Proper Patient IDs Still a Challenge in Era of EHRs

Misidentification still occurs, from registration to discharge and afterward. An IT safety checklist can help organizations improve their practices.

By using sophisticated software, physician leaders expect hospital patients to be matched accurately with their medical records. But misidentification still occurs, from registration to discharge and afterward — placing countless patients at risk.

To prevent accidents that span the spectrum from minor mishaps to major mixups, ECRI Institute — a nonprofit organization that applies scientific research to patient care — unveiled a resource to help health care leaders strengthen existing identification programs.

In February 2017, the institute’s Partnership for Health IT Patient Safety published a guide to help health care organizations improve IT safety practices. With input from more than 50 expert contributors representing numerous health care organizations, the Toolkit for the Safe Use of Health IT for Patient Identification aims to protect patients from harm and help providers avoid reputational damage and financial losses.

“Patient identification has been a problem long before technology was involved,” says Lorraine Possanza, DPM, JD, MBE, the partnership’s program director. Inaccurate information and omissions have resulted in errors such as delays in diagnosis, allergic reactions to medications or hospital dietary items, and incorrect treatments. “Making leaders aware of how many different areas where correct identifications are involved is really an important aspect of solving the problem.”

The partnership convened a multidisciplinary workgroup to develop safe-practice recommendations using technology-based interventions. Participants focused on the processes of “patient intake” and “patient encounter.” The issues included incorrect patient identification during registration and scheduling, diagnostics or procedures ordered for or conducted on the wrong patient; results for laboratory, radiology or pathology tests linked to or provided for the wrong patient; or specimens, reports or monitors that were mislabeled.

“Most hospitals don’t currently have systematic strategies and procedures to prevent, identify and reduce identification problems,” says Hardeep Singh, MD, MPH, who chaired the workgroup and is chief of the health policy, quality and informatics research program at Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas.

The workgroup’s essential safe practice recommendations encompass three main goals: deploying technology to improve the accuracy of information gathering (such as “catching” patient attributes), facilitating the “matching” of that data and displaying it with consistency to enhance patient identification across the health care continuum, Singh says.

Allocating resources for biometric identification methods can help reduce errors. One caveat: These recognition scans of fingerprints, palms, irises and veins need to be fully integrated with existing systems, says Lesley Kadlec, MA, RHIA, CHDA, director of practice excellence at the American Health Information Management Association.

“Not everything works out of the box,” Kadlec cautions, while adding that a thoughtfully conceived project plan should precede embarking on any change or addition to current technologies.

Another option to help prevent misidentification involves embedding a patient’s photo within the electronic health record, says Jeff Brady, MD, director of the Agency for Healthcare Research and Quality’s Center for Quality Improvement and Patient Safety.

Otherwise, it’s not farfetched to say a provider inadvertently could document information about a patient’s visit -- including orders for medications and other treatments -- in another individual’s electronic health record.

“If the electronic system doesn’t have clues to make it obvious which patient’s record is being worked on, that can be a recipe for trouble,” Brady says.

Asking for a patient’s date of birth is the easiest way to validate identity. Too often, “physicians rely on the familiarity with patients” and might hesitate to verbally confirm basic information because it “feels unnatural and duplicative,” says Ana Pujols McKee, MD, executive vice president and chief medical officer at The Joint Commission.

They might encounter first-time patients with names and appearances that resemble those of existing patients, and these types of similarities can cause confusion. “Many of us have been in situations where we have misidentified someone that we thought we know,” McKee says.

Disclosure: The American Association for Physician Leadership® is a collaborating organization with the Partnership for Health IT Patient Safety.

Susan Kreimer is a freelance health care writer based in New York.