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Patient Linking

Patient Linking

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Published by Rich Elmore
ONC HIT Policy Committee
Privacy & Security Tiger Team
Patient Linking - Public Hearing
December 9, 2010

Rich Elmore, Allscripts
ONC HIT Policy Committee
Privacy & Security Tiger Team
Patient Linking - Public Hearing
December 9, 2010

Rich Elmore, Allscripts

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Published by: Rich Elmore on Dec 05, 2010
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01/04/2011

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Patient Linking Hearing Allscripts Richard Elmore Page 1
U.S. Department of Health and Human Services
 
Office of the National Coordinator for Health Information Technology
 
HIT Policy Committee
 
Privacy & Security Tiger Team
Patient Linking Hearing
 
Thursday, December 9, 2010
Allscripts
 Written Public Testimony
Richard Elmore
Vice President, Strategic Initiatives
Introduction
To Deven, Paul and the Privacy & Security Tiger Team members – thank you forthe opportunity to participate in in this vitally important hearing.Allscripts provides electronic health records and revenue cycle managementsystems – both inpatient and ambulatory - as well as analytics, ePrescribing,financial and clinical transaction services, clinical trials, care management, EDand home health software and services to over 180,000 physicians, 1,500hospitals, and many thousands of post-acute care organizations across thecountry. In working to best serve our clients and help advance our collectivegoal of improving health for the nation’s citizens, Allscripts promotes a vision of aconnected community of health built on this foundation. As you can imagine,with a client base this size, we do a lot of matching of individuals acrossheterogeneous platforms. Identity management and matching are critical toAllscripts.
A Clarification on Matching / Linking
The published purpose of this hearing is “to learn about experiences in
linkingor matching
patients to their information”. In the technical community, therehas been a debate when a patient match is established regarding the relativemerits of dynamically linking the patient information versus the merging of thepatient information. As a result, in this testimony, the word “matching” has beenused to establish when information from two systems are determined to refer tothe same person. The word “linking” is used to refer to links to information forthe same person.
 
 
Patient Linking Hearing Allscripts Richard Elmore Page 2
Summary
 In preparation for this hearing, we surveyed eleven larger provider organizations(with patient populations as large as 4 million) as well as a similar number of internal and external experts on the topic of patient matching.The most important requirement identified by Allscripts clients when it comes tomatching is high quality patient demographic information. Data governance andmanagement, user workflows, provider verification and a clean patient registryare vitally important to patient matching.From a technology perspective, electronic health records, master patient indices,and patient identification exchange standards are critical components to ensuringand improving the high accuracy levels reported by our clients. Based on oursurvey, electronic health records are serving as apositive safety and privacymechanism.
General Topics for All Panels1.
 
Standards for identifying individuals
Individual identification standards are established by the provider. Typicallythese include “out of band” verification of identification through cards such asdriver’s licenses and health insurance certificates. Minimal basic demographicsinclude full name, date of birth, sex, address, zip and preferably the last 4 digitsof the social security number. For pediatrics and other special workflows,additional demographics are required. Some states and organizations, however,do not collect social security numbers.One note is that discipline and completeness of demographics tends to be betterin organizations that see patients on a recurring basis, and better in revenuecycle departments than in clinical departments. With the exception of certainurgent care workflows, identity usually flows from the revenue cycledemographics data capture process to the clinical departments.
2.
 
Ensuring accuracy in matching a patient with his/her data
There are no perfectly accurate matching approaches, and there is no one-size-fits-all approach to patient matching. The best approach for a given healthcareorganization depends on a number of factors related to the populationcharacteristics, the way the information is used and managed, data quality andalgorithms employed by various systems involved in information exchange,among other factors.
 
 
Patient Linking Hearing Allscripts Richard Elmore Page 3
Patient information is matched in two basic ways:
 
Statistical patient matching based on demographic factors, with moreadvanced systems including rules, demographic weightings andprobabilistic algorithms with configurable attributes.
 
Unique invariant non-disclosing patient identifiersThese linkages can be established at any number of points in the workflow, butthere are two basic methods:
 
Dynamic linking, which is real-time linking based on demographics withrecords kept separate, or
 
Static merge, which means a link is established, with the data potentiallycombined and maintained at that point in timeThere are two types of errors associated with patient matching:
 
A false positive – which incorrectly links or merges clinical information tothe wrong patient.
 
A false negative – which fails to match information to a patient and mayresult in an additional record for the same patient, with each recordmissing some information.Most legacy systems in use in the U.S. today use deterministic matching (themost basic statistical matching looking for exact matches over 4 or 5demographic variables). This may have been a workable solution for smallerpatient populations that resided in a society where demographic factors likename and address were more stable, and where the collection of uniqueidentifiers like social security number was better tolerated. All of that has rapidlychanged, however, and many of the legacy systems haven’t kept up with theneed for advances in patient identity.
 
As the distance between the settings of care gets smaller, and as there is moreinterconnectedness, the opportunity for error rises rapidly. In an interconnectedworld, the borders get fuzzier. Patient matching was important in the 90’s ashospitals consolidated and now, with ACO’s, Community Health Teams and otherpayment reform initiatives rapidly gaining momentum, the pace of consolidationis quickening even more, with the importance of accurate linking growingexponentially alongside.Patient matching technologies are employed in a variety of systems. Reviewingrecent strategic decisions by Allscripts clients, we can generalize how thesematching approaches are being applied today including:
 
Patient identity management systems (community patient registries andEMPI’s) with robust probabilistic matching are found in health information

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