Community of Interest for Patient Identifiers AGENDA 1

Community of Interest for Patient Identifiers AGENDA 1. NHII’s Unique Health Information Identification Requirements - Soloman I. Appavu, SIG Leader 2. Identification Methodology Currently in Use, its Challenges and Solutions - Michelle O’Connor, MPA, RHIA 3. Security Standards that Protect Patient Identifiers and Identification Methods - Lori Reed-Fourquet 4. Accurately Linking Health Information across NHII - John Halamka, MD 5. Discussion on SIG Recommendations for Future Course of Action - Soloman I. Appavu

President’s HIT Plan & Framework for Strategic Action President’s HIT Plan: • “. . Electronic Health Records will ensure that complete healthcare information is available” • Completion and Adoption of Standards to store and share medical information electronically Framework for Strategic Action: • Medical information would move seamlessly with consumers – Vision • Regional Collaborations & National Health Information Network – Interconnect Clinicians

Current Practice • Provider-Specific Master Patient Index – Facility Level Identifiers – Enterprise Level Identifiers • MPI Errors – Local Level & Enterprise Level • Problems – Access to Incomplete Medical Records – Increasing Fragmentation & Complexity – Patient Care Risks, Wasted Dollars, Time & Staffing, Disservice to Patients & their Longitudinal Record etc.

Patient Identifier is an Integral Part of Patient Care • Delivery of Care – Positive identification of patients for blood transfusions, surgical procedures, invasive testing, medication administration • Administrative Functions – Eligibility verification, billing & reimbursement

Patient Identifier is an Integral Part of Patient Information IDENTIFICATION OF INFORMATION • Coordination of (Multi-disciplinary) Care Processes • Medical Record Keeping & Information Management • Administrative Functions • Manual or Automated Linkage of Longitudinal or Lifelong Health Record • Aggregation of Health Information

Improve Efficiency & Health Status • • Timely Access to Information Timely Care Continuity of Care Quality of Care Reduce Cost of Integration Optimum Use of Technology Improve the Health Status of the Nation

Unique Patient Identifier • Allow the various Players in the Healthcare Systems to Perform their Respective Functions – Admin. , Financial, Clinical, Preventive, Research, etc. • Accurately Identify an Individual & Access an Individual’s Health Information – Within an Organization, Across Multiple Organizations or Across the Industry • • Enable the Multi-Disciplinary Care Processes Provide a Longitudinal View of Patient Data Facilitate the Continuity of Care Help Protect the Privacy of Health Information

Unique Patient Identifiers Provide An Architectural Framework For Healthcare • A Comprehensive Framework – Provider ID, Health Plan/Payer ID, Employer ID, Patient ID – All Players Within the Healthcare System Work Together – Improve the Overall Efficiency of the Healthcare System – Enhance the Overall Health Status of the Nation

CURRENT MPI ERROR RATES AMONG PROVIDERS BY SIZE • 100 K TO 500 K Records 4 – 7% • 1 M TO 5 M Records 9 -12% • >5 M Records >14% Evaluation of 300 MPIs (1/3 rd single provider) from 2000 to 2003 • 2 Facilities out of 300 <2% • 98% of providers Exceeded 2% • 55% of large facilities >15% • 1/4 th >10% Source: Initiate Systems, Inc.

Discussion Questions • Will access to incomplete EHR hurt patient care? • Current record keeping, information management and patient care practices are based on patient identifiers. Should we use two (2) different methods; one at provider level and another at national level? • Can we enhance the use of patient identifiers to protect privacy, increase the quality of care, reduce cost, achieve efficiency and meet our objectives? • Lessons learned: Do not overlay the technology without changing the underlying processes ( NHII ’ 04 speakers: John Chamber, Helen Darling, etc. ) • MPI errors & inefficiencies: computer will run faster and multiply the errors and inefficiencies exponentially. What will be the quality of our linkage? • Can we leverage from the current momentum and leadership to accomplish our goal the right way?

SIG RECOMMENDATIONS • Build on Existing Infrastructure – – HIM/HIS/SDOs/Developers/Payers/Providers/Users JCAHO/Professional Standards/Policies & Procedures Current demonstration projects use global MPIs Proposed methods that use centralized MPI with pointers also rely on ‘behind the scene’ identifiers – Include projects that use Voluntary Patient Identifier (VPI) • Cost will be distributed if existing process & infrastructure are leveraged • Congress to lift the ban - VPI is patient’s choice • NCVHS to advise HHS & Congress to act – Privacy Regulation based on federal legislation is in place • Patient Identifier Action is long overdue – Not a major change; but evolve, grow and improve

FOR FUTURE SIG ACTIVITIES Soloman I. Appavu Director Systems Planning John H. Stroger, Jr. Hospital of Cook County & Cook County Bureau of Health Services 1110 S. Oakley Blvd. , Suite 318 Chicago, IL 60612 Phone: 312 -633 -8100 Soloman 277@cs. com