Someone meeting him for the first time saw a very ill older man. I had known him before he became that ill. I needed those two perspectives to meet. Sometimes a staff member already understood much of what I wanted to explain. Sometimes a detail seemed new. I knew handovers took place, but from the bedside I could not tell which parts of our conversations had reached the next person. 

Prognosis should be revisited as the patient changes. It should incorporate direct observation, pre-admission function, family knowledge, response to treatment and the patient's own goals. 

In health care, we invest heavily in confirming that the right wristband, order, medication and chart belong to the right patient. That is essential, but correct matching is only the first level of identity. The deeper challenge is ensuring that the information attached to that identity remains accurate, contextual and human as it moves across shifts, disciplines and days. 

The first inpatient report I opened in the hospital’s patient portal described an older man with COPD and a history of smoking. It was not my father. My dad hasn't smoked in over 60 years. He did not have COPD. Yet there it was: an attending physician’s report inside his health record, presenting a medical history that belonged to someone else. 

In 2025, 89% of Canadians said they were interested in electronically accessing their health information and using digital tools to manage their care. Yet only 13% reported access to all three core components of their health record, and approximately 10 million Canadian adults reported having no electronic access to any of their health information. There is a significant gap between wanting to be connected and actually becoming connected. That gap has a cost. 

An invitation is not a connection. An account is not engagement. A download is not understanding. The first connection is complete only when the patient can use it. 

Healthcare has invested heavily in patient portals, and for good reason. Modern patient portals can give patients secure digital access to appointments, test results, medications, messages, educational information and other elements of their health record. They have become an important part of modern healthcare infrastructure. But there is an important distinction we sometimes overlook: Having a patient portal is not the same as having a patient strategy 

Family members and trusted care partners are often the people holding the patient journey together. Yet health care continues to treat them largely as visitors. They may be essential to the patient’s care, but they frequently remain outside the digital workflow. They receive information second-hand, depend on the patient to forward messages and often have no structured way to participate, or participation digitally has a complicated workflow. The family has become health care’s forgotten interface. 

Digital onboarding should be a safety workflow. A QR code, portal invitation or mobile application is not, by itself, onboarding. Digital onboarding becomes meaningful when it is connected to verified patient identity and designed around the care workflow. This is the premise behind mySPOT Onboarding. 

Questions that could have been answered digitally become interruptions during already busy clinical workflows. Discharge instructions are forgotten or not understood and follow-up compliance declines. None of these failures occur because clinicians aren't committed. They occur because the communication pathway wasn't established early enough. 

Most wristband workflows focus on one question: “Is this the right patient?” That question is essential. It sits at the centre of medication safety, specimen collection, imaging, transport, procedures, documentation, and discharge. However, modern health care increasingly depends on another question: "Can this patient securely access & easily our digital tools or required workflow?” 

To the system, the scan may look successful. To the dashboard, it may look compliant. To the audit report, it may look like the barcode process worked, but from a safety perspective, the identity process has failed. The barcode identified the wristband. It did not necessarily identify the person. That is the hidden audit trail of identity failure. More precisely, it is the missing audit trail. The most important failure may be the one the system never recognizes as a failure, it’s accepted. 

Patients already play a role in identity assurance every day. They correct the spelling of their name. They question a medication they do not recognize. They notice when a specimen label has the wrong date of birth. They remind staff about an allergy. They ask why they are being taken for a test they were not expecting. They say, “That is not my wristband.” They say, “That is not my medication.” They say, “I already had that done.” They say, “I think you have the wrong person.” These moments matter. 

Hospitals are complex. Emergency care is unpredictable. Not every patient can speak. Not every patient arrives with identification. Not every registration record is clean. But local flexibility also creates risk. If the identity process is mostly internal, mostly local, and mostly invisible to the patient and family, the system may not generate a clear “identity uncertainty” signal until harm has already occurred. In baggage, an exception becomes a case. In health care, an identity exception must become a safety event. 

Patient identity is not protected by the wristband alone. It is protected by the relationship between the patient, the team, the workflow, the technology, and the safety culture around exceptions. The wristband tells the system who the patient is supposed to be. But when the wristband leaves the wrist, the system may still think identity has been confirmed. 

Aviation still uses visible tags, colour-coded identifiers and human-readable information because not every situation is routine. Some bags are priority. Some bags are connecting to another flight. Some require special handling. Some miss a scan. Some are delayed, rerouted or damaged. Health care is no different. A patient identification wristband connects the patient to the digital record. A barcode can support positive identification for medication, specimens, diagnostics, procedures and movement through the hospital.