Title: Identifying Key Principles and Learning from Case Studies Track 4: Technical Aspects Track CoChairs:
1Identifying Key Principles and Learning from Case
Studies Track 4 Technical AspectsTrack
Co-Chairs Bill Braithwaite, MD, PhDeHealth
Initiative and FoundationWes Rishel, Director,
Gartner, Inc.
- Accurately Linking Patient Data
THURSDAY, MAY 26 915 am 1030 am
2Accurately Linking Patient Data
- HIPAA The Secretary shall adopt standards
providing for a standard unique health identifier
for each individual, - in 1994, this was an attempt to solve a
recognized problem. - You cant treat a patient based on information
that may or may not be about that patient. - Note it does not specifically require that the
government assign a unique number to each
individual. - It requires HHS to adopt standards for how each
individual shall be identified. - Could consist of a standard set of demographic
data elements that, together, serve as unique
identification, for example.
3Why Link Patient Data?
- Making all patient information available will
help to - prevent drug interactions and adverse events,
- avoid medical errors,
- help inform decision making for the patient and
clinician, - enable the support of public health efforts,
- improve research,
- better physician and organizational performance
and benchmarking, - empower patients and families as active
participants in their own healthcare. - The linking problem is simple to describe but
hard to solve how does a healthcare professional
link a patient with their health files, and how
do they know that any two files stored in
different places refer to the same person? - occurs every time a provider asks to have a
patient's file pulled or updated, and every time
a patient moves or changes doctors, visits a new
lab or specialist, or falls ill while traveling.
4Access Benefits vs Privacy Risks
- The ability to locate patient records and deliver
them securely will enable a number of
improvements in healthcare, including especially - Increasing the ability of authorized clinicians
to access vital patient records in near real time
in the event of an emergency. - Improving patient access to their own records,
allowing them to see and correct mistakes. - Decreasing the number of tests that need to be
re-run because the original results can't be
found on a timely basis. - Lowering the risk of negative drug interactions
because physicians don't know a patient's current
conditions or medications. - The privacy, technical, and policy issues need to
be addressed to effectively share information
across multiple organizations. - Controls must be applied to limit improved
electronic discovery and delivery of patient's
medical records to only when they are needed,
where they are needed, and to authorized
individuals who need them.
5Current Linking
- Current solutions tend to be ad hoc, paper based,
local, and ineffective. - Every institution in the healthcare system from
sole practitioners to giant hospital chains faces
the linking problem. - There is no standard solution, and for many sites
of care, paper records are still the norm. - Paper records have the advantages of tangibility,
making it possible to aggregate individual files
easily within a single institution, but are hard
to search and hard to share.
6Local Data Only
- The only files on a patient that can be easily
called up are those held locally. - Healthcare personnel must often work with a
partial subset of the available information on a
patient in their care. - Results in frequent re-running of tests because
earlier results are unavailable. - Creates enormous waste and additional expense.
- In one case, 15 of expenses were in running
duplicate tests because the early results were
unobtainable. - At worst, it delays critical diagnosis or exposes
patients to invasive procedures unnecessarily.
7Common Framework
- Thirteen major health and information technology
organizations collaborated to endorse a "Common
Framework" in response to 2004 RFI -- - New health information environment would allow
appropriate users to find, request, and retrieve
patient records rapidly and accurately, subject
to patient authorization. - Decentralized approach
- takes advantage of the significant investment
already made in information technology in U.S.
health care, - protects the privacy of patient information, and
- allows rapid progress toward providing Americans
with more reliable, higher quality care. - Accurate patient identification based on uniform
and standardized methodologies but without a new,
mandated, national, unique health identifier. - Record Locator Services (RLS) created and
controlled regionally, or within other
sub-networks, help authorized parties learn where
authorized and pertinent information is housed -
but never contain that information.
8Basic Principles
- Solution must support the accurate, timely, and
secure handling and sharing of patient records. - It must increase the quality of care, the
economic sustainability of the healthcare system,
and preserve the privacy of patient information. - It must create value for many different kinds of
participants, from private, non-profit, and
government institutions to the individual
healthcare professionals and patients.
9Theoretical Identifier Characteristics
- Unique
- Only one person has a particular identifier
- Non-disclosing
- The identifier discloses no personal information
- Permanent
- The identifier will never be re-used
- Ubiquitous
- Everyone has an identifier
- Canonical
- Each person in the system has only one identifier
- Invariable
- A persons identifier wont change over time
10Master Patient Index (MPI)
- Healthcare organizations typically maintain an
MPI as the definitive listing of all of their
patients. - All patient data stored by the organization is
assigned a patient ID that can be looked up using
the MPI. - Two pieces of information concerning the same
patient will (ideally) share the same patient ID,
stored in the MPI. - Where information needs to be shared between
multiple providers, or any other health
organizations, patient information must be
matched across multiple MPIs. - The same patient will usually be assigned
different patient IDs in each organizations MPI.
- The patients identifying information will need
to be matched so that all the patients
information can be tied together.
11Recommendation For Linking Patient Records
- Design a system for linking authorized patient
records using existing demographics and
identifiers, but without foreclosing the ability
to take advantage of new identifiers should they
arise. - The system should not require the existence of a
national unique health identifier - The system should be designed to create the
potential advantages of a national unique health
identifier without requiring top-down issuance - The system should use probabilistic algorithmic
matching of commonly available identifiers to
link records
12Accurately Linking Patient Data
- Speakers
- Lorraine Fernandes, RHIA, Sr VP of Healthcare
Practice, Initiate -
- JP Little, Chief Information Officer, RxHub
- Shaun Grannis, MD, Regenstrief Institute, Inc.
-