Harm of Non-Return

Specification v3.4.0, section III.A

The documented harm from patient matching failures is extensive:

• Approximately 38% of U.S. providers experienced an adverse event in the prior two years attributable to incorrect patient matching (eHealth Initiative/NextGate 2020 survey)
• More than 7,600 identification errors across 181 healthcare organizations in a 2.5-year period, with roughly 9% resulting in patient injury or death (ECRI Institute 2016)
• Average healthcare facility loses $17.4 million per year to misidentification-related claim denials. Studies show that the average hospital loses $17.4 million annually due to misidentification-related claim denials. But lost revenue doesn’t just stem from the initial denial. Fixing each one costs an average of $25 per claim for practices and $181 for hospitals. On top of that, over a third of organizations report spending $1.3 million a year trying to resolve patient identity issues (Imprivata survey)
• Black Book Survey found that duplicate patient records cost an average of $1950 per patient per inpatient stay and over $800 per emergency department visit. According to the same study, one-third of rejected insurance claims are attributed to inaccurate patient identification, costing the average hospital $1.5 million and the US healthcare system $6 billion annually.(Black Book Research 2018)
• An estimated $3.6 billion per year is spent industry-wide on patient identity management and matching (extrapolated from Intermountain Healthcare testimony)
• Disproportionate impact on Black, Latino, homeless, incarcerated, and disabled patients

These harms occur under the status quo, a system where a large percentage of record queries fail silently. No one logs a match that should have happened but didn’t. The patient simply doesn’t get the data. The physician simply doesn’t see the history.