While it is widely recognized that correct record matching is critical to prevent medical errors, avoid delays in care, and reduce administrative burden, inadequate record matching has remained a persistent problem. This study considers patient-empowered approaches to this problem and proposes an iterative three-stage process to develop a mobile phone solution with app-based functionality that holds promise, given further development and testing.

Cover: Defining and Evaluating Patient-Empowered Approaches to Improving Record Matching
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Defining and Evaluating Patient-Empowered Approaches to Improving Record Matching

by Robert S. Rudin, Richard Hillestad, M. Susan Ridgely, Nabeel Qureshi, John S. Davis II, Shira H. Fischer

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Research Questions

  1. What "patient-empowered" approaches offer promising solutions to current problems in medical record matching?
  2. To what extent can any solutions meet the following criteria: improvement in record matching if widely implemented; patient control; likelihood of adoption by patients, by providers, and by vendors; feasibility (of development, pilot testing, and implementation); minimal security risks; sustainability (operational and financial); political viability; potential to foster new uses of matched records; and low potential for unintended negative consequences?

Despite widespread adoption of electronic health records and increasing exchange of health care data, the benefits of interoperability and health information technology have been hampered by the inability to reliably match patients and their records. The Pew Charitable Trusts contracted with the RAND Corporation to investigate "patient-empowered" approaches to record matching — solutions that have some additional, voluntary role for patients beyond simply supplying demographics to their health care providers — and to select a promising solution for further development and pilot testing. After extensive consultation with a variety of experts, researchers did not identify a "silver bullet" or achieve consensus on a single solution. Instead, this report recommends adopting a three-stage approach that aims to improve the quality of identity information, establish new smartphone app functionality to facilitate bidirectional exchange of identity information and health care data between patients and providers, and create advanced functionality to further improve value. The report also suggests that because the solution contains multiple components involving diverse stakeholders, a governance mechanism likely will be needed to provide leadership, track pilot tests, and evaluation, as well as to convene key stakeholders to build consensus where consensus is needed.

Key Findings

This report identified ten potential patient-empowered solutions to improve record matching, evaluated them using 11 criteria, and proposed a three-stage solution combining elements of several approaches.

  • Implementing a voluntary universal identifier.
  • Using a public key as an identifier.
  • Expanding the use of existing government-issued identifiers.
  • Adding knowledge-based identity information.
  • Adding biometric data.
  • Having patients verify identity information.
  • Using consumer-directed exchange.
  • Using health record banks.
  • Having patients manually verify record matches.
  • Having patients supply record location information.

These potential solutions varied greatly in the level of detail and experience being tested. Application of evaluation criteria found notable strengths and weaknesses with every solution and, on balance, a reasonable argument could be made to further develop most of them. Given high uncertainty as to the extent to which any specific solution can ultimately succeed, further investigation, development, and pilot testing of a range of solutions are warranted.

Recommendations

A promising approach is to advance a three-stage solution that leverages mobile phones and smartphones and aims to (1) improve the quality of identity information used for record matching, (2) establish new functionalities of smartphone apps to facilitate transfer of this information to providers, and (3) create advanced app functionality to further improve record matching and address other evaluation criteria (e.g., likelihood of adoption, sustainability).

Specific recommendations include those that will advance the selected three-stage solution through development and pilot testing by:

  • Developing technical specifications for verified data fields, developing best practices that allow health care providers to verify mobile phone numbers, and iteratively pilot testing and refining the specifications and best practices to maximize feasibility and usability
  • Developing application programming interfaces and best practices for establishing bidirectional communication between a smartphone app and health care provider registration systems at the point of care, and iteratively pilot testing and refining them
  • Developing advanced app functionalities to further improve record matching and increase the value of apps to patients and providers.

Two additional recommendations intended to help accelerate efforts to improve record matching are:

  • Establish or designate an organization to oversee national progress in record matching
  • Conduct more rigorous research into the nature and magnitude of record matching errors, and create methods for health care providers to objectively benchmark their record matching performance.

The research described in this report was funded by The Pew Charitable Trusts and conducted by RAND Health.

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