Written by: Cheryl Reifsnyder, PhD and Auren Weinberg M.D., M.B.A.

With the increased use of electronic health records (EHRs), advances in interoperability facilitating the exchange of patient records, and even individual patient wearables that capture and transmit biometric and performance metric data-today's clinicians can access more patient information at the point of care than ever before. But the amount of patient data available to clinicians at the point of care only matters if that data is reliable and high-quality.

That's because safe and effective patient care requires accurate, complete, timely, and relevant patient data. Unfortunately, poor-quality patient data is an immense problem in our current healthcare system. In particular, duplicate patient records-which occur when 2 or more medical records are created for the same person-are surprisingly prevalent. Research shows that the average healthcare organization experiences a 10% duplication rate; some institutions have duplicationup to 18%.

Many healthcare organizations ignore the data duplicity issue, but each duplication has a trickle-down effect, compromising and threatening patients, providers, employees, and payers. Duplicate records affect the organization's finances and overall workflow, causing issues such as:

• Missed appointments
• Additional expenses
• Potential delays in diagnosis
• Medical errors in patient treatment
• Administrative inefficiencies

The results can be detrimental, or even dangerous, to patient care and cause problems with billing and reimbursement.

This blog is designed to increase awareness of duplicate patient records and how this problem affects patients, providers, healthcare organizations, and more-as well as provide some strategies for combatting the problem.

Causes of duplicate patient records

Human error-especially during patient registration

According to the National Patient Misidentification Report, nearly all duplicate patient records are caused by human error during the patient registration process. Duplicate records are often created when overworked data entry workers are unable to match the information they have in hand with existing patient records; instead, they default to creating a new patient identity rather than continuing to search for the right patient in their files.

This is a particular problem for patients who do not have sufficient information recorded. When patient records are incomplete, data entry workers have to browse through hundreds of records to locate the correct patient's information. When provided verbally, the traditional identifiers used for patient records, such as demographic data, social security numbers, and addresses, are easily mistyped, which can also lead to record duplication. Some patients use multiple names or shortened versions of their full names; some represent their first name with an initial followed by a full middle name. Language barriers can also lead to misunderstood information being entered. There are also many common patient surnames and variations in spellings, which can lead to numerous patients with the same or similar first, middle, and/or last names

Children are especially at risk for record duplication. Most lack official forms of identification. Also, children cannot always speak for themselves, leading to a higher error rate in pediatric than adult records. The patient's family and caregivers sometimes provide incorrect information, exacerbating the problem.

Human error is also prevalent when dealing with clinical laboratories, most of which use paper requisitions and manual entry of patient demographics. The numerous typing errors that result usually generate duplicate patient records, each containing only small amounts of clinical information.

Inconsistent patient registration process and/or poor data management

A lack of sufficient technology to manage patient data and patient records is another key contributing factor to the duplication of patient records. Without a consistent format and a consistent registration process for healthcare professionals to follow when inputting patient records, both within a single facility and across separate facilities, patient data can be difficult to reconcile and match. In the absence of standardized health data management systems, it is easy for patient medical records to be duplicated, causing confusion among caregivers.

Patient self-registration

Many digital health applications require patients' self-registration, which also frequently leads to record duplication-especially if the patient uses different identification or contact information than what is already on file or if a language barrier exists. In fact, 71% of healthcare organizations agree or strongly agree that portals allowing patients to self-schedule and/or self-register actively contribute to the increasing number of duplicate patient records.

Clinical impact of duplicate records: Patient safety risks

Correct patient identification is vital to safe and efficient patient care. Failure to access the correct patient records can significantly impact patients' health outcomes, because it can lead to inaccurate diagnoses, medical errors, treatment delays, and incorrect treatments.

This is because viewing incorrect records when seeing a patient makes it more difficult for clinicians to see previous diagnoses, treatments, and medications that the patient has received. For instance, the physician may lack information about the medications a patient is currently taking; or they may lack information about drug-to-drug interactions or drug allergies that will affect the patient.

If a patient takes medication intended for another patient, the consequences can be devastating, even leading to death-making it especially important to confirm the patient's identity before administering medication. For instance, analysis of blood transfusion errors at the University of Kentucky showed that lack of accurate patient identification was the most common cause.

Preventable medical errors form the third largest cause of death in the U.S. after heart disease and cancer. Duplicate patient records account for nearly 2,000 preventable deaths each year.

Medical errors due to patient misidentification

In the 2016 National Patient Misidentification Report, 86% of respondents reported having witnessed or being aware of a medical error resulting from patient misidentification. This type of error directly impacts patient care by:

1. Making it difficult for providers to obtain comprehensive, accurate medical histories for patients, which can lead to inaccurate diagnoses, treatments, or medication errors.
2. Resulting in patient treatment errors because, without patients' complete medical histories, providers may prescribe drugs that interact negatively with the patient's other treatments or medications. This can cause long-term health effects for the patients or even put the patient's life at risk.
3. Leading to treatment delays, because providers must spend more time reviewing patient records or conducting additional tests to ensure they have all the necessary information. Delays of this type are particularly troublesome in emergency situations, where they can prevent access to needed treatments or increase complications.

Beyond the clinical realm

Operational inefficiencies

The impact of duplicate patient records often extends beyond the immediate clinical consequences. Duplicate records can also cause reduced operational efficiency for the organization overall.

This becomes particularly problematic when merging healthcare systems create the need to integrate and reconcile patient data from disparate sources. As organizations combine and expand, duplicate patient records can unintentionally proliferate-resulting in delays in patient admissions or discharges, challenges related to resource allocations, scheduling delays, and an increased workload for medical staff attempting to reconcile records.

Health Information Management (HIM) professionals are those responsible for the organization, storage, and maintenance of patients' medical records. However, duplicate records can lead to data inconsistencies-making their task of maintaining comprehensive, accurate patient records much more difficult.

Care coordination

Duplicate patient records become a particular problem when providers across an affiliated network-one using heterogeneous EHR systems-need to coordinate a patient's care. Both providers will need to access complete, trustworthy information concerning that patient. If the patient's data are divided into 2 or more medical records, each provider will only be able to view a portion of the patient's history.

Collaboration is essential when more than one provider contributes to a patient's care or to ensure continuity of care from one healthcare organization to another. However, duplicate patient records make the exchange of necessary information more complex and difficult and can even endanger the patient's health.

Unnecessary utilization

Duplication of patient records may also mean a patient's treatment history or test results fail to appear in the medical record a clinician references when ordering additional tests or care. Without access to the patient's complete scope of already received testing and treatment, testing and/or treatment protocols may be repeated; even if the clinician is aware of missing test results, delays may result while they attempt to locate them.

Compliance failures

Duplicate patient records can also lead to noncompliance with healthcare regulations, such as HIPAA, due to privacy violations stemming from duplicate records. When multiple patient records exist, it can become extremely difficult to identify which records are the most current and more accurate. This can lead to unauthorized access to or misuse of patient data.

Quality reporting systems, such as star ratings, HEDIS, and payer performance, all depend on accurate quality reporting to assess the quality of healthcare services provided. However, duplicate records can also affect the accuracy of quality reporting, making it more difficult to determine the number of patients truly seen or the specific services provided to them, resulting in inaccurate reporting.

Financial costs

The many downstream effects of duplicate patient records often cost healthcare organizations much more than they realize. Duplicate patient records frequently result in the provider ordering repeat tests or care for the patient. If duplicate patient records lead to a patient receiving the wrong treatment, that patient may need additional care. A recent AHIMA study showed that repeated tests and treatment delays add $1,100, on average, to the cost of patient care.

Duplicate records also impact value-based care initiatives. More and more often, providers' success is based on their ability to influence patients' health outcomes-but to do so, they require visibility into the patient's complete, authentic medical record. If that record lacks clarity regarding a patient's lab tests, for instance, that missing information may mean the difference between a performance bonus and a financial penalty for the provider.

Duplicate records can also have indirect financial effects. They can negatively impact patients' satisfaction with their healthcare; dissatisfied patients are then likely to take their business elsewhere-or share their dissatisfaction with a broader audience, potentially decreasing the number of healthcare clients at your practice or organization.

If record duplication has led to worsened patient health outcomes, your organization may also find itself the subject of malpractice lawsuits. According to the medical liability insurance provider, SCICO Strategies, patient identification errors-which often result from patient record duplication-generate nearly $1.7 billion in malpractice costs annually.

Strategies to avoid duplication of patient records

AHIMA has outlined a number of strategies healthcare practices and organizations can use to help prevent patient record duplication. The first step in maintaining a clean, duplicate-free database is implementation of a consistent set of record-keeping procedures that will be followed throughout the organization. The record-keeping system should be standardized and set up with unique identifiers that can be used to distinguish individual patients. Biometric technology can be a particularly powerful means of identifying patients.

When registering patients and entering their health record information the first time, it's critical to ensure their records contain the correct information, correctly spelled, from the outset. To create error-free patient records:

• Avoid rushing during the patient registration process-take time to record patient information clearly and accurately.
• Avoid making assumptions about patients; instead, ask them to spell their names and other potentially difficult-to-spell information.
• Double-check all entries for errors.

The second strategy to help prevent record duplication: Staff must take the required time to find a preexisting patient record rather than just creating a new entry.

AHIMA's third recommended strategy for limiting the number of duplicate records in your system is to regularly review and cleanse the individual patient records. Doing so will enable you to identify and merge duplicates, helping you to maintain a clean and accurate database.

AHIMA recommends that all healthcare organizations work toward a 1% duplicate error rate.

How Veradigm can help

Veradigm Ambulatory Suite is a comprehensive platform comprised of EHR, practice management, and patient engagement solutions and services. Our solutions are integrated, allowing them to share patient data seamlessly.

Always use the strategies above to avoid duplicating records, but, in addition, Veradigm Practice Management has configuration options designed to help you prevent errors. Veradigm Practice Management will provide a warning when registering a new patient if a record already exists based on name, date of birth, and/or social security number. Also, unique patient identifiers can be stored in Veradigm Practice Management and can be used for matching to let you know if there is already a match in the system.

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