For Hospitals, Patient Misidentification Impacts Patient Safety, Productivity and the Bottom Line

Patient misidentification costs the average clinician close to 30 minutes in wasted time per shift and contributes to 35 percent of all medical claims being denied, which is an estimated loss of $17.4 million per year per hospital, according to research by The Ponemon Institute.

The Ponemon Institute sought to examine the root causes of patient misidentification and its impact on healthcare organizations and their patients. The findings of the survey are presented in the “2016 National Patient Misidentification Report,” in collaboration with Imprivata, a healthcare IT security company.

As the healthcare industry has transitioned to digital health records, patient misidentification has become a widespread problem and one that carries significant consequences that negatively impact patient care and the hospital’s financial performance. Patient misidentification can result in medical errors, financial loss, loss in clinical productivity and a negative impact on the patient experience.

The Ponemon Institute surveyed clinicians, chief financial officers and healthcare IT leaders. Of the respondents, 27 percent were professionals in nursing (chief nursing officer, nurse practitioner or registered nurse), 15 percent were physicians, 14 percent were chief financial officers (finance and accounting leadership team), 12 percent were chief information officers (IT operations leadership team) and 5 percent were chief medical information officers (CMIOs) or chief medical officers (CMOs). Other respondents included risk management, quality officers, compliance officers, patient access office and revenue cycle office.

According to 64 percent of respondents, a patient is misidentified in the typical healthcare facility very frequently or all the time, and the majority of respondents (84 percent) strongly agree or agree that misidentifying a patient can lead to medical errors or adverse events.

Further, 86 percent of respondents say they have witnessed or know of a medical error that was the result of patient misidentification. Difficulty finding charts or medical records and finding duplicate medical records for a patient contributes to errors. Sixty-seven percent of respondents say when searching for information about the patient they find duplicate medical records for that patient almost all the time.

The issue of accurate patient identification and correctly matching patients' to their medical records has been an ongoing concern and a top priority for healthcare IT leaders. Many health IT organizations have supported legislation just signed into law by President Obama, the 21st Century Cures Act, for the law's provisions specifically focused on improving patient records matching. The law, which President Obama signed Tuesday, directs the Government Accountability Office (GAO) to review methods used for secure patient matching, including methods used in the private sector, and then report its findings to Congress.

Since 1999, the federal government has been prohibited from spending public funds on the development of a national patient identifier. Samantha Burch, senior director of congressional affairs at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), said in an interview last week that the GAO study mandated in the law is a step forward in addressing and studying solutions to increase the accuracy of patient data matching. “HHS [U.S. Department of Health and Human Services] is not engaging in the patient matching issue in any meaningful way. They need to be at the table. We’re moving towards some House Labor report language, which also addresses this issue, and I think we’re moving toward an understanding in Congress of the impact of the ban and the need to clarify and study this issue and move forward,” she says, referencing a House Appropriations Committee subcommittee on Labor, Health and Human Services, and Education bill that clarifies that the restrictions on HHS “does not prohibit HHS from examining the issues around patient matching.”

"We're hoping that this will be a launching pad to really achieving an understanding and recognition to clarify HHS being a partner to work with the private sector in this area,” Burch says of the patient records matching provision in the new law.

To tackle the issue of accurate patient identification, the College of Healthcare Information Management Executives (CHIME) launched last year a National Patient ID Challenge, a $1 million crowdsourcing competition to incentivize the private sector to develop a patient identifying solution that links patients to their medical records. Finalists of that challenge will be announced in March.

"The absence of national solutions for patient identification and patient matching not only pose serious risks to patient safety, but also lead resources being wasted on cleaning up duplicative medical records, as well as creating other inefficiencies. We believe that accurate patient identification is central to improving patient matching,” Russell Branzell, president and CEO of CHIME, said in a statement regarding the patient identification provisions in the 21st Century Cures Act.

Drilling down further into The Ponemon Institute's research presented in the Imprivata report, according to the findings, patient misidentification incidents also impact the financial side of the healthcare ecosystem. On average, hospitals have 30 percent of all claims denied. Survey respondents attributed inaccurate patient identification or incomplete patient information as the reason for 35 percent of all medical claims being denied, which are valued at an estimated $17.4 million per year per hospital.

Patient misidentification also contributes to a loss of productivity for clinicians. According to the survey, the average time clinicians waste per shift is 28.2 minutes, costing the average healthcare organization $900,000 per year in lost productivity.

The patient care experience is also impacted through misidentification as it results in delays of care. Sixty-nine percent of respondents agree that up to or more than 30 minutes per shift are spent contacting medical records or HIM departments to get critical information about their patients. Further, 37 percent of healthcare professionals say up to an hour or more than one hour is spent contacting medical records to get critical patient information. “This is a productivity hit for healthcare, which also impacts the speed with which patient care is provided,” the researchers wrote in the report.

Survey participants also provided insights into what they see as the root causes of patient misidentification. It seems that misidentification starts at the beginning of the patient’s experience, at registration. Sixty-three percent of respondents cited incorrect identification of patients at registration, such as incorrect armband placement, as a root cause of the problem. Respondents also cited the time pressure when treating patients as a major contributor to patient misidentification (cited by 60 percent of respondents).

The survey participants also cited a number of other causes for patient misidentification—insufficient employee/clinician training and awareness (35 percent), too many duplicate medical records in the system (34 percent), registrar errors (32 percent), turf or silo issues across departments/workflows (29 percent), inadequate safety procedures (20 percent), over reliance on homegrown/obsolete identification system (15 percent) and patient behavioral issues, or misinformation (9 percent).

According to the study report, the following errors are very common in most healthcare facilities.

• Inability to find a patient’s chart or medical record (68 percent of respondents)
• A search or query resulting in multiple or duplicate medical records for that patient (67 percent)
• A patient is associated with an incorrect record because of the same name and/or date of birth (56 percent)
• The wrong record is pulled up for a patient because another record in the registration system or EMR has the same name and/or date of birth (61 percent)

Three-fourths (77 percent) of the healthcare executives and care providers surveyed agree that positive patient identification through biometrics could reduce overall medical errors by reducing patient misidentification.

The report authors also offered a number of recommendations to address patient misidentification problems. Healthcare leaders should assess and analyze the vulnerabilities in the patient registration process. Based on the assessment, healthcare organizations should implement procedures that will reduce these vulnerabilities, the report authors wrote.

“If the healthcare facility is overly reliant on homegrown identification, the business case can be made of the need to invest in technologies, such as biometrics, to increase the accuracy of patient information,” the report authors wrote.

Additionally, healthcare organizations should conduct clinician and administrator training and awareness programs that address the common errors made in patient registration and other tasks related to ensure the correct care is delivered to the right patient.