Patient Identification and Record Matching – WEDI 2013 Report

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The Workgroup for Electronic Data Interchange (WEDI) just released its 2013 Report documenting a new road map for the industry to get “the right information to the right place at the right time.”  The report addresses accelerating innovation with new technologies and solving the challenges of achieving greater efficiencies at a lower cost. As such, WEDI focused on four megatrend areas:

  • Patient Engagement
  • Payment Models
  • Data Harmonization and Exchange
  • Innovative Encounter Models

Equifax participated in the Patient Engagement Workgroup which emphasized the need for standardizing the patient identification process across the healthcare system. One of the main questions we debated is whether the healthcare industry can solve the patient identification and record matching process in the absence of a unique individual identifier. After all, how can the right information get to the right place at the right time if the inability to accurately match patient records results in fragmented, incomplete medical records?  The accuracy of today’s enterprise master patient index matching algorithms is limited by the reliability of the demographic data supplied by healthcare providers.  The challenge for these providers is the difficulty in keeping up with changes to addresses and names (i.e., due to marriage and divorce). This leads to conflicting information about the same person in disparate provider databases and results in false negative matches. There was also discussion about using biometrics to more accurately match patient records.

In the absence of unique individual identifiers, reliable 3rd party demographic and name change historical data can greatly improve patient match rates by reducing the number of false negative matches. That would help to mitigate patient matching on the back end. Also, patient identity proofing must be performed at the point of registration or enrollment. In light of the facts that:  1) there is a large population of patients who do not have government issued photo IDs and 2) there is an ever increasing number of fraudulent identity cards and identity theft, an alternative process needs to be considered.  If the industry moves to adopt a unique patient identifier and/or biometrics, these must still be linked to the correct person. Therefore, patient identity proofing should be the first step in the process.