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Data Integrity Matters Newsletter™
April 2014

From ONC to HIMSS to AHIMA and beyond, the healthcare industry's leading agencies and associations have made patient matching a top priority for 2014. This issue of Data Integrity Matters takes a closer look at some of the more pressing issues surrounding the patient matching challenge.

Our feature article focuses on the need for Health Information Organizations (HIOs) to embrace their responsibilities for ensuring data integrity by establishing strong data governance programs to manage sharing, access and utilization of the data that flows through their walls.

We also take a look at the problems that can arise when hospital and health systems rely too much on the out-of-the-box patient matching algorithms that come standard with EMRs and other clinical systems. A new study conducted by Just Associates' data integrity experts demonstrates the significant difference in results between standard algorithms and those that are more heavily weighted to reduce resource-sapping false-positives and false-negatives that can damage the integrity of the MPI.

Industry Highlights


Taking a Page from the Airlines: 
HIOs Need a Zero-Tolerance Policy for Patient Matching Errors

A whopping 60 percent of the more than 195,000 deaths that occur in the U.S. each year due to medical errors are attributable to improper patient identification. Compare that to the U.S. airline industry, which flew nearly 737 million passengers domestically and internationally. Of 132 million U.S. flights, just 41 included "high risk" mistakes by air traffic controllers. 

If the airline industry can support a zero-tolerance policy when it comes to passenger safety, so too can healthcare. What is required is a vastly improved approach to patient matching—an objective that is taking on greater urgency with the rise of healthcare information organizations (HIOs).

As Beth Just notes in this Health Data Management article, a good first step took place in December 2013 when the Office of the National Coordinator for Health Information Technology (ONC) released its draft report on patient matching challenges and best practices. It included eight recommendations designed to address the most vexing issues faced by large health systems and HIOs. The ONC has since issued its "Patient Identification and Matching Final Report." 

HIOs can extrapolate and implement a number of other best practices from ONC's recommendations. Most importantly, the report makes it clear that HIOs must place a far higher priority on accurate patient matching than they have in the past. 

Limited awareness of their responsibility to assure accurate patient matching has caused many HIOs to implement policies that can potentially damage data integrity and jeopardize patient safety. For example, some expect participating organizations' staffs to merge duplicates and fix overlays directly in the HIO's system. This creates a serious liability due to inconsistent validity decision-making amongst data trading partners and non-HIO staff making changes to the HIO's data. A better policy is for data issues to be corrected in the originating system and then update the data in the HIO's system via an electronic message.

To prevent this, Beth recommends in this Health Management Technology article that every HIO establish a data governance sub-committee of the HIO's board of directors to put in place a strong information/data governance program. This program should 1) define data fields to populate and set minimum percentages that must be populated with valid data, 2) determine a formula for calculating intra-facility duplicate record rates and establish the maximum allowed and 3) include a comprehensive data sharing agreement. Compliance with data governance should be a condition of participation. 

Data management policies and procedures should also be developed and responsibilities established based upon industry best practices. For example, source facilities should merge same system confirmed duplicates and correct demographic data errors in their systems, then send electronic update messages to the HIO for processing. The same should occur when the source facility corrects overlaid records in its system. 

HIO staff should be trained on correcting cross-system overlaps and the system's record matching algorithm's effectiveness should be audited periodically. Dashboard metrics should be reported both to the HIO governing body and each source organization to allow source organizations to benchmark data, providing value to each HIO member.

Finally, HIOs should ensure sufficient staff resources to review potential cross-facility matches and communicate same-system duplicates to the originating facility for correction. Data integrity errors should also be communicated, including records without enough data to verify identify and potential overlays. This communication is another value-add the HIO can provide to its member organizations.

Patient matching is a challenge for HIOs in particular because of the need to ensure accuracy across organizations. By leveraging the lessons learned from the environmental scan, input currently being solicited on the ONC's draft report and subsequent recommendations from ONC, it is possible to support a zero tolerance error policy for patient record matching and identification.

Large Teaching Hospital Learns its Lesson:
Over-Reliance on Out-of-the-Box Algorithms Can Compromise Patient Matching Accuracy

Most EMR and other clinical systems come standard with record matching configurations designed to keep a facility's master patient index (MPI) clean and duplicate-free. However, many are finding out too late that these out-of-the-box algorithms are weak, resulting in sub-optimal identification. 

This was the case at a large teaching facility that relied on Epic Identity to manage the integrity of its MPI. It soon discovered that the system was returning too many false alarms that required manual review by an HIM department that was already stretched thin. Also, a high rate of false-negatives was allowing undetected duplicates to enter the MPI, increasing dirty data in the system's database.

The situation presented Just Associates with an ideal environment in which to test IDOptimize®, our unique service that evaluates and optimizes a facility's record matching configurations to improve the accuracy of duplicate identification for greater data integrity, resulting in a higher level of patient care and safety. IDOptimize leverages our deep knowledge of industry systems and record matching technologies to enhance patient matching performance through stronger algorithms. This, in turn, reduces false alarms and optimizes operational output.

We performed a two-phase analysis to determine how IDOptimize impacted duplicate patient identification. In Phase 1, a "False Alarm" pairs analysis was performed on 29,207 possible duplicate pairs identified using Epic Identity's "Identity Duplicate Configuration" (IDC) settings. In Phase 2, a "False Negative" pairs analysis was performed on 28,669 possible duplicate pairs identified using Just Associates' IDC settings.

First, duplicate pairs were analyzed to determine appropriate validity decisions based on our comprehensive guidelines to indicate the likelihood that each was actually the same person. Then, we inserted our own IDC settings alongside the Epic out-of-the-box weights for each property and total match weights were compared. Further analysis was then performed to determine how IDOptimize settings impacted duplicate patient identification.

When compared to Epic Identity's out-of-the-box settings, IDOptimize configurations identified 40% more real duplicates and reduced false alarms by 38%. This dramatic improvement in accurate duplicate identification translates to enhanced overall EMPI data integrity. More importantly, it improves patient care and safety, as many additional duplicate patient records can be identified, resolved and combined under one medical record number.

Patient Matching News from Around the Industry


ONC Releases Final Patient Matching Report

Require standardized patient identifying attributes in relevant exchange transactions and coordinate any changes to patient data attributes in exchange transactions with organizations working on parallel efforts to standardize healthcare transactions are just two of nine recommendations made by the Office of the National Coordinator for Health IT in its Patient Identification and Matching Final Report. Issued in February, the report is the result of a collaborative initiative developed to describe common data attributes, processes, and best practices currently in use by private and public healthcare organizations in an effort to improve patient matching across disparate systems. In a HealthITBuzz article on the report, the authors note that one of the largest unresolved issues in electronic exchange of health information is the need for a nationwide patient data matching strategy that will ensure accurate, timely and efficient matching of patients with their healthcare data across different systems and settings of care. The report’s findings will help to form continuing discussions within ONC and with ONC’s Health IT Policy and Standards Committees.

HIMSS14: New ONC Head Calls Patient Matching Critical

Karen DeSalvo, M.D., the newly appointed head of ONC, told HIMSS14 attendees that nationwide health information exchange is attainable within three years, but only if patient matching, privacy and security concerns can be addressed. GovInfoSecurity reports that Dr. DeSalvo, in her HIMSS keynote address, said that “the issue of ensuring that all the correct data from multiple sources about the correct patient reaches the right clinician at the right time.” The issue, she added, is as much about safety as it is about security. 

AHIMA: Patient Matching is a 2014 Priority

Patient matching returns to the spotlight in 2014, according to the annual “The Year Ahead for HIM” in the January Journal of AHIMA. In a press release, AHIMA noted that, while not a new issue, the task of matching patient identities is critically important in 2014. The organization wrote: “As the Affordable Care Act continues to push providers toward accountable care organizations and meaningful use standards require providers to have interoperable EHRs, the demand for better patient identity matching technologies has never been greater.”

Just Associates News


Sharing our Expertise

A number of Just Associates experts have been making the rounds of key conferences over the past few months, sharing their data integrity expertise. In March, Susan Lucci shared with NCHIMA Spring Conference attendees "The 5 Most Important Topics for HIPAA in 2014" which took a closer a look at the five HIPAA topics that should be keeping us awake at night.

Also in March, this time at the 2014 THIMA Annual Meeting and 64th Anniversary Celebration, Karen Proffitt discussed "Information Governance: Assuring Accurate Patient Integrity." The presentation helped attendees grasp the importance of accurate patient identity, better appreciate its challenges, recognize the importance of accurate patient identity in linking and sharing information, understand operational impacts and considerations when managing MPI quality and projects, and realize the steps that can be taken to mitigate issues and improve MPI data integrity.

In February, Beth Just facilitated a breakout panel at the eHealth Initiative (eHI) Government Affairs Retreat focused on "Patient Identification and Matching—Leveraging Health IT and Data to Ensure Accuracy." During the session, discussion focused on assessing a strategy for progressing patient identification and matching. Also in February, Beth spoke at an eHI 2014 Annual Conference workshop, this time teaming up with Steve Kotyk of ARGO Data to discuss "Driving Data Governance and Data Integrity in HIOs." The pair focused on understanding how to diagnose the current health of your patient record system, treat the extent of the identified problem, and prevent reoccurrence resulting in improved records that support better treatment and financial understanding.

Data Integrity Webinars

Just Associates kicked off the year with two informative webinars. On January 16, Beth and Craig York of ARGO Data, presented "Patient Matching: What's in the Pipeline for 2014" as part of eHI's policy workgroup webinar series, providing an industry perspective of ONC's patient matching findings and common challenges and solutions to patient matching. On January 30, we sponsored a webinar on "Tackling The Record Duplication Epidemic."

Just Associates in the News

In a recent Health Data Management blog, "What HIOs can Learn from the ONC Patient Matching Report," Beth Just discusses how HIOs can leverage the information in the patient matching challenges and best practices report issued recently by the ONC to implement data sharing agreements and solid governance policies and processes to ensure the integrity of the data being exchanged. In a Thought Leaders column for Health Management Technology, "Patient matching must be an HIO priority," Beth notes that a lack of awareness about their data integrity responsibilities has caused many HIOs to implement policies with the very real potential to damage data integrity and jeopardize patient safety, and offers best recommendations for tightening up control. 

In a recent hippomsg blog, "Patient Confidentiality in the Digital Age: An Interview with Susan Lucci," Susan shared with readers her insights into HIPAA violations and what can be done to prevent them. She also shares her thoughts on why encryption is one of the most overlooked areas of HIPAA compliance.

Finally, Beth and Grant Lansbach, data integrity/MPI manager for the Sisters of Charity of Leavenworth (SCLHS) and Exempla Health System, teamed up on "Five Risky HIE Practices that Threaten Data Integrity," published by the Journal of AHIMA. In the article, they explain five risky HIE practices that threaten data integrity and how to avoid them.

Recent Contracts


CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of almost 350 services and facilities, including more than 60 hospitals and long-term care facilities, 175 clinics and outpatient centers, and dozens of other health ministries and ventures. 

CHRISTUS Health services can be found in over 60 cities in Texas, Arkansas, Iowa, Louisiana, Missouri, Georgia, and New Mexico in the United States, and Mexico. 

Just Associates has finalized a contract with CHRISTUS Health to resolve their duplicate records prior to their deployment of a new EMPI. Just Associates is excited to start this project.

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