The law of unintended consequences is a virtual certainty in crafting complex solutions, passing new laws and in proposing quick fixes to intractable problems.
That is one of life’s great realities. The other is that nothing is as it appears.
In 1956 a popular television game show called “To Tell The Truth” aired in prime time, a panel of four celebrities would ask questions of a three member group of contestants who all claimed to be the same person. After questioning was complete they had to choose the correct person. The moderator would then ask, “Will the real…please stand up?”
It was amazing how many times these clever panelists, asking interesting and questions, were unable to identify the right person.
Fast forward to 2016.
Electronic Health Records, hailed as the be-all, end-all to the problems with quality patient care and sloppy documentation, presents an interesting parallel. While EHR did go a long way to addressing many of the issues, it has created troubling patient safety challenges.
Medical records and other related technology systems enable hospitals to capture a tsunami of data that can be used to design more appropriate roadmaps of care. However, with this flood of information comes with unintended consequences.
One of the biggest issues, medical record and information technology gurus say, is with patient matching. There is so much data that there is real concern as to how much of it is accurate. The old rule of garbage in, garbage out is in play, information technology specialist say.
A process as simple as a patient reporting to the registration desk for admission can produce a torrent of questions, concerns and threats, to patient safety, the information technology specialists say.
Matching the information of the patient presenting for care with the hundreds of thousands, or millions, of names in their system, is no easy task and is fraught with the opportunity to make a potentially serious mistake.
David Muntz, principal of Muntz and Company and a highly respected healthcare information technology consultant, shared the following information he gathered from a 2011 study conducted by the Harris County Hospital District (HCHD in Houston, which operates the famous Ben Taub General Hospital in the Texas Medical Center and Lyndon B. Johnson hospital on Houston’s near north side.
If you do not see the danger signals in this information, you need a reset.
In 2011, according to the HCHD, they had 3,428,925 patients in their database. Here is the interesting, if not startling breakdown:
- Number of times two or more patients shared the same first and last names: 249,213
- Number of times five or more patients shared the same last and first names: 76,354
- Number of times two or more patients shared the same last and first names, and the same date of birth: 69,807
- Number of patients named Maria Garcia: 2,488
- Number of Maria Garcia’s sharing the same date of birth: 231
For internal recruiters assigned to find clerical personnel to staff the various registration desks in the HCHD hospitals and numerous health clinics, this should be eye-opening. Slamming an untrained, warm body into such a seemingly mundane job can have catastrophic consequences.
What happens if a minimum wage clerk who is not feeling well, or worse, is ambivalent about the seriousness of his or her duties, just grabs the first data base entry with matching first and last names and the same birthday?
The chances for a preventable medical mistake, it would seem, begins at the registration desk and the extremely expensive EHR program may not solve this problem. Human error trumps technology again and again.
Leaders need to pay attention to this problem. Patient matching issues and inaccurate data is a huge concern.
Will the real Maria Garcia please stand up.