7 common causes of patient misidentification – and how to solve them

Published: July 2, 2019 by Experian Health


Patient identity is the backbone of the healthcare system. However, when patient records are mismatched, overlaid, or incomplete, it can lead to serious and wide-ranging consequences. Patients may receive incorrect drugs or treatments, while clinical staff face increased workloads trying to locate missing information and overcome delays. Billing teams may issue statements with incorrect amounts or send them to the wrong address. Moreover, data breaches expose providers to both financial and legal vulnerabilities.

It’s a wicked problem. And it’s an expensive one – a survey by Patient ID Now found that healthcare organizations spend an average of $1.3 million per year attempting to resolve the issues. Identity management involves multiple individuals, teams and systems that are constantly changing. Solutions can be hard to pin down in such a dynamic environment. While there’s no single cause, understanding the contributing factors is the key to preventing mismatched patient records to ensure safe, effective and efficient patient care.

Common causes of mismatched patient records

Misidentification occurs for several reasons. Some of the most common operational pitfalls include the following:

  1. The patient is linked to the wrong record during registration.
  2. Queries result in multiple or duplicate patient records, or no record at all.
  3. Time pressure means staff are forced to work quickly and may miss important details.
  4. Insufficient training and awareness mean staff aren’t following identity management protocols properly (in one evaluation of 60 patient transfers, not one transfer was carried out according to the hospital’s patient identification policy).
  5. Identity management protocols are non-existent or substandard.
  6. Inefficient information-sharing between departments leads to gaps or duplication in patient records with no easy way to verify patient details.
  7. Over-reliance on DIY solutions fails to deliver robust, lasting results.
  8. Human error – staff may accidentally enter the wrong details into the patient’s record.

Beyond the operational factors, patients themselves play a role in misidentification. Usually this is inadvertent: they may give a slightly different version of their name or address than the one listed in their record. Sometimes it is deliberate, when patients submit false information to access treatment or medication that may be otherwise unavailable to them.

Most errors do not occur because providers or patients are being careless. Patient data is complex and changing:

  • people change their name, address or contact details
  • many individuals share the same names and birthdates (one Houston-based health system reported 2833 patients called Maria Garcia, 528 of whom had the same date of birth)
  • data can be formatted in different ways, so one person’s details look like they belong to different people.

To add to the challenge, the volume of data being created, accessed and exchanged within and between health systems is increasing exponentially, complicated by greater use of remote devices. It’s no surprise that organizations have an average of 10 members of staff devoted to patient identity resolution.

How to avoid and fix mismatched patient records

The most effective way to manage and match patient data would be with a national unique patient identifier. This would assign a bespoke code to each patient that would follow them throughout their healthcare journey, ensuring the integrity and security of their data. Healthcare organizations (including Experian Health) have advocated for such an approach for many years, though federal funding currently remains out of reach.

In the absence of a national UPI, healthcare organizations must rely on alternative solutions. Many use traditional matching tools, such as an enterprise-level master patient index or manual verification processes. However, these tools are often a feeble response to the challenges associated with the “4 Vs” of big data – volume, variety, velocity and veracity – which make patient records so difficult to manage.

Experian Health’s Patient Identity Management solutions help providers build a more connected data ecosystem, using universal patient identifiers. This approach creates the most complete view of patients from reliable health, credit and consumer data sources, to reduce the risk of mismatched records. Universal Identity Manager spans hospitals, health systems and pharmacy organizations, processing more than 550 million health records. Integrating patient information from sources beyond an organization’s own enterprise-level data makes it possible to accurately match, manage and protect patient data, and root out the causes of misidentification before it occurs.

Prevent patient misidentification with proactive identity management solutions

According to the Patient ID Now survey, just under half of healthcare organizations are planning to implement new identity management processes and solutions in the next 12 months. Alongside a more robust software solution, providers should also cultivate a culture that encourages proactive risk assessment, rather than waiting until after a serious mistake occurs before acting. With the right workflows, training and identity matching software in place, patient misidentification is preventable.

Learn more about how to address the most common causes of patient misidentification with patient identity management solutions.

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