Royston Adamson-Green is the EMEA & APAC Channel Director of Sales for NextGate, the global leader in healthcare identity management.
Accurate patient identification is a critical aspect of healthcare delivery in the NHS, especially in the push toward facilitating safe, highly-coordinated, patient-centric health services across the country.
With considerable efforts and funding going into NHS England’s £53.5m local health care records exemplar (LHCRE) project—which recently announced a second wave of sites to establish a regional patient record that combines GP, hospital, and other health and social care data—accessing one’s complete history can no longer remain a scavenger hunt. For most GPs, data continues to be isolated, trapped in silos or incompatible with other IT systems, triggering medical errors, unnecessary duplication of services, administrative burdens, and higher total costs of care.
To deliver on the promise of a fully-modernised digital health system, that can bridge the gap between burgeoned resources and the growing demand of an ageing population, correctly linking individuals to their data across various agencies and GPs is paramount for effective care decisioning and outcomes improvements.
In the U.S., duplicate and incomplete records cost hospitals $1.5 million a year and the national healthcare system over $6 billion annually.. In addition to the negative impact on an organisation’s bottom line, patient matching issues contribute to poor data quality and low patient satisfaction scores.
Duplicate patient records occur as a result of multiple name variations, data entry errors, and lack of data standardisation processes where fields do not map between systems across the healthcare continuum. A typo or absence of a single digit in one’s birth date, address, phone or NI/NHS number only compounds the issue. Individuals move, marry, divorce and visit multiple providers in their community—where new records are created and the potential for duplicates grows. National registration systems that rely on Primary Care to manage patient identity, risk the creation of multiple identifiers for a single patient, particularly with transient populations, where names can be incorrectly entered when registering demographic details.
Social care will be a critical factor for coordinated, accountable care delivery
Reliance on HIE or Electronic Health Records (EHR) matching functionalities perpetuates the issue when trying to manage patient populations across large geographic areas and boundaries. This is because Master Patient Indexes (MPI) within EHR and HIE systems lack the sophisticated algorithms to compare records from systems outside the organisation. This becomes significantly challenging when attempting to integrate data from social care, volunteer organisations and blue light services into a single patient record, and in turn, becomes a sizeable barrier to achieving the goals of the Local Health and Care Record programme.
When sent to downstream systems, duplicate and disjointed records trigger further harm, such as skewed analytics and reporting, electronic ordering inaccuracies, increased safety and litigation risks.
In health IT, enterprise patient identity management refers to a fully-integrated patient record that moves beyond a single HIE or EHR. An “enterprise” Master Patient Index (EMPI) is a centralised, cross-platform solution designed to link and reconcile records in real-time from diverse systems and settings of care, including HIEs, ACOs, shared services for maternity, laboratory, pathology, outpatient clinics, GP practices, and rehabilitation facilities in healthcare. When coupled with the ability to handle any numbering system from any disparate non-healthcare source system and National ID systems, the EMPI reaches out across multiple landscapes, but with the person or patient at the centre, by the creation of the single best or golden record.
A 2018 survey of 1,392 health technology managers by Black Book Research found that before implementing an EMPI for managing patient identification, duplicates accounted for 18% of an organisation’s records. Respondents utilising EMPI tools reported accurately identifying patients at the point of registration 93% of the time and at a rate of 85% for records shared outside of their organisation. Those hospitals not using an EMPI reported a match rate of just 24 percent when exchanging medical records with other providers outside their hospital network.
An EMPI provides superior matching accuracy over an MPI since it compares multiple demographic fields by leveraging both probabilistic and deterministic matching algorithms to account for minor variations in patient data. Additionally, the EMPI allows for higher accuracy in identifying individuals and a considerable reduction in remediation efforts by recognising more records as a match or potential match. In contrast, MPIs have very limited data fields for patient matching, which creates an influx of erroneous MPI data and risk of associating two different individuals with the same record. Therefore, MPIs must continually undergo clean-up to resolve patient record discrepancies and missing demographic data fields.
Unlike an MPI, an EMPI can provide extensive data stewardship capabilities to maintain the integrity of the patient demographic record and minimise the requirement for manual remediation and ensure accurate matching within the Care Record. By pre-defining workflows and thresholds, an EMPI can not only link records automatically, but flag potential duplicate for remediation and review within its user interface. Where the source systems allow, the EMPI can also send notifications downstream, via the organisation’s integration engine to keep the master patient record synchronised and facilitate accurate data exchange in and out of the network.
Achieving the goals of the LCHRE can only be realised when patients are accurately and consistently matched with their data. To ensure organisations are providing a complete view of individuals across the health and social care continuum, demographic records must be free of errors, duplicates and incomplete information. Superior identity management technology, like an EMPI, yields not only a rapid result in de-duplication of records and pro-active remediation, but also immediate value in data interoperability and integrity to make quality interventions possible and support the requirements of coordinated, accountable, patient-centred care.
