“You Can’t Do It Without Identity”: The Critical Role Patient Matching Plays in Providing Seamless Care

There’s a well-known saying, ‘When one door closes, another opens.’ And in healthcare, as facilities were forced to close their doors due to the pandemic, the digital front door was finally opened. With increased access, however, comes several barriers — one of which is accurate patient identification.

“We’re seeing all of these different ways to engage, both digitally and physically,” said Clay Ritchey, CEO of Verato, during a recent panel discussion. “The identity challenge becomes even more exacerbated as you’re trying to manage care across the continuum.” And beyond that, provide the high level of service that consumers have come to expect.

Doing so, he noted, requires “being able to bridge all of those different encounters” to form one cohesive experience. “And you can’t do that without the identity piece.”

This, of course, is no simple task. During the webinar, Ritchey and co-panelists Michael Saad and David Chou spoke about the importance of accurate and complete patient data — particularly in relation to core objectives, and how they’re managing the myriad challenges that arise.

“We need to make sure we have the right patient at the right time, and the correct match for that patient, throughout the entire spectrum of care,” noted Saad, who serves as CIO at University of Tennessee Medical Center. Failing to do so can negatively impact care quality, safety, and even the bottom line.

For example, if a patient with the same or similar demographic information as another patient presents in the ED, clinicians are forced to make a quick determination. “Just from a patient flow perspective, it’s problematic,” Saad added. If multiple records are created, the HIM and IT departments must work to merge different records, which can lead to “potential patient safety issues.”

There’s also the financial piece, he said, citing a Black Book Survey which found that 33 percent of claims denials can be attributed to mismatched data. “If it’s true, that can create a significant impact on revenue streams.”

“Single record of truth”

Chou agreed, noting that “even within an organization, being able to get to a single record of truth has always been a hurdle.” And when the data need to be aggregated with publicly available information or third-party partners, it becomes even steeper. “Getting to that unique patient identifier is the true north. That’s where folks like Verato can help organizations — and the industry — get to that stage.”

Verato’s core objective, according to Ritchey, is to help organizations create a 360-degree longitudinal view of all the patients they serve, which in turn can improve care delivery. This is done primarily through referential matching, which involves taking partial fragments of a person’s identity and connecting them with existing data to verify the correct identity. “We’ve collected data on pretty much every citizen in the U.S., which allows us to fill in the gaps where an algorithm or fuzzy logic can’t go,” he said, adding that the data come from “well-vetted” sources such as credit bureaus.

And although accuracy is a critical component in the process, the ability to connect and “be the bridge across all of these different services and data sources is a key part of a modern EMPI and identity resolution platform,” Ritchey noted. “Those are two areas in which we’re investing a lot: how do we create accurate identity resolution matching technology, and how do we make sure we have the proper interoperability to bridge across these disparate systems.”

The chicken or the egg?

Interoperability, of course, can’t happen without accurate identity, noted Ritchey, creating something of a “chicken or egg” situation. “You can’t have one without the other. One of the fundamental premises of having liquidity of data is in knowing who the data belong to, so that you can have a high level of confidence to leverage data to either deliver a better care experience or to better understand a patient population and its associated risk factors.”

Without accurate identity, it’s a moot point. Information can’t flow to the right place at the right time, noted Saad. “You can have an enterprise data warehouse or a revenue cycle system and clinical system that talk to each other, but if you don’t have that EMPI or the knowledge that it’s exactly the same patient, it creates a lot of issues. And it can impact things downstream like social determinants of health and analytics.”

Economic justification

If organizations are able to demonstrate the impact, it can help enormously in garnering executive support and buy-in, according to Ritchey. “Connecting ROI to business processes that are negatively affected, such as revenue cycle, patient retention and experience, and not being able to charge for duplicate labs and services, is important.” To that end, Verato works with customers to help identify useful metrics and provide a “clear economic justification for investing” in patient identification solutions.

Finally, the panelists urged attendees to focus on forming strong partnerships with community-based organizations, HIEs, vendors, municipalities, and others to push the initiative forward. Like so many challenges in the healthcare space, it’s not one that can be conquered alone—but it’s one that needs to be met now in order to secure a better future for patients.

“It’s about putting the patient at the center of the care journey,” said Ritchey. “As we start opening up the world, we need to be able to create a seamless experience.”

To view the archive of this webinar — Establishing Accurate Patient Identity as the Cornerstone of Your Interoperability Strategy (Sponsored by Verato) — please click here.