IBM Software Group, Information Management HealthcareWhite Paper

Unified View of Patient Data enables Better Healthcare at a lower cost

2 Unified View of Patient Data enables Better Healthcare at a Lower Cost

Executive SummaryUnified View of Patient Data enables Better Healthcare at a Lower Cost

The European Union, Central Europe and countries around the globe have recognised the value of care coordination and are building or updating their eHealth infrastructure to connect and share information. Accurately identifying and matching patient records across systems to create a unified view for eHealth applications is a must. However, it is not an easy challenge to solve.

• National identifier systems which are capable of validating insurance coverage or administering payments are not typically built to support the level of accuracy and complex, real-time information sharing required to enable coordinated care across a broad and distributed set of healthcare providers.

• Legacy systems have a lot of rich historical data that is important to include in a person’s medical record. These same systems bring special difficulties to many organisations that can make it difficult, even impossible, to add a universal health identifier (UHI) as an attribute.

• Protecting patient privacy is a significant concern due to the sensitivity of health information. Most if not all countries have regulations limiting the use and distribution of a patient’s health information.

• Government authorities and healthcare providers alike are challenged with providing cross-border healthcare to an even wider range of citizens of very different cultural and linguistic backgrounds. And semantics and culture vary widely across the continent.

Rapid, accurate patient identification, coupled with a unified view of the patient’s medical history at the point of care irrespective of where the data is held, is vital to meeting the EU’s goal of providing better healthcare at lower cost.

This paper considers the situation in Europe – that is, broadly, the European Economic Area (EEA) and Central and Eastern Europe – and shows how sophisticated data matching and record linking techniques, such as an enterprise master person index (EMPI), support rapid, accurate patient identification which is essential to enabling effective health information sharing to deliver better healthcare at lower cost.

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Accurately linking patient records across disparate systems to enable secure information sharing is critical to the success of any eHealth initiative.

Healthcare leaders around the world recognise the need to leverage information and communication technology (ICT) to improve efficiencies, enable coordinated care delivery and control costs. A significant challenge, however, is harnessing and managing information about a patient when it is distributed across providers in individual system silos that aren’t built to interoperate or share information.

Aggregated information obtained from procedures, hospital stays or outpatient visits, as well the effects of attendant social care or responses to medication, is valuable for coordinated care. When anonymised, it can also be used in research and analysis for future planning and delivery of healthcare services.

The European Union, Central Europe and countries around the globe have all recognised the value of care coordination and are building or updating their eHealth infrastructure to connect and share information. Accurately identifying and matching patient records across systems to create a unified view for eHealth applications is a must. However, it is not an easy challenge to solve.

The European Parliament particularly notes, in its reports and discussions on cross-border healthcare, the need to improve electronic systems for patient identification. The EU’s eHealth Action Plan writes of ‘the need to identify a person unambiguously’ as being ‘an important component’ of any national or regional eHealth infrastructure. Canada Health Infoway, Singapore, Australia and many U.S.A. health information exchanges call for patient and provider registries as part of their electronic patient record (EPR) infrastructure to ensure accurate and secure patient identification and health information sharing.

Contents

3 Introduction and Overview

4 European challenges in linking information

5 Building and maintaining a high quality data foundation

6 The power of the enterprise master person index (EMPI)

6 The importance of speed, flexibility and scalability of the EMPI

6 Following standards and protecting privacy with the EMPI

7 Conclusion

Unified View of Patient Data enables Better Healthcare at a Lower Cost

4 Unified View of Patient Data enables Better Healthcare at a Lower Cost

In response to the realisation that patient identification is paramount for eHealth, some governments have issued health ID cards or extended the use of a national identifier (beyond a benefits and payment system) as a means to identify patients. Developing or extending the use of a health identifier is something which appears straightforward, but it’s harder than it looks. In fact, it can be difficult at best, and many times impossible, to add a health identifier to a legacy system to enable accurate identification and information sharing with other systems.

National identifier systems which are capable of validating insurance coverage or administering payments are not typically built to support the level of accuracy and complex, real-time information sharing required to enable coordinated care across a broad and distributed set of healthcare providers. Nor are they built to support privacy requirements that many regions or countries are adopting.

European challenges in accurately identifying and linking patient health informationThere are special challenges to European healthcare. Semantics and culture vary widely across the continent. Certain languages dominate but there are perhaps forty in reasonably common use in various countries and regions.

The patient’s language and that of whoever enters data into the system may vary and mistakes will inevitably occur. In addition, government authorities and healthcare providers alike are challenged with providing cross-border healthcare to an even wider range of citizens of very different cultural and linguistic backgrounds.

For example, the project Smart Open Services for European Patients (epSOS) exists to develop and evaluate a service infrastructure demonstrating cross-border interoperability between electronic health record systems in Europe. Also, the Single Market provisions generally allow any EEA national to live and work in any part of the community or EEA area, showing their entitlement typically through possession of the now mandatory European Health Insurance Card (EHIC). These broad-based initiatives, coupled with the local challenges of providing care for a culturally diverse population, bring some complex issues when it comes to interconnecting systems and securely and accurately sharing information.

Sorting out the Jones’s recordsWales is a country of three million people bordering the west of England and washed by the Bristol Channel and the Irish Sea. People variously speak English or Welsh or both. It’s part of the UK but has many powers devolved to the Welsh Assembly, health included. In 2003, the Assembly established the Informing Wales Health Care Programme (IWHCP) to improve Welsh healthcare, something now developing well.

Information was fractured and scattered not only through the seven health boards but also among both hospitals and individual departments. Patients had a multiplicity of identifiers and there were numerous duplicate patient records. Further, some Welsh names are widespread and the likes of Margaret Jones or Thomas Davies were at high risk of having their records confused with those of others.

IWHCP identified correct patient identification as a key need and contracted with IBM to deploy the IBM Initiate Patient EMPI as part of the eHealth architecture. This brought additional benefits to the NHS Trusts merger programme and helped the development of the Welsh Clinical Portal.

Earlier, it was difficult and time consuming to search several administrative systems to track down patient information. With the IBM Initiate Patient EMPI at the foundation of the eHealth architecture in Wales, clinical staff now see unified patient views, learn instantly where supporting records are held and can order tests online. “Much quicker,” enthused one doctor. “It’s just like internet shopping!”

Irrespective of the initiative or the eHealth approach, the common element is the patient. It is important to have robust, powerful and flexible systems capable of interoperating in a standardised way to identify patients rapidly and accurately, link the right records to the right patients and securely provide a full view of their medical history to authorised providers, something which a good enterprise master person index (EMPI) is proven to help deliver.

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Building and Maintaining a High Quality Data Foundation Life events such as moving house or work, changing names, divorce or marriage, or even death, are consequent to data degradation within a system and also impact the ability to match and share health records. This is a serious but not uncommon problem. Many estimates indicate data inaccuracies that exceed 8% of a client file. In a million record database, that would be 80,000 inaccurate records.

Cleaning data is expensive and time consuming. In business, poor data quality or inability to identify relationships across systems means poor customer service and decreased profits; in healthcare, it means poor service delivery, increased costs and, at worst, compromised patient care and malpractice suits. Consider the time and cost involved for patients who have to undergo duplicate testing or who encounter adverse drug interactions because records are not properly linked across systems to create the single Electronic Patient Record.

Computer systems are very good at finding records that give an exact match. If a patient is allocated a unique identifier, with all the relevant records linked to that, and if the identifier is entered correctly, then that person’s relevant records will be found. This is the argument for numbering passports and driving licences on a national scale. The logic flaw is not to do with how computers work but in understanding how society and human beings behave in real life.

In healthcare, different clinical departments and services often use their own identifiers. Many do not use the national identifier as the primary means of identification, or at all, due to privacy concerns, system functionality limitations or simply because the systems are older than the number itself.

Semantic and cultural differences can lead to difficulties in finding records. If a record is not found, then typically a new patient ID will be created which may or may not include the person’s nationally assigned number.

Although countries have national or health identifiers, that does not mean that everyone “always” has one or that it is captured “100% of the time”. Reliance on any one data point is risky. Using an array of data points is necessary to achieve the highest percentages of accuracy when linking records together.

An IBM study of one nation’s highly controlled universal identifier found some surprising figures that indicated data quality issues and missed opportunities for linking patient records together for the EPR. The study showed:

• 4%–5% of the records in the system were duplicates.• Of the 13 million records spread across 12 different

systems, only 5.1 million were unique. This indicates a high degree of overlap across organisations, which means that patients have records in more than one system that are not being linked together.

• Nearly 800,000 (6%) of the records had missing or inaccurate dates of birth.

• Nearly half (45%) of the phone numbers held were wrong, including 28% of the home phone numbers. This impacts a physician’s ability to contact and follow up with patients.

The table below illustrates data from a country that has a national identifier. The health ministers and health IT managers believed a national identifier would suffice for eHealth Initiatives. An attribute validity study was conducted to determine quality checks on the capture rates. The data in the table shows less-than-adequate capture rates on the health identifier, phone and forename (middle), which degrades the ability to accurately identify the patient and create a unified view for health information sharing and coordinated care. These low capture rates on key identifying attributes compromise the eHealth initiatives.

Attribute Validity

Source System

Patient Administration System (PAS)

( 1,118,057 records)

Accident and Emergency (A&E) (208,000 records)

Surname 100% 100%

Forename (First) 100% 100%

Forename (Middle) 29% 24%

Gender 98.8% 100%

Birth Date 90.6% 99.2%

Health Identifier 41.9% 10.7%

Phone 35.8% 90.9%

Address 99.5% 99.2%

6 Unified View of Patient Data enables Better Healthcare at a Lower Cost

The power of the enterprise master person index (EMPI)Healthcare is complex, with multiple disparate systems that each ascribe to different data management techniques. While the universal health identifier (UHI) can be very useful in managing identification, it really is merely one attribute among many that should be used to identify a patient and effectively share information across providers for coordinated healthcare delivery.

An EMPI, especially one that employs probabilistic matching, achieves highly reliable matching and linking of results to create a unified view of a patient for the healthcare system.

For example, the probabilistic matching in IBM Initiate Patient, an EMPI, is proven to be invaluable for overcoming the semantic and cultural differences that exist in Europe.

• It compares a number of attributes such as name and demographic data such as date of birth, gender, phone and address, along with the health identifier, to identify the best possible match.

• It accounts for common data matching challenges such as nicknames, contractions, name transpositions and phonetics and homophones, such as Tom, Thom and Thomas, as well as Gerald and Jerold.

The probabilistic matching of IBM Initiate Patient EMPI provides a way of rapidly identifying the commonality across a range of records despite their variation, so that authorised clinicians checking their patient’s record in the EPR or other connected system can be confident that the view is both accurate and complete. This complete view saves time and money, and improves the overall experience and safety for the patient.

The importance of speed, flexibility and scalability of the EMPI Healthcare is increasingly fast moving. Knowing immediately whether a person in the Accident and Emergency unit is diabetic or intolerant of certain medications or has a cardiac abnormality may be critical in deciding how to act safely. For general practitioners, it may be important to know whether a patient is continuing with prescribed drugs – in this case, seeing immediately on a patient’s unified record that a regular weekly prescription has not been collected could be important evidence.

• IBM Initiate Patient EMPI works in real time with sub-second response capabilities to enable core healthcare applications to accurately identify the right patient and create the unified view of health history, lab results and pharmaceuticals for authorised healthcare providers.

It’s important that systems on which care delivery organisations rely should be both scalable and able to interface with legacy systems. One of the worst experiences organisations have is to find they’ve outgrown the computer applications on which they rely and to have to face the disruption of taking a major step to something new.

• IBM Initiate Patient EMPI is designed from the start to scale – if more capacity is needed due to expanding the number of systems, records or patients, then simply expanding the capacity of the solution is all that is required.

• Legacy systems have a lot of rich historical data that is important to include in a person’s medical record. These same systems bring special difficulties to many organisations. For example, it may be impossible to add a UHI as an attribute.

• In contrast, the IBM Initiate Patient EMPI does not solely rely on the UHI for patient identification. It captures patient records using a multitude of identifying attributes along with the UHI and links to other systems to enable a single, unified view of the patient – a much cleaner, faster and more efficient approach.

Following standards and protecting privacy with the EMPIImplementing information systems that are standards-based is important to ensure long-term viability and interoperability. IBM has consistently been a leader in standards development and compliance.

• IBM is one of the early members of the Continua Health Alliance, a non-profit open industry organisation of healthcare and technology companies who collaborate to promote interoperability according to standards-based approaches in order to improve the quality of healthcare delivery.

• IBM is also a long-standing member and active participant with IHE (Integrating the Healthcare Enterprise), an organisation which promotes standards-based health information sharing through real-world use cases.

• IBM Initiate Patient has been consistently compliant with HL7 requirements and offers an open platform which allows for application development.

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existing system environment to provide quick time to value and ongoing returns on investment as your business needs evolve.

Protecting patient privacy is a significant concern due to the sensitivity of health information. Most if not all countries have regulations limiting the use and distribution of a patient’s health information. In order for providers and patients to embrace the benefits of health information sharing, they must be confident that the data is protected and only shared with authorised individuals.

• IBM Initiate Patient EMPI does not require data to be moved to a central location. Instead, it creates a virtual index which points to where the patient information resides.

When the downstream applications call upon the index for patient identification, a virtual composite view of the patient is returned linking all records for the patient together. The view can be comprehensive or limited in order to support local privacy requirements, the unique needs of each patient administration or clinical system, and organisational preferences.

ConclusionAn EMPI enables secure and accurate health information sharing across disparate healthcare providers by matching and linking the right records to the right patient. This is something which is difficult to achieve with the use of a UHI on its own.

With the EMPI at the foundation of the eHealth infrastructure, healthcare organisations can deliver more comprehensive and accurate information to applications like patient administration systems, electronic patient records, clinical portals and more, without solely relying on the UHI.

Rapid, accurate patient identification, coupled with a unified view of the patient’s medical history at the point of care irrespective of where the data is held, is vital to meeting the EU’s goal of providing better healthcare at lower cost. This is what the sophisticated technology of the IBM Initiate Patient EMPI helps deliver in conjunction with the UHI and as part of the broader eHealth infrastructure.

Health information sharing across a hospital networkBelgium is a federal state of eleven million people where three different native languages are spoken: Dutch, French and German. This adds considerable complexity to health information systems.

A large public hospital network wanted a means of accurately identifying and matching patient records across its five hospital sources to facilitate the sharing of data for registration purposes and the clinical portal.

Data quality and inability to share information across facilities was an issue prior to implementing IBM Initiate Patient EMPI. Some 40% of patients are treated in more than one hospital; because each hospital has a distinct database and its own system of codes, it was impossible to get unified views of patient histories. The existing systems were using exact matching techniques for searching; because this made it difficult to find records, this resulted in the creation of many duplicate records. In addition, more than 20% of patients didn’t have a health identifier on file, so using the Belgian health identifier was not a reliable option for matching and linking records for health information sharing.

IBM Initiate Patient EMPI is helping greatly. Records are matched and linked across systems to create a single view even when data is incomplete. This has facilitated use of the new clinical portal, where authorised physicians access a consolidated view of a patient’s records regardless of which facility they visited.

In today’s volatile economic climate, it is critical to maximise the value of existing resources as well as invest in solutions that will result in quick return on investment.

An EMPI is a technology that can be implemented alongside existing systems to make an immediate impact on productivity and have a long-term impact on the health information sharing required to enable coordinated care.

• IBM Initiate Patient EMPI is highly configurable and adaptable. It can be implemented in a few months into your

8 Unified View of Patient Data enables Better Healthcare at a Lower Cost

About IBM Information Management solutions for healthcareThe journey to sustainable healthcare systems starts with a smarter approach to information sharing. IBM Information Management solutions for healthcare deliver master data management (MDM) capabilities that help stakeholders to connect and share clinical information accurately, securely and cost effectively. IBM Initiate Patient and IBM Initiate Provider are a trusted foundation for information sharing around the globe; they help healthcare organisations improve collaboration to increase quality of care, streamline compliance and increase patient and provider satisfaction.

For additional information Contact your IBM sales representative or IBM Business Partner, or visit us at: ibm.com/Infosphere/Patient

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