Duplicate and overlay medical records have existed since the first use of computers in healthcare. Overlay records, perhaps better named “wrong patient errors” (WPE), occur when data from one patient is entered into a different patient’s record. Overlays, or WPEs, can occur from EHR users selecting the wrong patient during a patient search, as may happen for multiple birth siblings or people with similar names. In addition, WPEs can occur when clinicians accidentally type or copy/paste notes into the wrong chart window, when lab results are mislabeled with the incorrect medical record number or similar errors. Finally, overlay medical records can be created when incorrect record merges are made during EHR cleanups, from the combination of EHRs during business acquisitions, or during record linkages to incorrect records in health information exchanges, for example
Regardless of how overlay medical records or wrong patient errors occur, the inclusion of incorrect medical records in a patient’s chart can be dangerous. Wrong blood types can be fatal, or an overwritten medicine list might cause incorrect prescriptions to be issued to the wrong patient, possibly causing adverse drug interactions with existing medication taken by the patient. Overlay medical records also cause revenue cycle issues when providers are denied payment due to duplicated medical procedures, lack of preauthorization for the correct patient, or simply submitting claims to the wrong payer. Lastly, overlay medical data present unique compliance issues that cause providers to run afoul of both HIPAA and 21st Century Cures Act requirements. For example, it is a reportable HIPAA violation anytime a patient discovers another patient’s information in their chart, say from reviewing their information on a portal or upon review of their records from a release of information (ROI) request. Conversely, it is both a HIPAA and 21st Century Cures Act violation to not supply patients with all legally required information and this is not possible when patients are records missing information because some of their data was stored in another patient’s chart. Duplicate records, by the way, also cause compliance issues for similar reasons when patients only receive part of their medical record.
Avant has created an infographic that summarizes the ways in which overlay records can be created and how to address each data error risk at the source of the problem.