GAO: Patient matching hampered by demographic data
While healthcare providers are increasingly sharing electronic health records, they continue to face challenges in matching patients to their EHRs, according to the Government Accountability Office.
Patients are matched to their medical records—either manually or automatically via software—through demographic information, such as name, date of birth or sex.
However, a GAO audit based on stakeholder interviews found that “inaccurate, incomplete or inconsistently formatted demographic information in patients’ records” is posing challenges to matching medical records. Particularly problematic is the matching of medical records for newborns and multiple-birth siblings such as twins, according to the report.
A provision in the 21st Century Cures Act called on the GAO to review patient record matching efforts in the context of EHRs.
In particular, auditors noted that EHRs “don’t always contain correct information (e.g., a patient may provide a nickname rather than a legal name) and that health information technology (IT) systems and providers use different formats for key information, such as names that contain hyphens.”
As a result, GAO warned that inaccurately matched records can negatively impact patient safety in cases where incorrect data are used to make medical decisions.
“Stakeholders said more could be done to improve patient record matching, and identified several efforts that could improve matching,” states the GAO’s report. “Among the examples of efforts stakeholders identified that could improve matching were implementing common standards for demographic data; developing a data set to test the accuracy of matching methods; sharing best practices and other resources; implementing a national unique patient identifier; and developing a public-private collaboration effort to improve patient record matching.”
Specifically, some stakeholders interviewed by auditors indicated that the Office of the National Coordinator for Health IT could require demographic data standards as part of ONC’s EHR certification responsibilities, while others said the agency could facilitate the voluntary adoption of these standards.
Another problem identified by the GAO is the difficulty providers experience in determining the accuracy of health IT tools used to match patients’ medical records.
“While the algorithms typically match records belonging to a patient and identify potential matches that need to be manually reviewed, users of these algorithms do not know how many matches the algorithm may have failed to make,” states the report. “Stakeholders expressed concern that it is not possible to assess the accuracy of algorithms without independent testing to identify matches that the algorithm may have missed.”
Auditors also reported that, according to the Department of Health and Human Services, the “proprietary nature of many patient matching algorithms makes it difficult to assess their effectiveness.”
ONC officials referenced in the GAO’s audit cited a number of challenges to developing a test data set for assessing a range of patient matching algorithms.
“The data set would need to be very large; would require an extensive and expensive effort to develop; could be difficult to implement from a practical perspective; and that, because data varies widely across patient populations and organizations, might have limited application for assessing algorithms that are designed to match specific data sets,” auditors quoted ONC officials as saying.
Nonetheless, ONC and some stakeholders indicated in the GAO report that ONC’s current effort to establish a national framework for exchanging health information electronically could address some patient record matching challenges.
“As required by the 21st Century Cures Act, ONC is taking steps to develop or support a framework for ensuring the full exchange of health information among health information networks,” states the audit. “ONC has referred to this effort as establishing a ‘network of networks,’ and it includes the development of a common agreement among health information networks nationally, which providers and others can use to facilitate the exchange of electronic health information, including patients’ health records.”