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Discussion Materials Today’s Topic: Patient Matching Hearing
December 10, 2010
Time 10:00 a.m. 10:05 a.m. Topic Call to Order • Judy Sparrow, ONC Introduction and Overview of Agenda • Deven McGraw, Co-Chair • Paul Egerman, Co-Chair Framing the Discussion: Patient Matching • Objective and Scope • Background Information • Key Themes from Testimony Public Comments Adjourn
11:45 a.m. 12:00 p.m.
Objective and Scope of this Discussion
• Provide policy recommendations on privacy and security issues associated with linking or matching patients to their information within healthcare entities in order to support information exchange across healthcare entities. • Information exchange between different healthcare entities depends on an ability to match patient identities without benefit of common identifiers. Issues include:
– Correctly linking patients to their health data is a vital step in quality health care; – Accuracy, integrity and quality of the patient data are also critically important; and – Internal data issues must be resolved before tackling the larger issues involved in exchange.
Applicable Law: Other
• HIPAA Privacy Rule – Minimum Necessary Standard
– Requires evaluation of practices and safeguards to limit unnecessary or inappropriate access to and disclosure of PHI
• HIPAA Privacy and Security Rules
– Include a generic provision of assuring the right data is associated with the right person
Proposed Questions for the Tiger Team
1. What level of accuracy should be established for patient matching (i.e., matching patients to their data)? 2. What standards, if any, might need to be established to assist with patient matching? 3. Are there best practices that should be recommended to assist with patient matching?
The focus of today’s Tiger Team meeting will be on common themes that emerged through the hearing that may influence our answers to these questions.
Why is Patient Linking Important?
• • • • Improved outcomes in clinical care Patient safety concerns Impact on efficiency of operations Reduction of fraud
Challenges in Patient Linking
• Patient linking is not a simple activity, and includes:
– Technology – Human processes – Workflows
• Different geographic settings pose different challenges
• • Poor data quality significantly inhibits the ability to accurately match patients to their data A variety of algorithms are used to predict a likely match
– These algorithms vary in their design – No formal testing or acceptance process
Increased margin of error the further removed from the original source of data Data linking challenges in HIEs may be magnified due to complexities with multiple data sources
Definitions: Accuracy, False Positives and Negatives
Accuracy = number of patients correctly identified / total number of patients
The records in reality belong to: Different people Result from matching Different people Same person
Clinical information assigned to the wrong patient
Same person False negative Correct result
Correct result False Positive
Clinical information not linked, patient has duplicate records
Most systems are designed around the falsepositive (erroneously linking records) rate
• Required levels of matching accuracy varies based on the situation
– Different care settings or data uses require different patient linking performance characteristics – Not possible to set one target that will apply to every situation
• Organizations should measure their matching accuracy as part of an internal improvement/learning process • Who should be responsible for measuring errors?
– Owners of the data - Viewed as an organizational responsibility and a necessary commitment to health information exchange – Entity in the middle (HIE) may play a role
Where Standards Might be Helpful
• Potential areas where standards might be helpful:
– Establishing consistent data fields and formats for minimum set of patient demographics
• Name, DOB, zip, address, and gender are 5 common fields • For example, establishing common formats for NAME (e.g., require use of middle name will significantly improve matching) • Accuracy and verification of address
Strength of Theme
– Requirements to use standards for data fields and formats – Matching algorithms – Matching accuracy
• Conduct evaluations of the effectiveness of algorithms
– encourage documentation, testing, and transparency – Common test data sets
Solicit best practices on how organizations ensure that they have “good data” for patient matching
– Types and attributes (structured data elements) of authoritative sources – How trust is assured in authoritative sources – Supplemental sources that can be used to support linking
• • • •
Recommend that organizations measure and track accuracy for performance improvement Recommend transparency in algorithms Create a learning system/community of interest to facilitate best practices and build on learnings and experience Enhance matching capabilities using biometrics or knowledge attributes (potential research opportunity?)
Role of ONC
• Broaden the discussion to cover data quality
– Define and understand the ecosystem and patient linkage opportunities – Shift emphasis to data quality
Support conversation about development of standards for minimum data set Promote transparency and consumer education/communication
– Process for sharing how patient matching is conducted, accuracy of the matching, and challenges in health information exchange – Transparency to the consumer so that inaccuracies can be identified and remedied – Develop a testing process for patient linking algorithms – Matching systems will never be perfect
Develop accountability mechanisms
– Disclosure requirements for mismatched records – Address Exchange Liability Concerns
• Change context from patient identity linking to consumer identity linkage
– Expands context from solely patient care to a broader view of health care management
• User-centric identity raises concerns based on variability experienced in other domains • While mentioned, universal patient identifiers, including voluntary identifiers, were not consistently described as an important part of the matching process.