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Elizabeth Eaken Zhani
Hospital Undertakes Initiatives to Identify, Respond to, and Prevent Medical Identify Theft
Efforts featured in July 2014 issue of The Joint Commission Journal on Quality and Patient Safety(Oak Brook, Ill., June 24, 2014) Joint Commission Resources today announced the release of the July 2014 issue of The Joint Commission Journal on Quality and Patient Safety. The issue features an article by Timothy Judson, M.P.H., and co-authors, “Medical Identify Theft: Prevention and Reconciliation Initiatives at Massachusetts General Hospital,” on how the hospital identifies, responds to, and prevents medical identity theft.
Medical identify theft refers to the misuse of another individual’s identifying medical information to receive medical care. An estimated 1.5 million Americans have been affected by medical identify theft, incurring damages estimated to average $20,663 per victim, according to a report cited by the authors. In 2010, there were 81 suspected cases of medical identity theft at Massachusetts General Hospital (MGH), Boston, a 999-bed academic medical center, resulting in a total of $2.92 million in charges at risk for not being reimbursed. These cases also resulted in significant patient safety issues, including inaccuracy of patient information such as blood type, medication allergies, or medical history. Both the victim and the person using the false identity are at risk for misdiagnosis or mistreatment.
Since 2007, MGH has implemented a variety of initiatives to prevent medical identify theft and to better identify and respond to cases when they occur. For example, MGH has used a notification tree to standardize the reporting of red flag incidents (warning signs of identity theft, such as suspicious personal identifiers or account activity). A Data Integrity Dashboard also tracks and reviews all potential incidents of medical identify theft to detect trends and targets for mitigation. In addition, an identity-checking policy, VERI (Verify Everyone’s Identify)-Safe Patient Care, requires photo identification at every visit and follow-up.
MGH data suggest that an estimated 120 duplicate medical records are created each month, 25 patient encounters are likely tied to identify theft or fraud each quarter, and 14 patients are treated under the wrong medical record number each year. As a result of MGH’s initiatives, in December 2013, 80 to 85 percent of patients were showing photo identification at appointments. The authors conclude that although an organization’s policy changes and educational campaigns can improve detection and reconciliation of medical identity theft cases, national policies should be implemented to streamline the process of correcting errors in medical records, reduce the financial disincentive for hospitals to detect and report cases, and create a single point of entry to reduce the burden on individuals and providers to reconcile cases
The remaining articles from the July 2014 issue are:
Methods, Tools and Strategies
Collaborative practice agreements (CPAs) were applied to hospital surgical teams in a postsurgical colorectal surgery unit at Mayo Clinic Rochester. For the 135 CPA–eligible colorectal and general surgery patients in January 2011–March 2011, as compared with 305 non-CPA patients on a comparable surgical unit, there were significantly more pharmacist interventions and completed medication reconciliations and rules-based interventions, as well as shorter time-to-decision values.
Teamwork and Communications
English National Health Service (NHS) hospitals have been encouraged to make use of methods closely based on the Leadership (or Executive) WalkRounds™ approach. A study conducted with clinicians and administrators at three hospitals and with NHS quality and safety stakeholders revealed modification and expansion of walkrounds. Such deviations risk replacing the main objectives of walkrounds with a form of surveillance that could alienate frontline staff and produce fallible insights.
Barriers and Facilitators for Taking Action After Classroom-Based Crew Resource Management Training at Three ICUs
Implementing the plans of action formulated during crew resource management (CRM) training may constitute an important first step in the successful uptake of skills. In a study conducted at three ICUs in the Netherlands, perceived barriers were negatively associated, and facilitators were positively associated, with taking action. Barriers and facilitators should be considered during the training and in regular CRM meetings afterward.
Coordination of Care
The Quality Improvement Organization in Rhode Island, using a multistage approach, prepared a set of eight best practices for urgent care center transitions. The best practices focus on clinician-to-clinician communication and patient activation, which can be implemented to establish measurable, communitywide expectations for communication to the emergency department or primary care office.
The Department of Anesthesiology and Pain Medicine at Nationwide Children’s Hospital (Columbus, Ohio), developed a medication-based trigger tool to identify adverse events. During the 15-month study period (December 2010–February 2012), the screening of all 17,350 cases with the trigger tool led to the detection of an additional 349 adverse events beyond the 647 identified through the self-reporting system. The findings have been used to prioritize and direct departmental quality improvement and related educational activities.
Joint Commission Resources (JCR), a not-for-profit affiliate of The Joint Commission, is the official publisher and educator of The Joint Commission. JCR is an expert resource for health care organizations, providing consulting services, educational services and publications to assist in improving quality and safety and to help in meeting the accreditation standards of The Joint Commission. JCR provides consulting services independently from The Joint Commission and in a fully confidential manner. Please visit our Web site at www.jcrinc.com.
A review copy of the Journal is available to reporters upon request.