New records-sharing rule could have damaging side effect

Giving patients access to more of their medical record data can help them better understand their health care and make more-informed decisions.

That’s the reasoning behind the recent interoperability rule from the Office of the National Coordinator for Health Information Technology (ONC). The rule requires health care providers to make more medical records electronically available to patients by eliminating information blocking.

But the new rule is likely to have the unintended side effect of spreading faulty and potentially harmful data in the form of duplicate or overlayed patient records.

Duplicate records, which are inadvertently created by labs, clinics, EHRs and hospitals when entering information about patients, are surprisingly common. For example, a hospital in Texas found that 22% of its patient records were duplicates, according to the Healthcare Financial Management Association.

The duplicate record problem

When the patient is not properly identified, multiple problems arise. One is that a patient’s record is duplicated in a health care organization’s master patient index (MPI). For example, a health care system could create multiple patient records for the same John Smith, based on different spellings, addresses, or phone numbers.

This is even more likely to occur when duplications and other patient identity errors span disparate environments. A patient may see multiple doctors, with each clinician using different laboratories, thereby increasing the likelihood of creating duplicate records. The resulting records are likely to be incomplete because they don’t include every diagnosis, test or treatment.

As a result of duplicate records, a doctor may have information from one lab while not knowing whether the patient has had tests at other labs. The doctor sees only a portion of the patient’s records and has no way of spotting diagnostic trends that could inform their clinical decisions. This type of care gap could result in patient harm, according to a study by the University of Texas School of Biomedical Informatics.

Even more dangerous than duplicates are “overlays.” These occur when one patient’s records end up in another patient’s chart. In this case, a clinician treating a patient isn’t simply working with an incomplete patient record—they unknowingly have the wrong medical information entirely. Overlays can lead to bad patient outcomes and significant litigation.

The new rule

Consider how those occurrences can be made worse by the new interoperability rule. Here’s what it requires:

In 2016, Congress approved the 21st Century Cures Act to promote access, exchange, and use of patients’ electronic health information (EHI). The interoperability provisions of the Cures Act were published in 2020 as the ONC Cures Act Final Rule. Those rules promote patient control over health information through the adoption of standards-based application programming interface (API), which is simply a way for patients to directly access their EHI from providers.

The rule also prohibits information blocking by providers and defines those practices that are considered reasonable and necessary activities that would not constitute information blocking. This makes it easier for patients to use smartphones, tablets, and desktop apps to access their personal health information from their providers’ EHR systems.

Like a virus

Duplicate records are common within a single health care system; the problem is even worse when combining records from multiple systems, each of which has its own MPI. Thus the more providers and health care systems from which a patient accesses their EHI, the more likely they are to get bad data.

And patients themselves can’t be counted on to screen for errors. Most patients will naturally assume their EHI is correct and not verify that their information has not been co-mingled or overlaid with someone else’s.

Imagine duplicate patient records as a virus in the health care system. Patients contract it when they access their EHI. And when patients unwittingly share their faulty records with a new provider, the virus spreads further.

Just as with a virus, spreading incorrect EHI resulting from duplicate patient records can be harmful. It can lead to misdiagnoses and wrong treatments that put patients at risk. For health care providers, the dissemination of bad information can lead to legal exposure and the expense of cleaning records.

Matching issues are also expensive for providers and patients. According to a 2018 Black Book Research survey of 1,400 health technology managers, patient matching issues that result in duplicate records cost an average of $1,950 per patient per inpatient stay and over $800 per ED visit.

Patients deserve accurate data and it’s the responsibility of their care providers and related organizations to make sure it is free of errors. This includes hospitals, labs, health information exchanges, health information networks, health plans and payers. They might not be able to control access to patient EHI, but they should do everything within their power to ensure it’s high-quality data by eliminating duplicates and overlays before patients access their data through the new rule.

Gregg Church is president of 4Medica, a provider of real-time clinical data management and health care interoperability software and services.