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Despite EHR, Patient ID Problems Persist

Scott Mace, for HealthLeaders Media, July 31, 2013

Not all hospitals have been able to make the kind of investment Geisinger has. "Right now, the current matching strategy [for] when somebody's not within the system is using their other identifiers: their name, their date of birth, their Social Security number, a variety of things," says Bala Hota, CIO and CMIO of Chicago-based Cook County Health and Hospitals System, with a 464-bed main hospital and a variety of clinics. "But what do you do if the patient doesn't have a Social Security number? Or if there's some problem with the data that you receive? In a public hospital system, that's often the case, and so then you're forced to do some other matching on the data elements."

While Cook County H&HS has "really good matching" about 70% of the time, he says that still leaves the other 30%. "You have to have manual matching. You have to have an inbox almost for somebody to do a match. There's a lot of work there," Hota says.

So he is turning to Cerner Corp., which supplies Cook County H&HS' EHR. "We've looked primarily at the system that's integrated with the Cerner electronic record, and they have this self-registration kiosk that they offer," Hota says. "The advantage is it's fully integrated into our existing electronic record and so we won't have to worry about designing and implementing a project to integrate some external system."

Payer-assembled data forms the cornerstone of the patient ID efforts of Salem Health, a two-hospital system with more than 450 acute care beds based in Oregon's Willamette Valley.

The insurance industry has previously struggled with the question "Was the Mary Smith who has BlueCross the same Mary Smith that has Aetna Medicare?" says Cort Garrison, MD, MBA, CIO of Salem Health. "They have some matching algorithms, as well as somewhat of a common database that we think covers about 70% to 80% of our population."

Salem Health plans to leverage this insurance industry work to bring up a communitywide central repository as part of its coordinated care organization, the state of Oregon's equivalent of an accountable care organization.

Since Oregon's 15 CCOs just organized starting August 1, 2012, they are "fairly new structures," and implementation of the patient ID system is depending on state Medicaid funding that is still pending, Garrison says. But an "agnostic" patient ID system must be built, because "no one EMR is a single source of truth in this community. Our Epic system has the inpatient and some of the outpatient stuff," but other record systems hold other patient data.

"We have basically three disparate EMRs that are prevalent in our community that we need to integrate for transformation purposes." Vendor-supplied EMPI technology alone is insufficient, Garrison says. "We could get there by using that technology alone, but I think we can get there faster by using a different source," he says.

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2 comments on "Despite EHR, Patient ID Problems Persist"


John Trader (8/1/2013 at 10:48 AM)
Although this is an informative article, it contains inaccuracies about the use of biometrics for patient ID in healthcare. First, the healthcare industry is not using fingerprinting and retinal scans for patient ID. Fingerprinting brings too much of a stigma of criminality for it to be a viable modality plus it requires physical contact with a hardware device which doesn't bode well for infection control in a hospital setting and retina scanning is too invasive and expensive to use as a means of identification. I think that perhaps what Scott meant to say was iris recognition biometrics, which is in fact being used by many hospitals across the country. Second, he mentions the use of palm vein biometrics for patient ID in the context that it is a biometric identification solution that will uniquely identify a patient which in fact, it is not completely. Palm vein biometrics rely on what is called 1:Few segmented identification which means that when a patient enrolls, and then is subsequently scanned when they come back into a medical facility, the back end search does not encompass the entire EHR system, but rather a segmented list of patients. This is not a true way of eliminating duplicate medical records and preventing fraud and medical identity theft at the point of service. When you mention biometric technology, it is vital that a factual explanation of the science behind the technology is properly presented so there isn't a continual perpetuation of misinformation and health care facilities can make educated decisions on what technology is the most appropriate to invest in. It's unfortunate that proper research and due diligence on biometrics wasn't conducted for this article, and what would have been more appropriate is not to even have mentioned biometrics at all if it isn't accurately described.

flp (7/31/2013 at 12:26 PM)
Great piece...and one of the reasons why systems in health care are more costly and complex. This issue first came up when hospitals installed IBM 1440 computers, circa 1960. And what if the patient uses an alias? Or shows up comatose in the ER? The real price (to the public) of a true EHR that can follow you everywhere is a unique person identifier – using biomarkers, cards, whatever. ONC is big on continuity /coordination of care, yet has not even ventured into this quagmire with any MU criteria...wonder why? It's not a technical problem, it's a political problem. Not an issue for other countries, but here in the USA it's a non-starter. So we probably spend hundreds of millions on technology and human work-arounds in the name of privacy. Then blame healthcare organizations for 'wasting' money running inefficient uncoordinated systems. And don't blame the vendors. As a former vendor I can guarantee you that if the feds came up with a unique identifier every one of them would have it in their system in a week. I have been in the HIT world for over forty years and I will say if you can 'solve' this one, you could knock an easy 2% of the cost of healthcare. Funny everybody wants it, but nobody is willing to 'pay' for it. Frank Poggio The Kelzon Group