Has The Time Come For Records Standardization?

By Karly Rowe

The financial cost of duplicate and outdated patient files has been a chronic condition in the healthcare industry, but the demands of the post-COVID-19 landscape—such as addressing “long-haul” issues, the potential need for boosters and actions on future variants, and interacting with millions of remote patients—make records standardization even more essential, yielding more efficient provider operations, billing, and, ultimately, better patient outcomes.

Records standardization entails at least three types of conformity: first, establishing which data fields are required versus requested so as to prioritize the ability to identify and subsequently merge or track patient data; second, making the fields consistent across data forms, again to ensure that information captured at various points in a patient’s healthcare journey can be compiled into a single, accurate view; and third, defining what the specific requirements of any data field might be—for instance, are months noted in fields for dates expressed in one or two digits?—to make the records more reliably searchable.

When you consider the added challenge of incorporating the volume and variety of data that is coming into systems now that patients are returning for care that was postponed by the pandemic, the time for records standardization has come.

A Chronic Drain on the System

The costs of duplicated and/or outdated patient records are all too apparent to healthcare providers, especially those managing the incessant flow of visitors to emergency rooms (ERs) and clinics. They know that the main culprits of inconsistent records are the well-intentioned imperfections of people capturing information at registration and/or the patients providing it. In the early days of the pandemic, duplicate record creation was already costing the healthcare system over $6 billion industry annually.

It’s highly likely that COVID-19 made that situation worse as it sped user adoption of digital interactions across all geographies and industries. Healthcare was no exception, with one report noting that 46 percent of patients used telehealth in 2020 compared with 11 percent in 2019. As with any innovation that makes life easier or better, that shift is here to stay, as Americans are adopting the technologies in a variety of aspects of their lives (77 percent of all people surveyed in one recent poll said they “don’t know what they’d do” without it).

While a variety of solutions in the financial world help reconcile the disparities in credit scoring and reporting that emerge from such distributed digital engagement, we may well face a resurgent and more critical problem of duplicate, incorrect, or incomplete patient records in healthcare.

The Care Remit Will Change

The science of COVID-19 is becoming increasingly certain that it’s not just a respiratory disease but a virus that can impact many other organ systems, and that those impacts can emerge weeks or months after infection and recur at varying rates and intensities. Patients who suffer this condition, informally called “long haulers,” will have care profiles that are diverse and often complex. This will require care that is more aware and sensitive to those symptoms, as well as informed of the potential intersections with other health and treatment data.

That emergent context for treatment is already complex. Researchers in Massachusetts report that two-thirds of surveyed adults take five or more drugs per day and that 27 percent take 10 or more. Correlated with other research that suggests half of e-prescriptions don’t match patient database profiles, and it reveals a gauntlet of challenges for issuing and then managing additional prescriptions and related therapies. Actions specifically related to COVID-19 only multiply the hurdles, starting with perhaps the most significant challenge: As with any disease, controlling the spread is a core tool in the healthcare arsenal, and it has and will play a role in managing COVID-19 and its variants, yet confusion over who is getting what, when, and where risks blunting the tracing weapon. After all, you can’t trace people if you can’t reliably identify them.

The issues of access/equity and patient data privacy will also grow in importance as time goes on, with some experts calling the use of vaccine passports for providing more freedom of travel and movement “a can of worms.”

Patients Will Expect More

Sales of health sensors that track a variety of biometric indicators continues to increase; in 2020, there was a 28.4 percent increase over the year prior, with the number of connected wearable devices worldwide expected to reach more than 1.1 billion next year. This is generating an immense and ever-increasing amount and variety of informational inputs as well as giving providers an array of data, both health-specific and more broadly behavioral, that can contribute to providing more holistic and effective treatments.

Capturing and using such diverse data streams is uncharted territory for many in our industry, including doctors, according to this survey. The fact that as many as half of all patient records may not be linked correctly makes this challenge of incorporating new data even more daunting, not to mention the absence of important data, such as costs, which aren’t available to approximately half of all physicians.

These challenges come within the context of the 21st Century Cures Act, passed in 2016 and requiring significant improvements in adoption of electronic health records, records interoperability, and added prohibitions of information blocking. Patients will be able to request their health information with the swipe of a finger, and providers and payers will need to comply. So, they won’t only expect better access to their data but will need and expect better outcomes, too.

But the transformation required to deliver those more robust and useful records, and the better health outcomes they capture and enable, starts with being able to identify your patient.

Digital Transformation Has Already Begun

The argument for a universal or national patient identifier is beyond question, as outlined in a recent Journal of AHIMA article. Yet the closest we’ve gotten to one without legislative action is using Social Security numbers, which are woefully inaccurate, with one analysis finding that approximately 20 million Americans have more than one and 40 million numbers are associated with more than one individual.

The ongoing debate about patient identification and matching needs to be seen within a broader context of digital transformation that has already begun, however unevenly and imperfectly.

So, while the push for a standard patient identifier should and will continue, there is a clear imperative to address records standardization now. The enormity of the challenge, and its long-term implications, doesn’t have to impede discrete actions that can yield short- and mid-term benefits. Businesses in other industries affect enterprise wide change using a similar one-step-at-a-time approach. Technology change is built, not revealed or imposed.

Providers could take steps to reduce the creation of new duplicates at points of registration and ongoing engagement. Duplicate records could be matched and sanitized at any number of touch points along care journeys. Adding new data streams could be a prompt for the same.

The processes and tools for implementing these activities are tested and well-known, as are the techniques to ensure that they provide an emergent platform for linking and integrating them into enterprise solutions. The time has come to step up to meet the challenge of records standardization.

Karly Rowe is senior vice president for Patient Access, Identity & Care Management at Experian Health.

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