- healtheConnect Alaska — formerly the Alaska eHealth Network — is taking steps to overhaul and optimize its health information exchange (HIE) services with an emphasis on improved patient EHR matching.
Problems with patient EHR matching have long since been a source of frustration for healthcare organizations, HIEs, and regulatory bodies.
Organizations including CHIME and ONC have made efforts to spur improvements in patient EHR matching over the years through innovation challenges centered on motivating health IT developers to create new, more accurate patient matching algorithms.
These efforts have so far yielded mixed results. While health IT developers have fallen short of delivering a patient matching tool that identifies patients with 100 percent accuracy, existing tools and algorithms have improved in recent years.
Accurate patient matching is especially important for HIEs. Healthcare organizations push and pull patient health data through HIEs from multiple data sources each day. The responsibility to ensure large amounts of health data about the right patients are exchanged between the correct organizations calls for reliable identity management.
For healtheConnect Alaska Executive Director Laura Young, implementing an updated enterprise master patient index (EMPI) solution was top-of-mind when strategizing ways to improve the HIE’s health data exchange services and ensure high levels of patient EHR matching accuracy.
“One of the goals of our organization is to become an identity manager for the state,” Young told EHRIntelligence.com. “Centralizing that identity management made a lot of sense.”
healtheConnect is in the process of migrating from its existing NextGate identity management solution to an enhanced NextGate EMPI. The solution will help to improve health data exchange for the state’s unique patient population.
“Alaska is a very large and remote state,” said Young. “There’s a population of about 800,000. About 400,000 live in Anchorage, but the rest are dispersed far and wide. We are connected all over the state in various places — some you can only get to by plane or boat.”
Young said Alaska residents also commonly seek care in nearby states part of mainland US, such as Oregon and Washington.
“Having interstate exchange is important for us because we have people that get procedures done in Seattle or Oregon,” said Young. “We need a way to make sure the guy in Oregon is really the guy in Alaska. Having identity management across state lines is something else we really need to look at.”
Recent research supports the potential for EMPI solutions to yield significant improvements in health data exchange, patient EHR matching accuracy, and hospital savings.
In April, a Black Book survey found healthcare organizations that do not utilize an EMPI tool have an increased risk of sharing redundant, duplicate, or fragmented patient EHRs.
Surveyed EMPI users reported that prior to implementing an EMPI tool, an average of 18 percent of patient health records were discovered to be duplicates.
Incomplete and duplicate health records can negatively affect patient safety and cost healthcare organizations money. Duplicate EHRs cost healthcare organizations over $800 per emergency department (ED) visit and over $1950 per inpatient stay, respondents said.
“I have bumped into organizations that don’t use an EMPI tool and I’ve always been stumped by that,” said Young. “Any time you’re receiving multiple data feeds, being able to authenticate the identity of a patient as accurate when you’re linking up to various different systems is critical.”
However, Young emphasized having a patient matching tool is only one piece of the identity management puzzle. Ensuring identification management tools leverage only accurate, complete data is equally important.
Utilizing reliable patient data for identity management
Advanced identity management tools are only effective if the data used to match health records with patients is high-quality.
“If you don’t have good matching data, it’s hard to do identity management,” maintained Young. “We do have a unique benefit in Alaska — we have what’s called a private permanent fund dispersement they give to residents who live in Alaska.
The Alaska Permanent Fund is a state-designated investment given to Alaska residents who have lived in the state for at least one year. Residents interested in receiving payments through the fund must sign up and provide verifying personal information to confirm their identity.
“It’s given us a really great data set of identities from a resident perspective that you wouldn’t get in any other state,” said Young. “They will authenticate themselves as residents, and that gives us a really good identifier to bump up against.”
“It isn’t the only identity we go off of, but it gives us an extra identifier so we can have a pretty accurate understanding of our patient population,” she clarified.
The dataset functions as a kind of golden record the HIE can utilize for patient matching. In combination with an EMPI solution, this high-quality dataset allows for improved patient matching accuracy.
“We will get an extract from the state’s dataset and bump it up against what we’ve already collected to further refine our patient identities,” said Young.
The HIE itself also collects identifying patient information through admission, discharge, and transfer (ADT) data.
“We have been receiving ADT information from the number of providers we are already connected to for several years,” said Young. “We have a good collection of identity through that.”
In addition to improving patient EHR matching accuracy, the EMPI solution will also assist healtheConnect Alaska with custom projects and initiatives it plans to launch in the near future.
One of these initiatives includes allowing HIE access to prescription drug monitoring programs (PDMPs). PDMPs allow providers to search for patient EHRs and access a comprehensive picture of a patient’s controlled substance and prescription history.
Improving provider access to patient prescription data allows providers to more easily spot patients who may be visiting multiple doctors for several prescriptions or misusing prescription drugs. By allowing providers to gain a more complete view of a patient’s prescription history for safer prescribing habits, PDMPs function as a way to combat the opioid crisis.
“We might use it for the PDMP and helping with PDMP projects,” said Young. “We haven’t identified a care coordination tool so to speak, but that’s important.”
“Notifications is a big one, especially around emergency events,” said Young. “But not just emergencies — they could be notifications around certain types of events that we could give to providers. That identity piece is really important. We wouldn’t want to be sending notifications about the wrong patient.”
While EMPI tools and high-quality data sets can help to boost patient matching, Young maintained the industry is a long way from achieving 100 percent patient matching accuracy.
“We don’t have a national identifier and we don’t use Social Security numbers,” said Young. “What we’re finding is that a lot of our participating organizations don’t collect Social Security numbers, so it’s one less thing we can match on.”
“Even with the best of tools identity management continues to be a challenge,” she added.
However, Young is confident there are several avenues innovators could take in the future to further enhance data quality and health IT for improved patient matching.
“You hear things about using finger prints and retinal scans where you can really make sure the person is who they say they are,” she said. “I do think a national identifier would take us a lot closer to where we need to be.”
Overall, Young emphasized the need to improve data quality. Information governance (IG) practices could help to ensure all areas of healthcare utilize reliable information.
“It’s not a problem with the tools so much as the data we have,” said Young. “We're not where we need to be for 100 percent patient matching.”