics for positive patient identification when patients present for care. The key to “patient matching” is ensuring that there is only one record per patient, and that record is connected to the correct individual.
While it’s important to have a unified view into each patient’s data, and a national strategy in place, it’s unlikely that a single vendor or entity in this country would be able to provide a solution to the problem (for practical, technical, and political reasons alike).
That is why we also support the overarching premise of the Framework and strategy which is that public and private sectors need to partner to develop solutions. We also support an “EMR agnostic” approach and are strong proponents of integration and interoperability, two key pillars of the proposed strategy.
Why “Patient ID Now?”
The name of the coalition that put forth the Framework is quite intentional; we need a national strategy for patient identity, and we need it now. There is real urgency to the problem. Those of us on the front lines need to educate legislators, industry constituents, and the public of this need. I think we can overcome some of the historic political objections due to privacy concerns if we emphasize the urgent risks and the significant benefits to health and safety, made even more evident by the COVID pandemic.
It will take a combination of statistics and stories, hard evidence, and personal experience to push this strategy forward. From my perspective, the COVID crisis, while devastating, could serve as an important catalyst for change. As an ER doctor, we live by the credo “never waste a good crisis.” I by no means want to diminish the traumatic and devastating effects of the pandemic. But despite the hardships, we have learned important lessons on how to adapt and improve our care delivery in many ways. This can be one of those improvements. We need to help the larger population realize that patient identification is a patient safety and public health imperative. It is the essential first step in every care encounter, so we must get it right. We can save lives if we act in favor of patient ID... now.