By David Bennett, Regional Director, NextGate
Twitter: @NextGate
COVID-19 has served as a sobering reminder of the continued interoperability and patient matching vulnerabilities of our nation’s healthcare system. As the potential for future waves loom, many health IT decision-makers are finding themselves at a critical juncture. To ensure their organizations have seamlessly orchestrated data that is readily available, accurate and complete, organizational leaders will need technological tools that will improve the integrity of their data, foster information sharing, and maximize impact for patients.
Tired of EHR systems that only provide a limited view of their patient’s health, progressive healthcare organizations and HIEs are leveraging enterprise master patient indexes (EMPIs) as a strategic advantage to integrate multiple disparate data sources and facilitate better coordination among hospitals and their state health departments. Robust patient identity management tools like EMPIs ensure that the right data is linked to the right individual so that providers are able to view and access all the available information about a person’s health. This includes diagnosed medical conditions, lab work, imaging, diagnostic tests, medications, allergies and family medical history.
But what kinds of questions should healthcare leaders ask before signing the bottom line on a new EMPI contract? Here are 7 key questions to ask to determine if the EMPI vendor is the right fit.
1. How long has this vendor been in the healthcare business, and what is their reputation in the field of identity management?
Does the vendor have experience in core EMPI platforms? Comparing and merging patient records is a sensitive and significant procedure that has profound implications, especially with regards to patient safety. Healthcare IT decision-makers should look for a vendor that possesses a solid history of success in healthcare, as well as a balanced portfolio of identity management solutions and experience working with organizations like yours.
There are very few vendors that supply a standalone EMPI. Find out if the software was originally developed for another industry or if it was inherited as a result of a merger or acquisition, since those conditions will influence the implementation timeframe and the quality of support you’ll receive before and after go-live. Also, many vendors that have recently entered the EMPI market have spawned from lab order management or revenue cycle services which do not typically have the expertise in complex multi system integration as well as the ability to scale to the level of an enterprise class application.
Know the capabilities of your current technology systems and look to see if the vendor has customer testimonials that are applicable to your network of data sources, EHR/HIS setup, or physicians and other users. ACOs, HIEs, complex health systems, and individual hospitals or medical groups can have complex data access processes, so inquire about the vendor’s implementation methodology and project management to ensure they understand and can accommodate site specific variances. Obvious duplicates are easy to manage. It’s the ones with subtle differences that require a deep understanding of data analysis and workflow.
2. Who owns the data and how is it being managed?
It’s critically important to know if your patient population is being used to feed a vendor’s database or if it is being managed locally. An EMPI is intended to provide a data governance framework to help organizations distinguish which workflows or sources of data are problematic, so the provider can then address those issues accordingly. For this reason, patient identity management must be conducted locally. Any EMPI vendor that pools their customers’ data into a giant melting pot is a serious red flag. This type of large-scale data aggregation has considerable privacy and security risks. Having hundreds of millions of pieces of identification about individuals in a single location can be devastating in term of a data breach. This approach encourages the mass storage of personal information that leaves consumers—in this case, patients—exposed. When you share your patients’ data to a third party, some vendors may require a degree of control. While the data can be used for a variety of different purposes, most are for the vendor’s benefit.
3. What national standards are employed to ensure reliable patient identification?
It’s important to know if the software provider is familiar and compliant with healthcare industry standards like HL7, PIX/PDQ, and interoperability approaches like FHIR and a full suite of secure API integration points. As HIEs and large health systems continue to acquire additional network participants, it’s important to know that the EMPI can scale to meet the increase in volume as more records from more systems take advantage of the EMPI’s unique patient identifiers.
4. Does the EMPI vendor have a reputable list of existing customers? Ask for a list of at least four references that are similar to your organization.
Whether you’re an HIE or large integrated delivery network, collecting a list of references is one of the most crucial steps in the EMPI selection process. This is your chance to talk with organizations about their vendor relationship, overall EMPI performance and satisfaction, the implementation process, and ongoing customer support.
Once you’ve collected at least four references of similar organizational size, ask each reference the following questions:
- When did you install the EMPI? How long did the deployment take and did the vendor maintain clear communications and engagement during all phases of the implementation?
- Trust and transparency are important. Were there any disconnects between promises and delivery?
- Is the system easy to use, and as it appeared during the software demonstration? And did they provide training?
- Did the vendor fully meet your goals and expectations? Did the vendor understand your business needs?
- Does the EMPI easily integrate with existing backend systems and legacy applications? Does itsupport interfaces so information can be shared between necessary applications?
- How well does the vendor honor client relationships? How would you rate their customer service and responsiveness?
- How many patients does the EMPI manage and is the platform easily scalable?
- How has workflow been impacted?
- Does the EMPI undergo regular software updates?
- Do you feel the vendor will meet your needs in the next 3 to 5 years?
Asking these questions will give you a clear indication of whether or not a specific vendor will be able to meet your expectations.
However, don’t just rely on the references provided by the vendor—find other providers using the EMPI you are considering from professional association listserves or working groups like HIMSS, SHIEC or AHIMA.
5. How does the EMPI standardize multiple patient identifiers, and what matching algorithm strategy and techniques are applied to the data reconciliation process?
Both of these concerns are tied directly to the outcome and quality of matched patient data—and are a big reason why an application’s local MPI is inadequate for true enterprise-level patient matching. Using a combination of algorithms, such as probabilistic, deterministic, and phonetic, gives the highest rate of matching accuracy. The more sophisticated and varied the algorithms are, the better your ability to automatically link records.
We’ve seen many overblown statements in the market claiming 100 percent record matching accuracy. Having been in the patient identity management market for over two decades, we can tell you that those claims are grossly exaggerated. EMPIs are highly effective platforms for patient matching due to their ability to compensate for a large variety of common data anomalies. However, poor data quality in healthcare is unavoidable, and there will always be some subset of records that need to be manually addressed. A single silver bullet solution to patient identification doesn’t exist. It has, and always will be, a people, process and technology endeavor.
Be sure to inquire about the EMPI’s ability to keep historical patient information on hand for record comparison, and its ability to link to outside sources.
6. Does the vendor support integration with clinical information systems and proactively prevent the creation of duplicates at the point of registration?
Ultimately, the real challenge of identity management has to do with integration and interoperability. More specifically, it revolves around the demographics and associated identifiers dispersed across multiple systems.
What is the company’s experience working with and integrating with other vendors? Knowing your vendor has a history of collaborating well with other vendors should help ease the heavy lift of managing vendor relations.
Does their EMPI support active integration to stop duplicate records before they occur? When an EMPI is installed with active integration, the registration system automatically checks for the patients existence across the enterprise during the registration process, thus preventing a duplicate patient record from being created while requiring no additional steps or software for the registration staff to interact with . Further, EMPIs powered by address verification technology to standardize and verify address information in real-time ensures address data is consistently formatted to avoid duplicate record creation and data errors at the point of entry.
7. How does the vendor support your data governance needs?
A sound data governance framework, coupled with the right technology and skilled resources, is imperative for strategically managing patient information across the continuum. Knowing the complexity in your current data sources, data access locations across the network, and your organization’s growth strategy, will help determine if the EMPI provider can support your environment. Ask what sorts of reporting capabilities the vendor provides? Can it report which of your patient registration specialists are creating duplicates? Does it allow the organization to improve upon its patient intake processes, and report measured improvements?
Challenge the Hype
Engaging an EMPI vendor is not a decision to be taken lightly. There is a big difference between pushing the truth and making false claims, so be sure to challenge bold marketing statements by asking the right questions and checking references.
Be leery of claims such as a “guaranteed” duplication rate of 1 percent or less and ask the tough questions. Currently, 86 percent of U.S. adults have made efforts to obscure their digital footprints. Further, it is illegal to use reference data for children under the age of 13, regardless of the fact that they would not have amassed any public record or personal information online as minors. So one might ask, how anyone could make a 1 percent guarantee claim? Minors makeup 23 percent of the US population and undocumented immigrants account for an additional 3.5 percent of the population. That’s 26.5 percent of the total U.S. population that would have to be excluded in such an assertion.
Health IT leaders should look for a partner, not just a solution provider—one that is committed long-term to the success of your organization and dedicated to continuous EMPI innovation.
By carefully weighing each vendor’s offerings alongside market maturity and growing customer base, healthcare organizations can make well-informed EMPI purchasing decisions. Assessing these seven areas of vendor compatibility should give your organization some good insight into your potential EMPI partner.
This article was originally published on the NextGate Blog and is republished here with permission.