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HIE Influence on Patient Identity Requirements and Sustainable

Working Solutions

Patient ID: Current State/Future State

Electronic Patient Identity Capabilities

Patient Access: Key to Success

Impacts – now & in HIE environment

Goal: Positive Patient Identification

Current Problems

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Nancy Farrington,

CHAM Based in part with NAHAM Special Projects,

Policy Development and Government

Relations Committees

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What can be done to improve 6

Agenda

Patient Safety, Satisfaction and Sustainability

Electronic Patient Identity Industry Trends

David Batchelor, Vice Chair -

Smart Card Alliance

Tiger Team Member - National Strategy

Trusted Identity Cyberspace (NSTIC)

10 Simplicity to Succeed

Community #1

Integrated Delivery System

Community Health Centers

Community #2

Medicare, Medicaid, CHIP, etc.

Labs

Pharmacies

The Internet Standards, Specifications & Agreements for Secure Connections

Health Record Bank or PHR Support Groups

Goal: Unifying Patient Identity, Connectivity and Mobile Access Sample: Nationwide Health Information Network

EMT/FRAC/FEMA

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Objectives of Patient Access Personnel

Accurately identify every

patient to their Medical Record

for each encounter

Continuing education of

common causes, complexity

and impact of duplicates &

overlays on patient safety and

cost containment

Practice techniques for reducing

the creation of dups as well as

techniques to identify & resolve

them

Review the adoption of

industry technology for the

automation of patient

identity and registration

processes

Participate in developing

national standards for data

capture to facilitate

matching in the absence of

an interview

Requirements & Solutions Requirements & Solutions

Authenticate Patients Identity

One Patient Identity

Always Link Patient to Correct Medical Record

One Medical Record

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Explore technology to help manage one unique patient identity

Technology

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Goal: MPI Integrity Management

Accurately authenticate

patients identity for each

visit or procedure and

correctly link patients to

their health record

across the continuum of

care

Registration is challenging, staff turnover is high Poorly defined, un-enforced standards Emphasis on speed, throughput Insufficient training on impacts

Human Factors

Poor patient query tools, insufficient error reporting Search results ambiguous, non-intuitive Corrective measures difficult to perform

Historical Information System Limitations

Past System/MPI Data conversions Decentralized points of entry Reference Labs, “temporary registrations” HIE: limitations on available data and limited acceess

for to patient for clarification

Other Factors

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Causes of Poor MPI Integrity

Overlays: Catastrophic

Industry estimate 8% to

12% of a hospital’s

records are duplicates

Rates may rise to 20%

or more for

organizations that have

acquired or merged

with other facilities

Implications for MPI in

HIE?

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Time & materials

wasted by researching,

identifying & correcting

“on demand” (in

multiple downstream

systems)

Duplicate testing

Billing issues

How Big is the Problem?

Risk of Clinical Error

Potential

confidentiality

breaches

Cost of litigation

Duplicates/Overlaps cost $100 or more Duplicates and Overlaps

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What is the Impact

Challenges with accessing previous electronic records

Incomplete clinical picture (ordering “duplicate” testing

Inability to readily compare PACs images

Lack of Confidence in your organization

A Physician’s Perspective A Patient’s Perspective

Loss of time

Inconvenience/discomfort

Increased expense

Dissatisfaction with your organization

Patient Portals

Avoiding / Resolving Duplicate Records, Overlays and Fraud

Research with your IT Department for technology solutions

Advanced Matching Algorithms

Biometrics* and/or

Smart cards*

Schedule webinar & follow up on-site demonstrations

Schedule site visits with vendor clients

Technology Improvements…

Process Improvements

Raise organizational awareness and propose solutions

Creation, implementation, enforcement of national patient ID

standards

Education

Avoiding

Impacts

Trends

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Increase patient care, satisfaction, and lower healthcare cost

Unifying Patient Identity, Current Medical Data and Community Engagement

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2012 Patient Identity Card Validation Trends

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HIMSS, HIPAA Privacy Rule, Meaningful Use

Patient Satisfaction - Medicare, Medicaid, etc. withholding percentage of profits of providers 1% reimbursements

NAHAM - National Association of Healthcare Access Management (Automated Electronic Admission – Smart card)

Secure ID Coalition (Lobbies for Identity Smart card for Medicare and other)

MGMA – SwipeIT.org (Electronic Admission Smart/Magnetic Card)

Medicare & Medicaid Proposals using Smart Cards

eCitizen, Kantara, NIST, NSTIC, Etc. Patient Identity

AMA (3 year study Health Security Smart Card for EMS and Natural Disaster)

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PSST! – HIMSS Focus on Patient Identity Integrity Posted on April 9, 2012 by Lisa A. Gallagher, BSEE, CISM, CPHIMS

Top Down: The HIMSS Privacy and Security Committee addresses Patient

Identity Integrity (PII) to having one common, individually unique data point (or

combination of data points) used to identify patients. This differentiation and

standardization are important internally to a healthcare system as well as across

multiple healthcare systems.

Bottom Up: Equally important is the integrity of individual identifier. The

accuracy and integrity of the information can cost the healthcare system and

negatively impact patient safety. Social security numbers can be mistyped, or

medical records numbers can be assigned in error, or any other number of data

integrity missteps can happen.

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Universal connectivity to valid identity between separate and competing Identity Vendors

Service Oriented Architecture (SOA) design, utilizing a software architecture to scale to billions of transactions

Modular solution allowing for seamless integration of multiple third-party healthcare and vendor systems

Interoperable solution to work within Federal Agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC)

Upgradable Card Technology for Secure exchange of clinical and administrative data with capabilities for Personal Identification Verification-Interoperable (PIV-I)

Fully HIPAA-compliant to ensure privacy and security of information, as well as patient opt-in and opt-out.

Imperative…Scalable and Interoperability between Providers and future Identity Vendors

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Bridging Identity with Disparate Groups

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• Date Last Modified/Updated Update Date

• Allergy Type • Name / Allergen • Reaction

• Source (personal/ discharge summary/ clinical note) • Severity

Allergy (multiple)

• Description

• Date

• Re-Route pipeline to additional data

Surgeries and Procedures

(multiple)

• Insurance Data (multiple)

• Carrier • Plan • Policy • Subscriber Name

• Guarantor Data • Name (First,

Middle Initial, Last)

• Relationship • Address (detail)

Insurance/ Guarantor

• Personal Identification Number(s) PIN • Patient Photo (low res), Biometric

• Note: Identity Management (Algorithm of Multiple Fields and Encryptions)

Patient Identity Verification

First Responder, FEMA/FRAC

Access

• Authority to read Smart Cards, date stamp, audit trail, time limit

• Enables immediate patient identification and Data access

• Provides authentication override to info when patient is impaired

• Facilitates accurate evaluation and rapid care at the scene or en route to hospital

• Transmit Patient Data to ER via Cloud

Medical Problems (multiple)

• Diagnosis/Problem description

• ICD-9 /SnoMed expression of problem

Medications (multiple)

• Generic Name

• Brand Name

Patient Demographics

• First Name

• Middle Name

• Last Name • Date of Birth

• Primary Care Physician Name

• Address

• Address2

• City

• Country • State/Province

• Postal Code

• Medical Record Number

• Emergency Contacts

• Telephone Number

• Gender

• Advance Directives

• Marital Status

• SSN • Drivers License

Number

• Drivers License State

• Blood Type

• Organ Donor • Language

• Faith

• LifeMed Corporate ID Number

Smart cards and Continuity of Care data dependent on provider, type of card and access points

Configurable for additional patient information

• Implanted devices

• Pacemakers

• Artificial valves

• Defibrillators

Configurable for Payments

• VISA/MasterCard

• Debit

• HSA

• Medicare, Medicaid, etc.

Smart Card Data (Online or Offline -Emergency Patient Data)

Unifies identity and historical data across all healthcare visits

No changes in workflow Integrates to all Providers

Authenticating Card and Identity

Verifying Patient Photo, PIN, Biometric

Medicare, Medicaid,

CHIP, Debit, HSA,

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Compares Disparate Historical Patient Data

Invokes Patients Record using Provider’s Current Software

Patient Data Exchange Portal

EMS Gateway Bridging EMS with

Patient Data and ER

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Authenticated Identity & Personal Data Emergency Check-in Points

with Plug & Play Equipment

EMS Gateway Cloud based Solution for EMS, FRAC and FEMA On or Off-Line Access

Demographic, Medical, Insurance Data, more

Emergency Responders

Store Front Shelters

Community Shelters

Designated Shelters

Health Information Exchange

EMS Gateway Patient Data Exchange Portal

LifeMed ID Identity Acceptance (universal Plug and Play hardware)

Automatic Updates at Sign-Out for Most Current Data

New Card Pre-Issued by Initial Visit to Healthcare Facility or Government (Medicare, Medicaid, etc.)

Re-Visit to any Provider with Health Security ID Card

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Bridging Disparate Provider’s EMR/EHR/HIE’s

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Hardware (Easy Plug and Play by client for ongoing growth)

Hardware

Smart or Magnetic Cards (including state issued

drivers license)

Plug and play card readers

Plug and Play - Point and click camera

Signature Pad

Biometrics: Finger Print, Palm Vein, etc.

Printers

Kiosks

Stand Alone, Wall Mount, Desktop, iPad

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“Care Management” with Patient Incentives and Rewards Tracking

Community Engagement Aligning local merchants with local providers

Simplicity to Succeed

Using Procedures & Technology to Simplify Complicated Processes

Educate Implement, Train and Measure

Incorporate Procedures & Technology

THANK YOU!

Nancy Farrington, CHAM Based in part with NAHAM Special Projects, Policy Development and Government Relations Committees Committees farringtonn@mlhs.org

David Batchelor, Vice Chair -Smart Card Alliance

Tiger Team Member - National

Strategy Trusted Identity

Cyberspace (NSTIC)

PI Integrity is the accuracy and completeness of data

attached to or associated with an individual patient. Data must

be reliable, reproducible, and sufficiently extensive for matching

purposes.

Completeness refers not only to having adequate data

elements present but also the correct pairing or linking of all

existing records for that individual within and across

information systems. PI Integrity is of central importance to

achieving quality of care, patient safety, and cost control

2009 Healthcare Information and Management Systems Society (HIMSS)

HIMSS Patient Identity Integrity

HIMSS Information, Articles and Resources in this presentation is for educational purposes only.

Because of its potential for impacting quality of care

and patient safety, patient identity management is a long

standing challenge in the health care organization,

provider office, or anywhere patient databases are

collected. The increasing penetration of technology into

the healthcare environment only exacerbates the problem.

http://www.himss.org/asp/topics_Piitoolkit.asp

HIMSS Patient Identity Integrity

http://www.justassociates.com/Practice-Briefs.html http://www.azumc.com/body.cfm?id=872 http://health-information.advanceweb.com/editorial/content/editorial.aspx?CC=151146

http://www.himss.org/asp/topics_Piitoolkit.asp http://www.smartcardalliance.org/pages/smart-cards-applications-healthcare

www.lifemedid.com

http://www.bloomberg.com/news/2012-05-15/health-exchanges-sharing-of-patient-

data-heightens-privacy-concerns.html