The patient misidentification crisis

Aug. 26, 2016
By Sean Kelly, M.D., CMO, Imprivata

Positive patient identification is the foundation of effective healthcare. It allows for the right care to be delivered to each patient based on his or her individual needs. Recently, ECRI Institute analysts discovered that patient identification issues were prevalent in healthcare, and these errors have significant patient safety and financial implications.1 According to research cited by Rand, 7 to 10 percent of patients are misidentified during medical record searches.2 Furthermore, approximately 6 percent of those patients suffer from otherwise preventable adverse events such as wrong-side surgery or incorrect procedures performed, medication errors, radiation exposures, blood transfusion reactions, radiology errors, or laboratory errors.

When a patient walks through the door of the emergency room, if the correct medical chart with the correct patient information is not accessed, there can be serious repercussions. Diagnosis and treatment is a complex process. Even seemingly minor inaccuracies can lead to big mistakes, because caregivers are basing many high-risk/high-reward treatments on that information. Data, such as past medical history or medication and allergy lists, can be easily omitted or inaccurately listed if a patient is not identified properly.

Patient misidentification commonly occurs when a staff member begins a new patient chart and certain imperative information is missing. When this happens without a physician’s knowledge, it could seriously impact a patient’s health. For example, if a patient has a severe allergy to IV contrast but the patient’s medical chart does not note this, he or she could experience a life-threatening allergic reaction when the physician orders a CT scan with IV contrast.

Another common danger is inaccurate medication lists. Consider anticoagulants, for example. These are important and potentially life-saving medications that can prevent strokes or heart attacks. But if a caregiver is unaware that a patient is taking anticoagulants, they may prescribe another, seemingly unrelated medication (antibiotics for treatment of a minor infection, for example) that could interact with the anticoagulant therapy and cause life-threatening hemorrhaging.

“It’s important to remember that, in addition to the effect on patient safety, misidentification
of patients also has a large financial effect.”

The availability of an accurate past medical history is another crucial piece of a patient medical record. When a physician evaluates a patient’s signs and symptoms but does not have access to their complete medical history (or even worse, accidentally viewing another patient’s medical history due to improper patient identification upon registration), there is a chance of misdiagnosis and mistreatment, which can lead to potentially serious medical consequences. If a patient has a history of stomach ulcers and their doctor starts them on aspirin or ibuprofen, they could have a massive, life-threatening GI bleed. If a patient has a history of blood clots in the leg and starts hormone therapy, they are at an increased risk of developing more clotting, including a pulmonary embolism (a blood clot in the lungs) that could be life threatening.
Photos courtesy of Imprivata.

Even in this day and age of technology, clerical errors play a significant role in patient misidentification. Patients may have multiple duplicate charts throughout a healthcare organization due to simple typographical errors, name misspellings, inaccurate birthdates, language barriers, misinterpretations, misunderstandings, and communication errors between hospital staff, patients, outside caregivers, and family members. And remember, sometimes patients may be confused and unable to provide accurate information due to delirium, shock, dementia, psychosis, intoxication, or drug overdoses – or they may even intentionally give inaccurate information for purposes of fraud.

Particularly in emergency situations with fast-paced triage, acutely ill patients, and oftentimes overcrowded environments, it can be difficult for hospital registrars to obtain accurate information and correctly identify the patient presenting for care. In these cases, in order to get the patient registered as quickly as possible, the registrar, rather than struggling for a prolonged time (precious moments when someone is in respiratory distress or bleeding profusely, believe me), may choose to just create a new chart rather than delay registration or risk picking the wrong patient’s chart and creating an overlay chart (one that has two different patients’ information tangled together in one chart). This, of course, results in a chart that includes none of the patient’s history and leads to all of the problems described above, compounding the situation further.

It’s important to remember that, in addition to the effect on patient safety, misidentification of patients also has a large financial effect. For example, if a doctor doesn’t know a patient has had a test in the past, he or she may order another CT scan, exposing the patient to unnecessary radiation, risk, and costs for both the patient and the healthcare system. Excessive and duplicate studies are a major problem in the practice of medicine, and without accurate patient identification, it is difficult to properly assess exactly who has had which studies and who needs a new test. Hospitals spend large amounts of money per year in human resources and information technology to sift through patient records after the fact and try to merge duplicate charts and separate out overlay charts. Furthermore, intentional patient misidentification (fraud) and unintentional incorrect patient identifiers lead to major financial losses for hospitals and the healthcare system as a whole, in part due to patient harm, liability and adverse events, inefficiencies in billing, and insurance claims denials.

Biometric data: An effective solution

Healthcare facilities need to find an effective patient identification system that identifies patients accurately and retrieves their correct medical record. Biometric identification creates a one-to-one link between patients’ identities and their medical records. An effective patient identification solution enables healthcare providers to improve patient safety. By positively identifying patients, physicians ensure that the right care is provided to the right patient. Smoother, more accurate recordkeeping also increases revenue cycle efficiency by reducing duplicate medical records, overlays, and insurance fraud; enhances patient satisfaction by accelerating the patient check-in processes; reduces the risk of identity theft posed by conventional patient identifiers; and seamlessly integrates with existing EMR, EMPI, and HIS solutions.

Imprivata PatientSecure is a biometric identification solution that uses palm vein recognition to accurately identify patients at any point of entry to care. To use, a patient simply scans their palm at any point of care, and the software quickly and accurately identifies the patient and automatically retrieves their unique medical record.

Biometric positive patient identification techniques, like palm vein recognition, have a high acceptance rate among patients because they are less intrusive and more user friendly than standard patient identifiers, such as fingerprinting. Some patients fear the legal implications of using a biometric also used forensically by the police or by other government databases, such as the immigration services. Palm vein prints are not kept on file by any government agency (you can’t leave your veins at a crime scene). Palm vein recognition is one of the safest, most accurate biometric identification methods available today.

Hospital patients also appreciate not having to provide the same information over and over again through an identification system. In addition to the convenience factor, PatientSecure also allows patients to protect sensitive personal information, such as social security number and date of birth, by not requiring multiple submissions in a public setting with each visit.

The future of patient misidentification

There is no doubt that biometric data will continue to be a huge benefit for medical professionals. With biometric identification solutions in place, doctors will no longer have to glean information from patients and can be confident that they are receiving truthful, accurate information.

We are increasingly finding that the use of this technology is helpful and gratifying with a little user experience and education. Once patients realize that all that is required of them is placing their hand down on a reader, their feedback on PatientSecure has been extremely positive. As mentioned, biometric data does not have any criminal, immigration, or forensic ramifications, giving patients further peace of mind when using a biometric identification solution.

For elderly and seriously ill patients, biometric identification solutions are even more powerful and transformative, as they can provide physicians with all of the necessary information without a lengthy intake process. Other methods cannot be as easily utilized in such a scenario.

And this one authentication method could be just the start. In the future, once a palm vein biometric is tied to a record, further methods could also be configured by the healthcare facility. Patients could easily be given a token system on their phone, for example, pre-register for appointments, and verify the accuracy of their medication list and medical record from home, before even visiting a doctor. As we continue to evolve our ability to properly, conveniently, and accurately identify the patient, technology like biometric identification will be the true separator between innovative, well-run healthcare organizations and those stuck in the past.

References:

  1. https://www.ecri.org/EmailResources/PSRQ/Top10/2016_Top10_ExecutiveBrief_final.pdf
  2. http://www.wsj.com/articles/SB10001424052970204124204577154661814932978

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