ONC leads public-private coalition working on a key interoperability challenge: how to match unique patients to their personal data as it moves across the healthcare system.
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The Office of the National Coordinator for Health IT (ONC) has launched a national, public-private initiative to tackle one of the most serious barriers to the advancement of health information exchange (HIE): uniquely matching a patient to the healthcare data about that patient.
"By identifying and recommending standardization of the basic attributes most commonly used for patient matching, we are looking to improve patient safety, care coordination and efficiency," wrote Lee Stevens, policy director of ONC's State HIE program, on the office's HealthIT Buzz blog. ONC is part of the Department of Health and Human Services (HHS).
According to Stevens, the new project will focus on two specific objectives:
-- Identifying the common attributes that achieve high positive match rates across disparate systems. The attributes may include common fields such as name, date of birth, address, sex, cellphone number and new criteria such as emergency contact and insurer.
-- Defining the processes and best practices that are most effective to support high positive patient matching rates utilizing these attributes.
Among ONC's partners in the patient matching initiative are the Federal Health Architecture, which includes more than 20 federal agencies; the College of Health Information Management Executives (CHIME); the Health Information Management and Systems Society (HIMSS); the Bipartisan Policy Center; Healtheway, which manages the eHealth Exchange, the successor to the National Health Information Network; the EHR/HIE Interoperability Work Group, which includes 19 states as well as electronic health record and HIE vendors; many large integrated delivery networks; and statewide and local HIEs.
After conducting "environmental scans and literature reviews," the participants will submit a report to the National Coordinator of Health IT by the end of the year.
CHIME applauded ONC's action to improve patient-data matching. "Despite years of development, no clear strategy has emerged to accurately and consistently match patient data," said CHIME president and CEO Russell Branzell in a statement. "As we advance interoperability and health information exchange, we are delighted to see ONC take action to ensure the right data is matched with the right patient. This is a necessary, concrete step to bolster patient safety."
It can also help healthcare organizations show Meaningful Use. As CHIME pointed out, the government has required health information exchange in its EHR incentive program, "but has not provided ... guidance on how organizations ought to approach patient-data matching."
In an interview with InformationWeek Healthcare, Branzell said that CHIME told ONC and the Centers for Medicare and Medicaid Services (CMS) several months ago that the most important thing the government could do to accelerate the impact of health IT on improving outcomes was to improve the accuracy of patient matching.
"We feel good that they listened and we commend ONC and CMS for that. But that just means we've come to the starting line, and we have a lot of work ahead of us."
The biggest obstacle, he said, is that "there are no clear accepted standards" for patient matching. Every statewide and regional HIE, every healthcare organization, and every physician practice has different patient identifiers and methods for documenting demographic information, he said.
He attributed part of this problem to the multiplicity of EHRs, which have different systems for identifying patients. The EHR vendors view this as an "outside issue" that is up to each organization to solve when they try to exchange data with providers that use different systems, he said.
National standards that all vendors would have to adopt -- such as a universal method for recording date of birth or a way to correct wrong addresses -- could go a long way toward solving this problem, he said.
CHIME doesn't have a position on a national patient identifier, Branzell said, but this is a dead issue because Congress has consistently blocked it. Government agencies such as Medicare and Tricare use Social Security numbers as identifiers, but that would be unacceptable in the rest of healthcare, he said. Still, he added, a consistent method must be found to match patients across public and private entities.
A basic assumption of ONC's approach is that healthcare providers can apply best practices that are already being used elsewhere to improve patient matching. "We hope there are standards and best practices out there that we can replicate in a meaningful way," Branzell said.
There are some organizations, including the Indiana and Delaware HIEs, that have found ways to match patients with great accuracy, he noted. In addition, the Care Connectivity Consortium, which includes Geisinger Health System, Kaiser Permanente, Mayo Clinic, Intermountain Healthcare and Group Health Cooperative, has spent a lot of time and money on the patient matching issue, he pointed out.
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