A proposed solution to the challenges of patient matching, in response to the GAO report

Earlier this month, the GAO (Government Accountability Office) released a report long-anticipated by Imprivata and those following commitments outlined in the 21^st Century Cures Act. In that 2016 legislation, the Government promised to review efforts to match patients’ electronic health records across healthcare providers.

Not surprisingly, the report confirms that patient record matching is critical to interoperability and is currently suboptimal. Current methods rely on matching demographic information, which is problematic because patients’ demographics change, and the process for entering information is often still manual and prone to error. More troubling is that records are often matched downstream in the workflow process after a patient encounter, which means clinical decision-making can be informed by an incomplete or inaccurate medical record.

While accuracy of demographics – and therefore their use in matching records - could be improved by agreeing on standards for demographic information, it is not the optimal stand-alone solution. A national identifier would help, but the probability of that occurring in the foreseeable future is low.

From an Imprivata perspective, we suggest a solution that is consistent with TEFCA and NIST requirements:

• At the first encounter with the patient, do a thorough job of identity proofing. Identity proofing means confirming against an authoritative source that an identity exists, and belongs to the patient desiring to receive care. If the patient is appearing in person at a healthcare facility, a trained Registration or Patient Access staff person may perform this task. If the patient is appearing for the first time online - for example, in a telehealth consultation - other methods may be required.
• Immediately following identity proofing, use state-of-the-art demographic matching to inform the questions that healthcare organizations, especially those concerned with providing value-based care or population health, should be asking themselves:
  • Has this patient ever had care at this IDN (integrated delivery network), including in facilities we recently acquired or partnered with, for example, a large physician practice?
  • Do we therefore have any records associated with this patient?
• Having confirmed patient identity and resolved questions about previous care, provide the patient with strong authentication methods appropriate for the healthcare environment and patient situation, such as biometrics. Different authenticators may be required if the patient wants to engage in a telehealth consultation vs. appearing in person at an urgent care facility. In this way, the identity proofing and record resolution steps above won’t have to be repeated at every subsequent encounter. Patients won’t be annoyed with repetitive or arduous identification steps, will be more likely to engage in online care, and generally will feel empowered to have an active role in ensuring their safe care.

A solution as described above would give patients and caregivers confidence that the correct care will be administered to patients based on their complete and accurate medical history, wherever they had previously been treated.

This type of solution is desired not only by patients and clinicians, but by hospital associations and healthcare industry groups. In another report released this week, the AHA (American Hospital Association) and AAMC (Association of American Medical Colleges), among others, cited greater need for interoperability and data sharing among providers, and impatience with the status quo.

The message of these recently released reports is consistent with that of the hearing on “Implementing the 21^st Century Cures Act: An Update from the Office of the National Coordinator” in December 2018: “The importance of a coordinated national approach to linking patients to their healthcare data must be underscored. Ensuring that patients are positively identified and matched to their records is a linchpin to increasing interoperability and improving the quality and safety of patient care, especially in a highly digitized environment.”