Data Reveal Top Causes of Duplicate Records

Duplicate medical records are one of the most dangerous and costly problems in patient access, but finding the root cause can be surprisingly difficult.

Researchers examined the underlying causes of duplicate records using a multisite data set of 398,939 patient records with confirmed duplicates.¹ Some key findings of the analysis, which examined reasons for data discrepancies between those record matches, include:

• the field that had the greatest proportion of mismatches was the middle name, accounting for 58.30% of mismatches;
• the Social Security number was the second most frequent mismatch, occurring in 53.54% of the duplicate pairs;
• most mismatches in the name fields were the result of misspellings (53.14% in first name and 33.62% in last name), or swapped last name/first name, first name/middle name, or last name/middle name pairs.

These findings didn’t surprise the study’s lead author, Beth Haenke Just, MBA, RHIA, FAHIMA, founder and CEO of Just Associates, a Centennial, CO-based consulting firm specializing in data integrity and data quality. She discovered similar results in a previous study conducted in 2007.

“The one data issue that improved from then until this recent study was the accurate capture of the patient’s date of birth,” Just says. “I believe this is due to the large emphasis over recent years on positive patient identification.”

Just would like to see patient access departments incorporate the findings into their training programs.

“If patient access staff understood more clearly the top data capture challenges and their impact on duplicate record creation, their data capture quality would increase,” she says. Just offers these recommendations:

• Capture the patient’s legal name accurately.

Nearly 50% of all duplicate records feature a discrepancy in the last or first names, some with both. “Nicknames and misspellings are common issues, and of course, the last name changes for women and some children,” Just says.

• Query the patient or parent about prior names used.
• Obtain a legal document from the patient, such as a driver’s license, and use that for entering the patient’s name.
• Ask the patient, “Have you ever been here before?,” and define the locations that “here” covers.

If the patient says “Yes,” and the registrar does not find the patient when searching the database, following up with a question such as, “Have you ever been here under another name?” is important.

• Obtain the patient’s full middle name.

“This is key to ensure there are enough data points captured on each record to uniquely identify the patient,” Just explains. In her view, it all starts with staff training. “I find that when registrars and schedulers understand that they are actually creating the patient’s medical record when they add a new person to the database, their quality increases,” Just says.

Adding technology solutions, such as an advanced record-matching algorithm and biometrics, is equally important. “This is a complex issue requiring multiple strategies,” Just adds.

Human Error

Deirdre LeBlanc, MS, RHIA, vice president of Health Information Management (HIM) at Parkland Health and Hospital System in Dallas, says biometrics, such as palm scanning, iris scanning, fingerprinting, and headshots of patients attached to their electronic health record, are important tools to prevent duplicate medical records. The same is true of technology that flags information that appears to be similar to another record, so that it can be reviewed.

“That being said, those tools are only as good as the person paying attention to such alerts and using the tools,” LeBlanc warns.

A registrar may rush through the process to meet productivity standards, bypass alerts, misspell a patient’s name, or transpose numbers on a patient’s date of birth. “Human error is the most common cause of duplicate medical records,” LeBlanc notes. She suggests these approaches:

• using two to three patient identifiers when registering patients;
• creating and enforcing adequate accountability measures;
• providing sufficient education of staff on the consequences related to duplicate medical records.

HIM monitors duplicate medical records closely, to identify any trends in registration areas. “We report that information back to patient access leadership for resolution and further education of registrars,” LeBlanc says.

REFERENCE

1. Just BH, Marc D, Munns M, Sandefer R. Why patient matching is a challenge: Research on master patient index (MPI) data discrepancies in key identifying fields. Perspect Health Inf Manag 2016;13:1e.

SOURCES

• Beth Haenke Just, MBA, RHIA, FAHIMA, Founder/CEO, Just Associates, Centennial, CO. Phone: (303) 693-4727. Fax: (303) 693-8437. Email: [email protected].
• Deirdre LeBlanc, MS, RHIA, Health Information Management, Parkland Health & Hospital System, Dallas. Phone: (214) 590-5454. Email: [email protected].