AXREM Publishes Patient Identification Paper

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In the summer of 2014 Lord Carter was asked to carry out a review of the NHS by the Health Secretary, Jeremy Hunt, as part of his aim to make the NHS the safest and most efficient healthcare system in the world.

The Carter Review says hospitals must standardise procedures, be more transparent and work more closely with neighbouring NHS trusts. It is said that Implementing the recommendations will help end variations in quality of care and finances that cost the NHS billions.

There are two strands to the objectives set by Jeremy Hunt and these are to make the NHS the Safest and most Efficient healthcare system in the world.

The AXREM members of the PACS / RIS Specialist Focus Group believe that the consistent deployment of a Unique Patient Identification Number, based on the existing NHS Number, can bring about benefits which would result in improved safety and efficiency across the NHS.

Issues relating to patient safety and efficient delivery of treatment

Correct identification of patients prior to a medical procedure is vital for clinical safety and quality of service and is the focus of several initiatives in healthcare, most notably in radiology under the IRMER regulations, which govern the diagnostic use of ionising radiation.

Performing procedures on the incorrect patient is viewed as a ‘never event’, and several protocols have been put in place to guard against this, including the current CQC ‘pause and check’ policy which calls for both repeated patient identification as well as a review of prior imaging before a further procedure is performed

Given this emphasis on correct identification, it is imperative that the information technology systems in use support these same quality standards, displaying appropriate information, and that robust operating procedures are put in place to ensure the correct patient is identified on the system. To this end, the use of NHS Number has been mandated several times over the last decade or so, but has failed in universal implementation due to inconsistencies with ensuring the numbers are made readily available to all relevant NHS personnel.

The value in a single identifier used across multiple systems and organisations is that there can be confidence that patients referred between providers, both within one organisation (such as the EPR, the RIS, PACS, LIMS etc.) or externally to alternative facilities, are all referencing the same patient. Within a single organisation this level of synchronisation between systems is normally managed with a Medical Record Number (MRN).
However, given that care is now provided across multiple organisations, coordination is required to ensure access to a complete medical record during each provider’s interaction with that patient. This is only possible through the use of a common identifier, or a robust method for matching/linking identifiers together. Technology exists for matching and linking of patient records, but provides a management and technical overhead that is usually borne by a central data quality team in each organisation. The use of a common identifier removes the risk around manual matching of records, and also removes the time taken for these records to be linked, resulting in timely access to the whole patient record.

There is a standard requirement both before imaging and during the reporting process to review prior imaging to ensure an informed diagnosis is made. Consistent identification of patients using a single identifier would remove the risk associated with the current disparate array of identifiers both within and between organisations, ensuring clinical confidence when reviewing prior imaging history.

In addition to imaging history, common patient identifiers enable timely access to the complete patient medical record, either through a clinical portal to view patient notes, or through an EPR. Applications that use a common patient identifier can be kept in context on the desktop to ensure consistency between applications being used to view the patient’s record, reducing the risk of errors due to manually typing patient identifiers into various disparate systems. Using context synchronisation the user can be confident that the information presented to them is for that specific patient, and can view data from disparate systems with minimum number of clicks.

The AXREM PACS / RIS Specialist focus Group has prepared a paper on this subject explaining how a Unique Patient Identification Number based on the NHS Number can be implemented and the paper can be downloaded from here