EXECUTIVE SUMMARY
Duplicate medical records potentially are dangerous to patients because care decisions are based on incorrect information. Albany Medical Center’s patient access leaders use these strategies:
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holding registrars accountable for following Patient Look Up policies;
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researching every wrong patient chosen and medical record duplicate to determine underlying reasons;
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striving to eliminate avoidable duplicate medical records.
“Hi, I’m Anna Smith. My cardiologist told me to come in immediately because I’m having shortness of breath.”
A registrar checking in this patient would have no way of knowing that the patient, who is clearly in distress, goes by her middle name — and also that she gave her maiden name because she’s separated from her husband. In fact, the patient’s legal name, under which the medical record is listed, is actually Maria Anna Garcia.
“Asking patients for their legal ID is critically important,” says Susan Sigler, regional director of Patient Access West at Navigant Cymetrix, a Gardena, CA-based provider of revenue cycle management solutions.
If an overworked, distracted registrar simply enters the name provided by the patient, a duplicate medical record could be created. Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center Hospital, says, “When staff members are busy, mistakes can happen.”
The biggest worry with duplicate records is that patient safety will be compromised. “A wrong patient chosen in the EHR [electronic health record] is the ‘cardinal sin.’ The clinician must be able to trust the information being reviewed in the EHR is that of their patient,” Pallozzi explains.
If the wrong patient is chosen, patient care decisions are made based on incorrect information. If there is a medical record duplicate, the patient care providers do not have the entire history of their patients. “The patient’s information is residing under another medical record number,” explains Pallozzi.
Possible solutions
Here are some possible solutions to decrease duplicate medical records in patient access areas:
• Patient access leaders can explain the importance of their role to clinical areas.
Clinicians are sometimes impatient with the check-in process, which includes matching the patient to the existing medical record. “Clinicians want to just receive the patient,” says Sigler. “But clinicians should focus on the clinical.”
Patient access can explain to clinical areas that registrars are the experts at matching the patient with the existing medical record, advises Sigler.
• Systems can give patients their own medical ID cards.
“It gives them a sense of belonging to your health system,” says Sigler. “It also makes it very simple to ID them in any access point.”
Albany Medical Center’s patient access leaders hold employees accountable for following this Patient Look Up policy:
• Registrars enter the first five letters of the patient’s last name and first two letters of the first name.
• When the patient is identified, registrars must stop and ask the patient to provide the spelling of his or her name and date of birth.
“It must be methodical, and the staff member can’t have the policy reviewed with them often enough,” Pallozzi says. The department is looking into investing in technology to make this process easier for staff. “We are working with our vendor to embed patient photos in our ADT [admission, discharge, and transfer] system header,” Pallozzi reports.
Every wrong patient chosen and medical record duplicate is researched by the hospital’s Quality and Development department. “Medical record duplicates have become a focus of monitoring and follow up,” says Pallozzi. Two things are determined:
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what the circumstances were that resulted in the wrong patient chosen;
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whether a wrong patient would have been selected if the appropriate policy were followed.
“Ninety-nine point nine percent of the time, had the correct protocol been followed, the wrong patient chosen or the medical record duplicate would not have resulted,” says Pallozzi.
A recent analysis of a “wrong patient chosen” revealed a registrar’s careless mistake. “Had the staff member stayed true to the expected two-step process, a wrong patient selection would not have resulted,” says Pallozzi.
Instead of entering the first five letters of the patient’s last name and first two letters of the patient’s first name, the registrar entered the full last name and full first name. “This led to the wrong patient chosen, as they did not spell the entire name correctly,” says Pallozzi. The registrar selected a patient with a similar name with a three-year difference in the date of birth. Since this mistake was the registrar’s third similar mistake in a short period of time, a corrective action was issued.
Managers track each Wrong Patient Chosen and Medical Record Duplicate reason by staff member. This tracking is incorporated into employees’ annual evaluations. “Depending on the number and reasons for Wrong Patient Chosen and Medical Record Duplicate, it impacts their overall quality rating and possibly their merit increase,” says Pallozzi.
Albany Medical Center’s patient access managers report avoidable Wrong Patient Chosen and Medical Record Duplicates at unit monthly staff meetings and quarterly staff meetings. “Any avoidable wrong patient chosen is not good,” says Pallozzi. “Keeping this number to only unavoidable reasons, such as incorrect information provided on a document, is a good first step.”
The department has not yet reached that level on a monthly basis. “But we have seen months where we have had as few as three,” Pallozzi says. “For an organization of our size, that is good. But zero is our goal.”
In June 2015, patient access leaders at Bakersfield, CA-based Kern Medical rolled out a biometric tool that scans patients’ fingerprints. (SafeChx, manufactured by Columbus, OH-based Cross Chx.) “This assists with encountering the correct patient information from the Master Patient Index,” says Edward Din, director of patient access.
Duplicate records found
The tool has resulted in the identification of 5,201 duplicate medical records, with 4,975 resolved, as of the end of February 2016.
“Staff training is key,” says Din. “Merely asking for the patient to provide you with their legal name and photo identification are not enough to protect patient medical information.”
Patient access also developed policies, in collaboration with the health information management department and risk managers, to address identity theft and the safeguarding of patient information, says Din.
Patient access staff members explain to patients that the fingerprint scans protect their medical information. “The majority appear satisfied to know the hospital has taken the initiative to secure their information from being used by others,” says Din.
SOURCES
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Edward Din, Director, Patient Access, Kern Medical, Bakersfield, CA. Phone: (661) 862-4901. Email: [email protected].
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Catherine M. Pallozzi, CHAM, CCS, Director, Patient Access, Albany (NY) Medical Center Hospital. Phone: (518) 262-3644. Email: [email protected].
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Susan Sigler, Regional Director, Patient Access West, Navigant Cymetrix, Gardena, CA. Phone: (424) 201-6302. Email: [email protected].
