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Patient Matching Isn’t Just a “Nice to Have”

patient matching
Director, Market Strategy

Managing patient information across care settings and platforms for core business functions, interoperability, and patient safety requires coordination and collaboration. Especially with new interoperability mandates going into effect on July 1, there are a lot of questions about what this means.

Mismatched and duplicate records aren’t just a nuisance, they can cause serious harm to patients. Now, more than ever, patient matching isn’t just a “nice to have.” Healthcare organizations must ensure that patient information is up to date across care settings. 

I had the privilege of participating recently in a webinar held by eHI, Innovative Solutions to Patient Matching and Identity Access Management. A panel of payer and provider industry experts discussed the patient matching challenges they are facing and how they are addressing them. Participants sent questions in advance for the panelists to respond to.

Below are a few highlights from the panel. Watch the video of the eHI webinar for the full discussion.

BCBS As an Industry Microcosm

Long before interop was a thing, BCBS understood the value of linking information across the spectrum. BCBS represents a microcosm of the industry, and they have been grappling with these challenges for some time.

Desla Mancilla, Business Lead Health IT, BlueCross BlueShield Association, commented: “It’s really all about the consumer in the long run. I remember when all our patient information was on small cards. We’ve come a long way. But we can’t have a discussion on interop until we have transparency for patients. July 1 is a big day. The first thing we have to know is if we’re sharing information with the right person.”

According to Mancilla, the healthcare consumer owns and should be able to access their information. BCBS thinks of patient matching as person matching because they aren’t always patients. “BCBS has approximately 99.5% accuracy rate,” she said. “Which is an industry best practice. But is it really good enough? We know there is a lot of work ahead.”

In the Face of COVID

COVID changed so many things, but it also helped to highlight all the digital accounts we have. It also showed the importance of patient matching.

Dr. Eric Rogers, Chief Medical Informatics Officer, Marshfield Clinic noted: “For me as an ER doctor, before COVID, you had to physically perform your screening, which changed overnight to an iPad interface. People had talked about it theoretically. Then it became real, and the parameters of identity was an unexpected lesson.”

Using portals and apps wasn’t new, but it exploded in weeks. The increase in device and remote technology moved the industry forward at least five years. And it’s not going away. “I would like to see a shift to patients being stewards of their care. And providers embracing that sharing.”

The Cures Act is Very Real

Now with the Cures Act, organizations must be able to share the patient record via an API. They will have a period of time to resolve issues, or they can be fined. Prior to the Cures Act, the primary fear was overmatching or releasing the wrong record to the wrong person which could risk a HIPAA violation or worse, a misdiagnosis. Now there will be significant penalties for over- and under-linking in the form of information blocking.

We can no longer just be good; we have to be great. Not just for compliance reasons, but for patient safety as well. Many organizations have probabilistic patient matching, where you put one record up against another and compare them side by side. The problem, however, is that often records don’t match because of data quality issues and life changes. Also, people aren’t comfortable with giving certain information (i.e. SSN), leaving records incomplete and sparse in data leveraged to match records. How do we overcome these data issues to effectively match?

LexisNexis Risk Solutions is providing solutions that allow customers to make the match. Leveraging our referential data and linking technology, we have the ability to resolve mismatched and duplicate records within existing systems. We then assign a unique identifier, a LexID®, to every patient record, creating one source of truth, or what we call “the golden record” for each individual patient.

This identifier promotes interoperability because every organization receives the same LexID for a particular individual allowing us to manage that cross reference of your record with any incoming record. By allowing LexisNexis Risk Solutions to become automated data stewards, customers are enhancing their current match capabilities, increasing match rates, reducing risk of patient safety and compliance, and reducing the cost of manual investigation and review.

Learn More about Patient Matching

Learn more about LexisNexis Risk Solutions Multi-Factor Authentication for Healthcare. Watch for details on a soon-to-be-published white paper on the urgency of patient matching challenges.

Read this case study paper on Person Matching for Greater Interoperability for payers developed by BCBSA through their collaboration with The Sequoia Project. This paper builds on the original Framework for Cross-Organizational Patient Identity Management.

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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