Overview

The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Example

Joanna Gonzales Morales, age 32, arrives in the office with her twin daughters Juana Maria Gonzales Morales and Mariela Gonzales Morales, age 3 years and 4 months. Juana Maria is 15 minutes older than Mariela. There is no record for either sibling in the provider’s EHR.

The intake worker in the provider’s office collects information from Mrs. Morales and enters Juana Maria and Mariela as new patients. The intake worker first determines if either child is already registered by searching for each child’s information in the EHR.  In conducting the search, the intake worker locates a patient with similar information, who is named Juana Mariana Gonzales.  However, Juana Mariana Gonzales is 6 years of age, which enables the intake worker to validate that this is a different patient, and that Juana Maria and Mariela Gonzales Morales are new patients whose information is not yet entered in the EHR.

The intake worker then registers Juana Maria and Mariela in the EHR by entering the necessary patient information.  As part of this process, the intake worker enters the mother’s maiden name (Gonzales), checks the multiple birth indicator for each, and enters birth order for each child in the appropriate field.

Guidance

The HL7 2.5.1 Implementation Guide lists data elements usable for patient identification. Click here for the full set of demographic data elements. When provided with such information, systems should store and submit it. The fields most likely to be absent in existing software the project evaluated include multiple birth indicator and birth order. These fields are helpful in immunization registries to differentiate children from multiple births, especially when other differentiating data are not available from the birth facility. Capturing complete data (e.g., a full middle name rather than a middle initial) is preferable to differentiate patients with similar names.

• Vendor Perspective. Products with the ability to store all elements listed as required (R), required if exist (RE), and conditional (C) may more commonly match patients with those in public health registries by allowing capture of a superset of demographic elements to manage the variation in statutory requirements.
• Provider and Implementer Perspectives. Capturing more demographic data elements for each patient helps match patients within the practice and especially when communicating with immunization registries. Better matching increases the likelihood that queries sent to the registry for information will identify unique patients and return data to the practice.

Test

Click here for a test script scenario that includes the capability Register New Patients. The script also indicates successful performance for each of the test sections. When provided with a patient’s full middle name, a mother’s maiden name, multiple birth data and birth order, the system will store and transmit all of the information, including the full middle name in queries and reports sent to the immunization registry.

Data Elements

Click here for the data elements associated with the capability Register New Patients.