Managing Patient Identity Takes a Village

By Daniel Cidon, CTO of NextGate
Twitter: @NextGate

Healthcare executives charged with managing patient data today face a dual challenge of building an enterprise master patient index (EMPI) that maintains accurate, up-to-date medical records for every individual and collecting both structured and unstructured health information stored and spread throughout fragmented systems.

The challenge is even more daunting when patient information is stored in multiple healthcare facilities. For instance, if a patient that has congestive heart failure took a chest X-ray two weeks ago at one facility and turns up at a different hospital with chest discomfort, doctors will want to view the two-week-old X-ray as they make a decision on how to treat that patient.

Faced with the complex task of managing the aggregation and exchange of data, it’s no surprise that the industry has historically been eager to find solutions that allow patient identity to be managed as effortlessly as possible. The social security number (SSN) in the United States, for example, was used for decades as a key source of identification. It was based on a blind faith that the identifier was truly unique to the patient—that data entry errors would not occur, and that there would be minimal fraud associated with its usage. Many healthcare institutions have now however stopped using the SSN as a part of their patient identification strategy after realizing the numerous patient safety and privacy issues it poses. In fact, some have completely abandoned collecting the social security number altogether.

No Magic Number or Silver Bullet for Patient Matching
A sound patient matching strategy requires more than simply focusing on a single source, like the SSN, to identify an individual. A similar statement can be made when discussing the use of external reference data as the key criteria for patient matching. Reference data is data that is external to the contributing systems of patient demographics and is drawn from sources like credit bureaus and public agencies. While it represents more than just a single identifier, there are similar data governance challenges in using the data. Clearly, mechanisms must be put in place to prevent a blind trust of data from a third party. For this reason, the data governance controls in using reference data are not all too different than the controls required to leverage SSN without trusting it entirely.

Ultimately, in today’s transformative digital healthcare landscape, health organizations are going to have to look at the patient identification problem as a data governance and interoperability challenge that requires a combination of people, processes and technology to minimize errors that can impact the delivery of care. Rather than a single silver bullet solution, the issue of patient identification takes a village. For example, establishing best practices among the participating systems on the minimum set of demographic fields to capture and guidelines around consistently managing emergency care patients and newborns can go a long way toward improving patient identity.

When it comes to technological approaches, the good news is that the need to give providers and patients access to their health information has pushed organizations and industry stakeholders to embrace interoperability as means to facilitate swift data exchange across different EHR systems. The ability to exchange and synchronize demographics across systems is a key element in dealing with the identity problem because ultimately the sources of patient data must be cleansed. An Enterprise Master Patient Index (EMPI), coupled with an integration platform, can help facilitate interoperability and monitor the effectiveness of policies and manual procedures instituted at contributing institutions.

As healthcare facilities focus on how they’ll leverage EMPIs to improve patient identification at points of care, recent research from Pew Charitable Trust drew some key conclusions that a single identifier assigned by an external party is unlikely to solve the problem entirely: “Participants liked that a lifetime number would be low-cost, but they feared it might be easy to steal, and they voiced considerable confusion over how a single-use number would help solve the problem of mismatching, especially if a person was unconscious or in need of emergency care. Similarly, most participants did not like the idea of a self-selected code or number, because patients would need to remember it. Some also raised the possibility of human error, such as transposing numbers when entering data,” the Pew research states.

Additionally, as patients have greater access to their electronic health information, the Department of Health and Human Services recently released a proposed rule that encourages individuals to play an increasingly active role in monitoring their health information. HHS calls for the use of standardized application programing interfaces (APIs), which will not only facilitate data exchange between EHRs, but also help individuals to securely and easily access structured health information using smartphone applications. Here again, the EMPI can serve as the data governance platform to best leverage any information contributed by the patient.

Moving the Patient ID Needle Forward
As healthcare organizations continue to develop new approaches and implement new tools to improve medical record match rates, they must recognize that reference data has its limitations and using one ID number for each patient comes with its own challenges. To truly move forward, the focus should be on implementing EMPI platforms that can store data from all sources and thereby provide a reliable, comprehensive view of each patient. This critical endeavor takes time, commitment and collaboration between providers, hospitals and healthcare systems, and the patients they serve.

For more information on Patient Matching, check out these white papers from NextGate.

This article was originally published on the NextGate Blog and is republished here with permission.