Why patient matching is a key challenge in achieving interoperability
Despite the push to facilitate data exchange, it fails if organizations can tell one patient’s data from another’s, highlighting the need for patient ID initiatives.
While interoperable patient health data will certainly speed treatment, reduce unnecessary testing and improve health outcomes, interoperability is worthless if internal and external IT systems can’t agree on patient identity.
It’s a problem as old as recordkeeping: How does a clinician know that John Jones who is being treated for cardiac issues isn’t the John Jones who has cancer? Hospitals and geographically concentrated health systems believe they are solving the issue with a master patient index, a centralized identity check on patients as they move among providers and facilities within the system.
While that may work within that hospital or health system, patients frequently see specialists and other caregivers not associated with that organization. Many people spend their summers one place and their winters somewhere warmer, not to mention those who take domestic vacations or fall ill while on a business trip.
Because interoperability can’t help organizations distinguish between a John Jones from Pittsburgh and a John Jones from Phoenix, the industry has a patient-matching problem; it’s a critical issue that many organizations are collaboratively trying to solve.
Accurate matching is a fundamental issue
The federal government has played an outsized role in the promotion of electronic health records and, now, the interoperability of health data. The HITECH Act of 2009 provided financial incentives to promote the meaningful use of EHRs while strengthening the privacy and security provisions of HIPAA.
Seven years later, the 21st Century Cures Act set in motion the Trusted Exchange Framework and Common Agreement (TEFCA), the mechanism that promotes the secure exchange of patient data among providers using common standards. TEFCA consolidated efforts by industry partners trying to exchange data on their own.
Despite deep federal support for electronic records and secure exchange, that support has not extended to the one-to-one patient matching that’s crucial for meaningful data exchange. In fact, legislation from 1999 specifically banned federal funding to create a unique patient identifier, which leaves providers and facilities struggling to match patient records.
Higher costs, potential catastrophic outcomes
Mismatched patient names can cause myriad problems, including misdiagnoses, unnecessary surgeries and unwarranted law enforcement attention. The latter occurred when an expectant mother’s medical record was merged with that of a drug-seeking patient. When the woman arrived at the hospital to give birth, staff notified police. What should have been a happy time turned into a bureaucratic nightmare.
In another case, patient mismatch led providers to tell a man he had terminal cancer, with mere months to live. Only weeks later did he learn the diagnosis was meant for another patient. While his relief was undoubtedly palpable, imagine what the other man must have felt when he was told about his terminal condition, not to mention that his loved ones lost several weeks during which they could have been saying goodbye.
In addition to the obvious angst caused by patient mismatches, serious financial consequences also can occur. Duplicate tests and procedures related to patient mismatches add nearly $2,000 to every hospital visit and $1,700 to each emergency department visit. Patient mismatches also results in denied insurance claims more than one-third of the time, adding $7.6 billion to healthcare costs.
How AHIMA Is helping
AHIMA has long advocated for its members and the industry in general, and the organization is taking a leading role in solving the patient-matching issue. It is one of the co-founders of the Patient ID Now coalition that advocates for a national solution to patient matching. So far, more than 50 organizations representing providers, health systems, health information exchanges, standards organizations and health IT vendors have signed on. Members include the Joint Commission, the American College of Physicians and DirectTrust.
The association also wholeheartedly supports the MATCH IT Act of 2025, bipartisan legislation that would bring clarity and consistency to patient matching. Tenets of the bill include defining a measurable, standardized way to assess match rates; identifying a minimum demographic dataset to ensure 99.9 percent match accuracy; standardizing how data is entered; requiring certified health IT systems to support standards; and potentially offering CMS bonuses to providers based on match rates.
Accurate patient matching is no longer a secondary concern — it is the foundation on which true interoperability must be built. Without reliably connecting health records to the correct individuals, even the most advanced data exchange frameworks fall short.
The human and financial risks of getting it wrong are too great to ignore. Many in the industry are continuing to push for practical, scalable solutions that ensure health information follows the right patient, no matter where they receive care.
Until a consistent national approach is adopted, the promise of interoperable, high-quality healthcare will remain just out of reach for millions of Americans.
Jennifer Mueller, MBA, RHIA, SHIMSS, FACHE, FAHIMA, FACHDM, is senior vice president of health information career advancement at AHIMA. To learn more about the MATCH IT Act or to join Patient ID Now, visit AHIMA Advocacy.